Azathioprin & Questran and alternative treatment options/advice

[Bobkat50]

Hi All - My name is Melanie and I am writing on behalf of my mom, seeking insight about her treatment. She was diagnosed with Crohn's almost 40 years ago (near the time of my birth in fact) and is now 60. She had surgery to remove a section of her intestines. Since then she has only taken Questran with every meal to bind the fats in her food (to do the job of the part of the intestine they removed).

Over the years she has had flare ups and general discomfort, but everything has been manageable without major meds. Recently the doctor found blood in her stools; a colonoscopy and further tests indicated that she has a 3-5 cm section that is active w/inflammation and has narrowed. Concerned about further narrowing of the area and further disease progression the doctor prescribed azathioprine - she will scale up to 150 mg. She can't take the Aza until 2 hours after she takes her Questran.

She has only been on the pills for a week, but is having some challenges. She has extreme fatigue and is just not herself. Additionally yesterday she has had diarrhea that kept her up all night. Each pill also seems to give her headaches behind the eyes.

Our questions:

1. Has anyone managed taking the Questran and Aza? Not sure if the diarrhea is related to having to 1. take the pill with less food or 2. Eat food w/out Questran (she is just taking a few crackers) or 3. a general reaction to the Aza.
2. Might her symptoms subside with time?
3. What other categories of treatments are there and how do they differ? The doctor explained that she could do the pills (Aza), shots, or an IV; I am not certain if these are the same class of treatments (with different ways to deliver) or completely differerent classes of medicines. She is now wondering if shots would be better, as she is having the digestion issues and timing the Meds is a lot.
4. Lastly - how, aside from colonoscopies or CAT scans, do they monitor to see if the meds are actually helping the Crohn's.

We appreciate any kind soul(s) who might have some time to share insight. My mom is sad, worried, and I'd love to help her get informed. (Once she is feeling better I will show her how to participate here.)

Thank you!

Melanie

 

[DustyKat]

Hi Melanie and :welcome:

1. Has anyone managed taking the Questran and Aza? Not sure if the diarrhea is related to having to 1. take the pill with less food or 2. Eat food w/out Questran (she is just taking a few crackers) or 3. a general reaction to the Aza.

Both of my children take Azathioprine and psyllium husks which is essentially a natural form of Questran. It has the similar restrictions when it comes to taking medications and also works by absorbing bile salts. My children did not have side effects when they commenced the medication

2. Might her symptoms subside with time?

Aza will take at least 3 months to become fully therapeutic and for some that stretches out to 6 months. So as you can see it is not a fast acting medication so for an adult steroids are usually prescribed at the same time as the Aza so that the Prednisone takes care of the inflammation straight away and then as the Pred is tapered the Aza takes over.

3. What other categories of treatments are there and how do they differ? The doctor explained that she could do the pills (Aza), shots, or an IV; I am not certain if these are the same class of treatments (with different ways to deliver) or completely differerent classes of medicines. She is now wondering if shots would be better, as she is having the digestion issues and timing the Meds is a lot.

Aza is in the drug class of immunosuppressives. There is a drug in this class that can be administered by injection called Methotrexate but I don't think that is what the doctor is referring to. I think when he says injection or IV he is referring to the biologics. Biologics are engineered from proteins and are designed to target specific proteins in your body that cause inflammation. The two most frequently used are Remicade, it is an IV infusion that is normally administered very 6-8 weeks after the loading doses are given. The other is Humira, it is a sub-cutaneous injection that the user or a carer administers and they usually start out as fortnightly shots after the loading doses are completed. They are fast acting meds.

4. Lastly - how, aside from colonoscopies or CAT scans, do they monitor to see if the meds are actually helping the Crohn's.

There are two different types of non invasive tests that are used to monitor response to treatment. Firstly are blood tests that measure that measure inflammatory markers. C-Reactive Protein (CRP) is normally preferred over ESR as it responds much more quickly to changes in inflammation both for the better and worse. Secondly there is a faecal test called Faecal Calprotectin (FC). It also is an inflammatory marker but the advantage of this test is it measures inflammation that is specific to the bowel, the bloods aren't. I personally feel doing both CRP and FC is the way to go.

Since your Mum has had an Ileal resection does she take any supplements, like B12 etc?

Has she had blood levels done for Iron Studies, B12, Vitamin D, Zinc, Magnesium?

Dusty. xxx

 

[rollinstone]

hi, sorry to hear about your poor mom , I havnt had any surgery and touch wood will never need to, but I am currently on azathioprine, I can say when I first started it at 100mgs I got the nausea, headaches behind the eyes and just felt off. Eventually it subsided as my body became used to the medication. As for how you notice if it starts to work, well luckily, so long as she can tolerate it she should start feeling better gradually (it takes about 6-8 weeks to become effective as it builds up in your system). Her doctor will want to do tests every two weeks to monitor her bloods and liver enzymes. After the 6-8 week mark her doctor will probably request that she does a fecal cal-protectin test, which will determine the level of inflammation in the intestines. I hope she feels better soon. I'm sure she will. Tell her to hang in there.

 

[Bobkat50]

Dusty and Joshuaaa -

Thank you both for taking the time to reply and share your insight. We very much appreciate it. We are glad to hear that the symptoms will most likely subside in time. The most concerning thing right now is that mom had yet another night of diarrhea. She knows her body is reacting to the pill. So perhaps in injectable form of the medication could help. We have a message into the doctor right now and are waiting to hear back. Though, I have to be honest, I'm not always impressed with the guidance given by the doctors. Therefore I am very appreciative to have found this forum.

-Melanie and Mom

 

[Bobkat50]

Since your Mum has had an Ileal resection does she take any supplements, like B12 etc?

Has she had blood levels done for Iron Studies, B12, Vitamin D, Zinc, Magnesium?


Dusty - PS - Yes, she moniters these levels.