Mercaptopurine and thiopurine metabolite levels

[walnut]

Hi all

First post here and I found the forum googling an answer to a question that I hope I can post here as I can't find any answers really.

I have been on Mercaptopurine (50mg twice a day) for about 6 years since a severe crohn's flare-up but I am now in remission.

I received a letter today from my consultant saying that my "Mercaptopurine metabolite levels are on the high side" and he wants me to reduce my dose to 50mg once a day.

Can anyone tell me if having high metabolite levels could have any side-effects such as fatigue/extreme tiredeness and/or prolonged diarrhea? As I said I did try googling but only really found medical research papers that were hard to read and understand.

I am just trying to understand the implications of having these high levels in terms of how it could affect me.

Thanks

 

[CrohnsChicago]

The thiopurine metabolite levels tested are 6TGN and 6MMP.

High thiopurine metabolite levels, specifically high 6MMP can indicate a higher risk of liver toxicity which would mean your doctor would have to readjust your dosage or take you off of the medication to prevent any liver damage. High 6TGN would mean you are at greater risk for leukopenia (a severe decrease in your white blood cell levels) leaving you at greater risk for all sorts of infections.

There is also a medication called allopurinol that doctors sometimes use with mercaptopurine to help manage your levels and allow you to remain on mercaptopurine. Something your doctor may discuss with you as an option at some point if he feels it is worth trying before transferring you to biologics.

As for the fatigue and diarrhea, those are listed as common symptoms of taking the medication in general.http://www.webmd.com/drugs/drug-590...ame=Mercaptopurine+Oral&source=0&pagenumber=6

 

[walnut]

Thanks for the reply - much appreciated.

I guess I will have to see how things go and hope that reducing the dosage does not aggravate the crohn's seeing as it is in remission at the moment

 

[DustyKat]

Hey walnut,

My son has been in remission for just over three years now and six months ago he too had thiopurine metabolite levels on the higher side. As a result his Imuran (Azathioprine, parent drug to Mercaptopurine) was reduced from 100mg to 75mg.

I had the same concerns as you but he has not suffered any ill effects from the reduction. Although he did not have any apparent side effects from the increased thiopurines, at his latest GI appointment, last Thursday, he said in the last 6 months he has felt better than any time since his diagnosis. So perhaps there was something niggling away there we just weren’t aware of??

Good luck, I hope all goes well with the adjustment.

Dusty. xxx

 

[walnut]

I am just so tired I was kind of hoping it was the increased level. Can't say I have noticed much difference since reducing.

I just hope the Crohn's doesn't flare up again.

 

[DustyKat]

Where is your Crohn’s located walnut?

Have you had any surgeries?

Dusty. xxx

 

[walnut]

I don't know the technical name for it but it is the lower end of the bowel nearer the rectum.

I should have had surgery when I had a massive flare-up cos I had about 5 abscesses on the bowel but I had a heart attack at the same time so they couldn't operate.

I had a hole in my abdomen for 7 months whilst they drained the abscesses and they were going to give me a stoma bag but I got a 2nd opinion and they put me on azathioprine but I was so sick on it all the time so changed it to mercaptopurine so I avoided the bag.

That was all 6 years ago now.

 

[DustyKat]

Whoa, you have been through the wringer. :ghug:

Have you had blood drawn for Iron Stores and Folate lately?

Have you had any imaging or scopes done recently?

Sorry about all the questions.

Dusty. xxx

 

[walnut]

Thanks - it was a pretty tough time and they told my mum and partner that I had a 90% chance of dying from it all but I am still here

I had some blood tests done in March but not sure if they tested for that or not. Will have to ask my doctor.

I am having a colonoscopy on the 16th - can't wait !!!!

No probs about all the questions and thanks for your replies.

I am Nicola by the way and I am 48 if that helps.

 

[DustyKat]

I bet you can’t! Good luck with it and please keep us posted with how you get on. :ghug:

Also let us know about the blood tests.

In view of your age and gender, do you think menopause may be playing a hand in any of this? I don’t mean it being the complete cause of your symptoms but just having a role in it.

Dusty. xxx