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6tg low, so lowering imuran?

Hi -
Just wondering if anyone has any experience with low white counts while on Imuran? After WBC came back at 2.6, we were told to hold the Imuran for a week, and repeat the CBC. WBC went back up to 5.2, but at the time of the low white count, the dr also added an Imuran level. Today they said that the 6tg came back low, and they said to restart the Imuran, but at a lower dose, then we'll recheck in 1 week.
Does this make sense? I found a chart thru the posts on here and it says if 6tg is low, then you should increase the dose?? But then that doesn't correlate with the WBC??
Of course our dr is on vacation this week, so this is the advice of another dr. Just want to make sure everything is being interpreted correctly.

Lady Organic

Staff member
yes this is the way to do. When WBC is low, dr will stop the imuran intake for a few days/week and then restart on lower dosage and test agin in the near future.
It makes sense WBC-wise to lower the dose on the Imuran. BUT if his 6tg is low, doesn't that mean that he has a lower likelihood of response to the Imuran?? So how is lowering the dose going to help that? It just doesn't really make sense.

Lady Organic

Staff member
I cant answer with certitude about the dosing of 6-TG, but one thing for sure is that if WBC is low, the medication -must- be lowered. I reread your initial post and I think the dr is trying to find the perfect middle in between WBC and optimal 6-TG level. I dont know about how accurate and precise 6-TG level predict success or failure of the medication in a patient, but I am guessing the dr wants to give a chance to this medication seriously.
In my case, its the opposite and 6-TG level were too high and we had to lower the dose, to a very minimal dose. Unfortunately, even if the the 6-TG went into a normal range, I lost the response to the medication.

my little penguin

Staff member
If I remember correctly your child is on humira as well
Which is different than imuran by itself
Humira is doing the heavy work
Imuran would be just boosting the humira and trying to lower the risk of antibody formation.

Similar to mtx you typically do not take a therapeutic dose since it's not doing the heavy work .

Ds was on humira a few years ago only took 7.5 mg of mtx
Which when taken orally is very tiny
Not atherapeutic dose at all

He is on a higher dose now but that is due to arthritis .

Glad his WBC cane back up
Thanks for your responses. I understand now that even though he's been on the imuran for 14 months, it may be losing effectiveness, but can still be helpful in antibody formation along with the Humira (yes, we started in February). But still doesn't explain why the WBC dropped?? Or maybe it's just the combo of the Humira/Imuran? But stopping the Imuran for a week, did allow his WBC to return to normal. So if I'm understanding correctly, it can still lower the white count even though it may be considered non-effective (therapeutically speaking anyways)?


Staff member
I think, from what I understand, it could still lower his WBC, even if his 6 TGN is low.

Our doctor watched my daughter's WBC very carefully (weekly or biweekly blood work) even when her 6 TGN was very low. We eventually increased the dose (since her WBC did not drop), but we wouldn't have been able to had her WBC been affected.

Since his WBC was low, they probably do need to lower the dose. The risk of infections is probably greater than antibodies - though you can check with your doctor to be sure. I am sure he thinks the risks of a higher Imuran dose outweigh the benefits, or he would keep your kiddo on the higher dose.

Another question to ask might be if he can try Methotrexate. Since Imuran isn't at a therapeutic level and his WBC is low, it seems like switching might be a good option now. MTX is also safer than Imuran, especially for young boys. Some kids are able to tolerate MTX better and WBC issues are less common with it.