Info on high strength vitamin d for crohns
I am taking 3,000 IU of Vit D evey day, that is 100,000 IU per month. Works well for me. I don't think you can really overdose vit d, unless you take many MANY times too much the recommended dosage. How much has he been prescribed?
Also, he has just been prescribed the aza/allopurinol
conbination therapy and the very worrying sude effects
are frightening me :-(
I am a long time azathioprine patient. Never had issues with side effects of aza.
Allopurinol is used in combination with aza to reduce the amount of aza used in patients where aza does not work due to a detrimental "break-down" of aza/6mp in the body. The combination is thus used if a patient would have to stop aza use because of the build up of 6mmp, but doctors do not want to stop aza and do not want to use alternatives like biologics and so try to get the 6mmp under control.
http://www.ncbi.nlm.nih.gov/pubmed/17296529
A few years ago, there were some publications
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096137/ that suggest to use the allopurinol/aza combination for all aza patients, but this has not been adopted widely, as far as I know.
Here is a good overview and background on the combination therapy allo/aza and some extracts:
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The purine analogues azathioprine (AZA) and mercaptopurine
(MP) have become established as first line immunomodulatory
therapy for inflammatory bowel disease (IBD), and
up to 60% of patients diagnosed with IBD will take thiopurines
at some point in their disease course.1 When effective,
thiopurines have advantages over biologic treatments, not
just in terms of cost and convenience but potentially also
safety and durability of response. They also retain an important
role as concomitant immunomodulation alongside biologic
treatment. However, thiopurines can cause significant
toxicity and a proportion of patients will fail to respond.
Strategies designed to overcome these issues would be highly
advantageous, ensuring that the greatest possible number
of patients benefit from this key treatment option.
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Combination treatment was considered in the following
circumstances:
Hepatotoxicity on thiopurine monotherapy — new abnormality
of liver function tests (LFTs) occurring on thiopurine
therapy which the treating physician attributed to the
thiopurine drug. All patients developing hepatotoxicity
were investigated for other causes of abnormal LFTs.
Other side effects on thiopurine monotherapy — the occurrence
of any adverse event co-incident with thiopurine
therapy which resolved on ceasing the culprit agent,
the event must have been severe enough to warrant
cessation of thiopurine agent. Where the thiopurine was
tolerated but side effects limited dose escalation and
therefore clinical response, patients were included as
sub-optimal responders.
Sub-optimal response — inability to achieve clinical remission
on thiopurine monotherapy with thiopurine metabolite
profile either suggesting hyper-methylation or
under-dosing which could not be corrected due to intolerance
of higher doses. This group also included patients
with a historical label of non-response to thiopurine
monotherapy and a TPMT activity N35 pmol/h/mgHb.
Predominant methylation only — patients with a ratio of
MeMP:TGNN11 but not currently experiencing a loss of
response or toxicity.
High pre-treatment TPMT activity — patients with a TPMT
greater than 35 pmol/h/mgHb (the threshold we have
previously demonstrated predicts non-response12) were
considered for combination treatment as first line thiopurine
therapy.
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In conclusion, allopurinol and AZA combination treatment
provides a safe and effective treatment option for
the majority of patients either intolerant or unresponsive
to thiopurines, increasing the number of patients that can
achieve remission on these first line agents. As long as the
dose adjustment for AZA is correctly applied, co-treatment
appears to be safe and can be monitored in the same way
as standard AZA treatment. TGN/MeMP measurements are
however important to identify suitable candidates for cotreatment,
to facilitate dose adjustments and to avoid doserelated
toxicity.
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http://ecco-jcc.oxfordjournals.org/content/eccojc/6/9/905.full.pdf
