Hitting the roadblock: Methotrexate or Imuran

[Kancer]

I have been on 20mg Preds for about 9 weeks now. I tried tapering off twice and have done so successfully but end up having fever. Talked to my GI regarding the side effects I have been having while on Prednisone (Eye Pain, Dry eyes, Possible Glaucoma, Constipation, Blurry Eyes).

My doctor thought prednisone isn't effective if I might end up having steroid-induced glaucoma. He recommended I switch to Azathioprine (Imuran) and discussed the side effects with me. To be honest, I didn't know if I was in the right mind to decide thus I am stalling now. He gave me 10mg steroids to take for the time being until I decided.

I have done my research and I see that MTX and Imuran can be used for Crohn's. I would really appreciate what you think of these 2 options and the dose you have taken/are taking. (I am 60KG, 5'7")

I am told that biologics can only be used as a last option as the hospital I visit is government run and medications are free (They aren't entirely confident with biologics and would only use Anti-TNF meds if Anti-Cancer drugs won't work).

 

[Clash]

We have never used Imuran with my son, he is 20 dxed at 15. He had been on mtx since about 6 months after his diagnosis. At diagnosis, he was put on remicade then about 6 mos later mtx was added.

He's been on both oral mtx and mtx injections. He's had no side effects with either but some people do tend to get nausea and fatigue for most it's with the oral form and switching to injection helps. Others experience it with either form. He takes 1mg of prescribed folic acid since mtx is an anti-folate.

He has been in various doses ranging from 7.5 to the highest which 25mg. He's been on 25mg the longest. I can't say how much it has helped CD wise but he also has a CD extra intestinal manifestation of the joints, spondyloarthropathy, and the mtx does help with that now.

I'll tag maya142 and my little penguin as they have both used imuran and or 6mp.

 

[ronroush7]

I have been on imuran for years. Once after checking my blood, they had to switch me from 100 mg. to 50 mg. I think it might have caused some minor hair thinning but nothing major. Wish you the best.

 

[Maya142]

We have used both Imuran and MTX. My younger daughter had more side effects with MTX than with Imuran -- nausea and dizziness. She hasn't had any side effects with Imuran, except nausea when we increased the dose (which quickly went away).

It's really pretty individual -- lots of people do really well on MTX and have no side effects at all. My older daughter takes MTX with no issues at all.

There are more cancer risks with Imuran than with MTX, so more doctors are beginning to use MTX instead, especially in the pediatric world. There is a slightly higher Lymphoma risk and a higher skin cancer risk with Imuran.

If you do MTX, make sure your doctor prescribes folic acid to be taken daily - that decreases side effects. They can also give you Zofran if you have nausea.

Both are much better options than using Prednisone long-term!

Good luck!

 

[my little penguin]

Ds was on 6-mp at Dx (age7) it's the sister drug to Imuran
It went to his liver but was worth trying .
We added mtx to humira at age 10 due to juvenile spondyloarthritis.
That has helped
He takes folic acid to combat any side effects .
We recently discussed coming off mtx and going to imuran since his Sweets syndrome is not under control
At this point given his age the risk of certain cancers is higher woth imuran so it was decided to increase his mtx to 25mg and change from pills to injection

Good luck with either one

 

[Kancer]

It is nice to hear all these feedbacks. The doctor recommended Azathioprine but is open to whatever I take. He also mentioned if I am reluctant to take either of them, I can take 5mg prednisone long term and it doesn't pose too much risk.

Do you think 5mg prednisone long term would do damage to my body even if it manages to control crohn's disease?

 

[my little penguin]

You want to save pred for when your flaring
Eventually it does stop working
Way back when they only had pred to treat crohns and more pred
Folks did not fair well
Mortality and surgery rate was high
I get being afraid of meds and side effects
But many parents on here had kids end up the icu
Others are having surgery after surgery
You basically pick a med and hope that it works
For ds we tried them all each one agonizing over whether it would be a good or bad or not have
Side effects etc
But those don't matter ALOT when the med doesn't work for you
Everyone with crohns is different and the one that works is the right med

So far ds has tried
Pentasa
6-mp
6-mp plus allopurinol
6-mp plus allopurinol plus asacol

Methotrexate plus pred
Remicade
Humira
Humira plus methotrexate plus pred
Now humira plus methotrexate
In the past five years
He has also done various diets to try to help
Including multiple times of exclusion enteral nutrition (een)
Nothing but formula by mouth no food
Currently his diet is 50/50
My point is there is no right med
Just the ones that work for you

 

[Maya142]

Prednisone has a LOT of side effects:

Adrenal insufficiency
Increase in infections
Diabetes
Glaucoma
Osteoporosis

sleep problems (insomnia), mood changes;
increased appetite, gradual weight gain;
acne, increased sweating, dry skin, thinning skin, bruising or discoloration;
slow wound healing;
headache, dizziness, spinning sensation;
nausea, stomach pain, bloating; or
changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist).

The list goes on and on. It's not really used as a long-term medication now (if possible) -- other maintenance medications are used much more (like Imuran and MTX and biologics). It's much safer to use a maintenance medication and to use Prednisone sparingly - just for flares.

There may be fewer risks at a really low dose of Prednisone like 5 mg, but it's also unlikely to control your Crohn's at that dose. You said you have had trouble going below 20 mg -- then 5 mg is not really likely to do anything at all!

Here is a good presentation about the risks and benefits of IBD meds:
http://programs.rmei.com/CCFA139VL/

Good luck!

 

[FrozenGirl]

I've been on both. Imuran (100mg) worked best for me in terms of disease control. Side effects were initially very few but 6 months in I had to stop it due to low white blood cell count even on a super low dose. Methotrexate initially had no side effects but about 2 months on the injection (15mg) I started getting liver issues and extreme nausea. Off it for a month and restarted (10mg) with folic acid, 1mg every day but injection day. Fixed my liver issues but still had the nausea so I switched to the pill version when I upped my dose to 15mg and upper my folic acid to 5mg/day. Haven't had issues since.

 

[Kancer]

Just restarting this thread as I have decided to go on Azathioprine. I will likely start at 50mg and move on from there. I have discussed with my GI and will likely start on Azathioprine starting a week from now and start tapering off prednisolone.

The doctor has talked to me about all the possible side effects and complications of the medication and its up to me to choose to continue Pentasa or move on to Azathioprine. Considering I have a fistula at the moment and I am hoping it would heal if i were on Aza without surgery (based on some success stories). I would like to know if there is any precaution I should take to certain diet/lifestyle changes I should take when starting Azathioprine.

Thanks in advance

 

[Kancer]

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