Azathioprine levels above 200 mg

[BWS1982]

Anyone ever take Aza at really high levels like 250 mg or so? I was up to only 125mg at my previous max last year, but as a last effort to elude the surgical strike with this disease, my current GI over the last 3 months has slowly increased it to now 250 mg (and if my metabolite levels aren't showing it's enough, he'll go even higher) because he says I've never really given Aza a shot at only 125 mg (obviously derived from my weight as well, which is now 170 lbs.) with other GI's, and he says his opinion is that a really solid shot at Aza for most adults is in the 200's, and I've seen some symptom relief over the last couple months, namely blood and frequency (urgency still there fairly consistently)....but antibiotics and dietary experimentation took place as well.

Rather than resurrect an old thread or refer to an old one, I thought I'd get a consensus of the current members. I know some people said all it ever did was make them tired or ill, but about 150 or so mg is about the tops I've usually seen for the most part here. The GI's keeping a solid eye on CBC blood draws and will check metabolite levels every few weeks too, to try to see how my liver is doing and if enough if circulating (within optimal range). If by chance this can give remission, I CAN go on this long term (though it's not preferable to taking nothing, as lymphoma is a bit of a parade rainer) as a maintenence therapy, unlike antibiotics or pred. It'd be odd if that worked out, seeing as how both Remicade and Cimzia both "failed" me in their own respects...

 

[RafHam]

I went up to 250mg for well over a year. Like you my GI doc recommended it due to my weight. I did blood tests to ensure that 250mg was the optimal level and apparently it showed that it was on the higher range but still OK. I was taking it in combination with Remi and Pred, with the plan to eventually ween the Pred.

I switched to Methotrexate about a month ago after a small flare, but like I said on another thread I've returned elevated liver function tests so I may go back to azothioprine.

Just to let you know my only remission period in 03 was maintained by 100mg azothioprine. This lasted for just under a year.

 

[BWS1982]

Well, really, the 250mg + he's got in mind is a "you're at the end of the line, that's all we can do" move more than anything, not really revolving around my "weight" per se as much. I'm okay with the present "course" getting off this damned pred again (I am/was that desperate for remission, but I see more sides than benefits, in fact, no benefits I wasn't seeing before it, but the GI and I decided it's plan "Y" (we tried plans A through X, Z would be a bag, at least that's my "analogy" for my 2.5 year battle through hell)

Hmm, I wonder if the AZA is really pulling weight or if it was the antibiotics, or the slow inception of the SCD (which I have been fiddling with to seek a tolerance to fiberous foods)...I can deal with long term variables like AZA's risks if it means I get to remission....at least it's not PML.

 

[Creepy Lurker]

Well, according to the official documentation, the max dosage for Crohn's 2.5mg per kg of body weight, which would be about 190mg. Anything higher than that would be in the realm of transplant rejection dosages.

I've been at the max for my body weight for a while now. Apparently, it just isn't working any more

 

[RafHam]

Hi creepy,

From what I understood the higher dosages are based on your ability to absorb the meds. I believe this is a relatively new approach based on a blood test which wasn't previously available (at least in the hospital that I go to) which somehow tests the level of absorption. When I went up to 250mg I think I weighed around 88kg, which is just over the max dose you quoted. But like you it seemed to just stop working for me recently.

 

[BWS1982]

They test the metabolite levels, from what I gathered. For example, another 170 pound male of similar muscular build to me may take 250 mg also, and his liver may be breaking it down (metabolising) so efficiently it's not the same as me taking 170. I am fairly certain the blood test for metabolite levels have to be pinned down, and a range has to be ascertained before such a rigid line of thinking can be in place, at least from what I've been told/read....

So much balacing of "well that would suck" vs "but that sucks more"......lymphoma, PML, losing your colon, losing your life, etc....