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I'm kinda freaking out...elevated ALT (liver) tests with 6mp


Sports Crohnie
I'm already hypersensitive to the ASA drugs. Now I've learned my liver tests are showing abnormalities at >50mg of 6-mp. Grrrrrr.

I feel fine symptom-wise but I'm trying to wean off prednisone and onto a maintenance drug. What if I can't tolerate 6-mp? What next?
6mp isn't an ASA drug, just to let you know, it's an immuno-suppressant similar to Immuran. I'm on a very high dosage of Immuran (AZA, as in Azathioprine, is what I think you meant to say) myself and at 250 mg the doc recently said "slightly abnormal but nothing to worry about" when he got a liver count blood test taken yesterday, then told me to up it to 275 mg (10% increase) because that's my only option left (other than surgery) because I've failed with everything else above and below Immuran. He wants to push it just a nudge further to see if full remission may happen from the sound of things yesterday.

I got a little worried too, because this is the first time anything hasn't been "perfect" (more or less) as I don't ever drink, I've only damaged my liver to any extent, if at all, via medications such as Immuran (or Tylenol or Seroquel) so this has me a bit uneasy, but it's either that or let the Crohns run rampant and get cut open.

What does "elevated" ALT define when you say it? Are you borderline abnormal or is it dangerous?
Hey fenway... sorry to hear 6MP didn't work for you, but don't freak out! I know, easier said than done...

I, too, was not able to tolerate 6MP. I'm kind of lost on where to go next, so I can't really offer advice; but I can tell you we are kind of in the same boat, so you're not alone.

Have you tried Imuran (Azathioprine) already? (It's similar to 6MP, but maybe you would tolerate it better?) I tried Imuran first, then 6MP but couldn't tolerate either. My doc said if you can't tolerate one, you might tolerate the other (guess that wasn't so in my case! but maybe it will work for you!).

I have been given the following options, and I'm having trouble deciding which way to go:

There are also the probiotics that Pen is having success with, VSL#3, but that might be expensive and I don't know if doctors are willing to try it ahead of prescriptions.

I've been on 4 rounds of prednisone in 2 years, so I am also hoping to acheive success with a maintenance drug... With Crohn's, finding the right medication is very much trial-and-error. I guess we'll never know until we try! Let us know what your doc suggests and how things go with the new med. *hug*
just to clarify: ASA drugs are like pentasa, asocol, colazol and rowasa?
and AZA are immuran and 6mp?

allright well the next drugs in line are the biologics i would assume, have you been on any?
Yep Kello, see, far from "dumb". :)

Some doctors like to do the "bottom up approach" and start with the lesser drugs like 5ASA drugs, and sometimes they like the "top down" so if someone's on Immuran/6MP, depending on the approach the GI took, they might have tried no biologics at all, in which case, they've got a good shot with the biologics, as they're heavier duty treatments.

I asked my GI about the differences and he said in the long run, there aren't statistically as many differences, and he personally prefers the bottom up because (I'm paraphrasing) the disease may grow along with the drug severity. When first diagnosed, patients are generally more likely to be mild, and so since the disease tends to be progressive, the treatment options can "grow" with it. Someone first sees blood/loose stools, has cramps, and 5ASA may be sufficient to battle it (it apparently was with me, since I was on just Asacol and hit my only remission for 4.5 months in 2007) but later if/when the disease progresses, they have bigger guns to use on the more severe status. He gave a couple reasons why he usually prefers the bottom up (including costs as well as side effects, why begin with thousands of $$'s in treatments if Asacol will work), but cited the statistics don't generally indicate much difference when you take the time-line out much further (seeing as how there's no cure for Crohns, the time-line has to inherently go indefinitely).

Now I'm just rambling, but I hope I help someone by giving my personal insight from experience (research?)...
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I know how you feel Fenway. I recently returned high ALT for Methotrexate so I had to stop. It's that dread in the back of your mind that every time you find out a drug doesn't work for you your one step closer to finding out that nothing will work. That's probably the toughest part of the disease for me to deal with, getting your hopes up for something and then realising that it doesn't work. Keep your chin up, I'm sure you'll find a way.


Sports Crohnie
Thanks, everyone. I really appreciate the support and hugs. It's just so frustrating to think like I've figured out a cocktail that will control the disease and then....setback.

By ASA, I mean I'm sensitive to asacol and colazal. Basically, it worsens my symptoms.

I'm concerned because I need to get off prednisone (at 5mg/day going down to 4mg tomorrow!) and if my body doesn't tolerate 6mp, I'm not sure what's next.

The ALT levels were not off the charts but elevated enough that my doc said I need to cut back from 75mg to 50mg. Go for bloodwork in 2 weeks and hopefully ALT levels come back down. She was hoping I would get to 125-150mg/day.

BWS - my doc espouses same theory. start easy and work up the chain. it's frustrating because the only reason why i'm moving up the chain is because my body rejects the drugs. only prednisone seems to have reduced inflammation and combined with diet improvements and supplements i've been pooping great for months.
Fenway, my liver function tests were always abnormal when I was on 6-MP.

The docs were worried at the start, but it turns out my Mother, brother and sister all have similar results.
We only found this out separately, while we all were having test done.

For us, it seems to be an hereditary abnormality.
Ah, sorry I misread you Fenway, I just looked at your post and realized you did differentiate between 6MP and ASA drugs with how you worded it, my bad.

Hopefully you can find a maintenance solution because Pred is not one obviously...Are Cimzia and Remicade options then since you did the bottom up?
For those interested, the difference between 6MP and Azathioprine is that Aza becomes 6MP when metabolized, there is a chemical reaction which transforms Aza into 6MP whereas 6MP is metabolized directly.
I know when i took 6mp my liver levels went from normal (which i think were suppose to be 10-20 or something like that to upwards of 130 which is REALLY bad, so they took me off and put me on remicade. Haven't touched 6mp since


Sports Crohnie
mark - mine spiked over 100. doc says it's not REALLY bad. however, anything not normal seems really bad to me.

guess remicade or something similar may be next step.