Combined therapy

[theblitherer]

Please forgive me if these questions have already been asked, but I am new to the forum and quite new to Crohns also.

I have very recently begun a combined treatment of Infliximab and Azathioprine. I have had no surgery yet and am naive to both medications. (I was previously on Budesonide).

I have heard something about the use or non use of various vitamin supplements and I am wondering what interaction to expect, how to help myself stay healthy basically.

I have also recently had a diagnosis of osteoporosis and am struggling with back problems (probably exacerbated or triggered by the Budesonide) and should take a combination of D3 and Calcium/magnesium but I have heard that you cannot take D3 with this form of therapy. I'm not sure why.

I have also been told that it depletes your levels of vitamin B12 and this can lead to depression. I was offered an immune boosting supplement but feel that this may be counter productive?

Anyway, a lot of questions - I am doing as much research as possible, but I have found it difficult to track down this kind of information.
Best Wishes.

 

[nogutsnoglory]

Every individual is different but generally I would avoid something that would boost immunity since these drugs are trying to suppress your immune system. As for D3 I think that is a good vitamin, yes it may boost the immune system but not at the levels of some drugs or herbs and many IBD patients are deficient in D3. This is my opinion and the best person to consult would be your GI. I also have osteoporosis and currently take remicade.

 

[theOcean]

I was on Remicade/Imuran and then later switched to Humira/Imuran. Apparently you need to avoid milk within an hour/two hours of taking Imuran, but outside of that there shouldn't really be any interactions. Do avoid taking immune-boosters, though, since apparently that interferes with the immunosuppressant ability of the medications as well.

I have osteoperosis in my family. If you are taking calcium supplements, I would recommend taking calcium citrate since it doesn't cause constipation like calcium carbonate does.

I haven't noticed any B12 reduction. In fact, my B12 level is 465, which is apparently as high as a toddler's. I would only go on supplements for it if your levels seemed low. You should be getting regular blood tests so you'll be able to tell.

 

[theblitherer]

Thank you for your responses.
I am based in London and our NHS system is riddled with deficiencies, as you will have heard. One of these is that those professionals in charge of my care (my GI nurse and occasionally, my consultant) do not offer much information of this kind. I feel that it is very much up to me to find out everything I can, and to take care of myself as best I can.

For instance, it was only after treatment with Budesonide (a corticosteroid which gave me shingles) that I discovered how closely linked it is to the development or exacerbation of osteoporosis, especially if you come off it and go back on it for short terms, which I did.

My next treatment will be in two weeks' time, and that is when I will see the nurse. At this early stage, her main concern is how I am reacting to the drugs. But I will definitely try asking her what she knows about supplements.

Thank you again.

 

[theOcean]

That's unfortunate... It seems like it's a very overcrowded system from what I've heard of it. I've been very lucky with my doctors here in Canada. It's good that you're at least able to get information online, and forums like ours definitely try our best to educate our members and help each other out!

That's surprising it would affect you so much going on and off of it in short-term doses. I think prednisone has a similar effect, but I thought it was only if you were on it long-term.

I'd recommend taking a list of questions with you if you aren't able to find answers on here, so that way you'll remember everything at the appointment. Good luck when you go!

 

[Magnolia24]

I was on Remicade/Imuran and then later switched to Humira/Imuran. Apparently you need to avoid milk within an hour/two hours of taking Imuran, but outside of that there shouldn't really be any interactions.

I haven't heard of avoiding milk with Imuran. Why is that? Where did you hear it? Just milk or would it be the same for processed dairy without lactose like hard cheese or homemade yogurt?

 

[theOcean]

I haven't heard of avoiding milk with Imuran. Why is that? Where did you hear it? Just milk or would it be the same for processed dairy without lactose like hard cheese or homemade yogurt?

I hadn't until recently, either. Apparently it interferes with uptake of the medication, rather than causing side-effects. I see a lot of conflicting information when I look it up -- some sites suggest taking Imuran with milk, others say to steer clear of it. Others mention it only being a problem in large quantities.

Having not learned about it until recently, I'm pretty sure I took my Imuran with milk most of the time. I may ask my GI for confirmation of this when I see him next month.

 

[Daisy123]

I am also based in London and get wonderful care. I am on all sorts of supplements including selenium, vitamin tablets, folic acid, b12 injections. I consider myself lucky to get such a great service free of charge. If it wasn't for my hospital, I would have been dead by now.