Prednisone, Imuran and Salazopyrin EN

[Webby1980]

Hi, I have recently been diagnosed with Crohns in March 2013 and was put on 40mg dose of prednisone initially and to taper dose by 5mg over a four week period, I was also was diagnosed with arthritis in my sacrum. The first three weeks I was on Prednisone I felt great (back pain almost did not exist), once at 25mg the effects were not as great. My doctor last week put me on 100mg of Imuran along with the prednisone (which i am still meant to taper) and also put me on Salazopyrin EN of which I need to gradually increase my dose so I get to 3000mg per day (two 500mg tablets three times a day).

11 days into taking the Imuran and Salazopyrin EN I started getting chills and fatigue which I hear are side effects of the Imuran, however I don't know if I should just put up with them and they might go away? Overall Crohns symptoms have still been there on and off since starting medication 5 weeks ago.

Is it normal to be taking these three medications all at once? Any feedback or information would be great.

 

[nogutsnoglory]

It is normal to be on multiple medications. It sounds like your doctors used pred as a strong fighting agent to start and then added on a maintenance drug while they wean you off of the pred.

Is your doctor aware of the side effects? If they are manageable and the medication is working you will need to weigh the benefit versus the negative side effects. There are also other drugs like 6mp or Azathioprine which are similar to Imuran which may not bother you.

 

[Twiggy930]

My son has been on all three of these medications at the same time.

With Imuran it is important to get regular blood tests done to check to make sure that it is not suppressing your immune system too much and to make sure that it is not harming your liver. Has your doctor talked to you about getting regular blood tests? I think we did blood tests every 2 weeks for a while, then every month and now he gets them done every 3 months. I would definitely tell your doctor about your symptoms.

My son also did a gradual start to the Imuran but he is was only a 10 year old so maybe 100mg is a gradual start for an adult. Are you gradually increasing your Imuran as well?

My son got terrible chills/sweats from prednisone. It would often happen to him at night and he would sweat so much that it was like someone threw a bucket of water on him. He would consequently then get chilled.

Hope the meds start working for you soon.

 

[Webby1980]

Hi Twiggy930,

Yes my Dr has advised that I need to have weekly blood tests and there has been no mention as to whether I need to gradually increase my dose of Imuran as yet, I suppose it will depend on how I respond to the current medication of which I am hoping will help soon.:smile:

 

[alex_chris]

Your doc seems to know what he is doing. This is the traditional treatment of moderate Crohn's (although even for moderate Crohn's biologics/imuran therapy has become more widespread due to its effectiveness http://fundapoyarte.org/contenidos/NEJMoa0904492Infliximab y Aziatropina en Enf de Crohns.pdf)

Anyway, imuran (that is the brand, the incredient is azathioprine) only really kicks in after using it 2-3 months. Some initial side effects are usual, but if they persist or get worse in the next weeks and months you might need to stop imuran and try 6mp or go for biologics (remicade, humira...). Imuran is given in a dose of 2-2.5mg per kg body weight, so it should be ramped up eventually to be effective.

I hope things are getting better soon, at the beginning Crohn's seems like a black box and all the drugs sound scary and taking them not getting better then feels as if something is wrong. But the truth is, drugs are just one piece of the puzzle when managing Crohn's, your diet, your stress level, endurance sport, vitamin therapy also play an important part. There is lots of info on this board, I would suggest to check it out.

 

[Webby1980]

Hi Alex_Chris,

Thankyou for your reply. Yes it is definitely very daunting when you first get diagnosed and given a load of paperwork to read and medication prescriptions galore to fill. It is all so very new and I am finding the posts on this forum very helpful. I have worked out that diet is playing a big role even though my Dr has advised that it doesnt make a difference and I have had to make some significant changes to what I eat.

_________________

Diagnosed CD: March 2013
Current Medications:
40mg Esomeprazole
20mg Prednisone
100mg Azathioprine
2000mg Salazopyrin EN

Supplements: 1250mg Calcium, Multivitamin, Pro-Biotic

 

[alex_chris]

I have worked out that diet is playing a big role even though my Dr has advised that it doesnt make a difference ...

I take back that your doc knows what he is doing... if he really said diet doesn't matter for someone who has Crohn's, he stands in stark contrast with the consensus of basically every single person who has Crohn's.

As you probably know now, there are various foods that just don't cooperate if you have an active Crohn's. Basically, all "aggressive" foods and dishes, things that are too spicy, too sweet, too sour, too salty, too oily,... in any way too extreme. Or in other words, the more neutral something tastes, the better. On the other hand, if you are in remission, you can virtually eat most foods, but the "too" category still won't be good for you and may lead to a flare.

Personally, I feel that food and sport are probably the single most important things to keep me in remission. Drugs are a nice way to help too, but if I wanted to (I definitely don't ;-), I could end up with heavy inflammation in a week or so, just by eating all kinds of things I shouldn't eat.

 

[Webby1980]

Lets hope he has some idea what he is doing, since my first post yesterday, I have broken out in a bad rash and was advised to stop taking Imuran and Sulfasalazine immediately and get blood test. I am due to see Dr tomorrow with blood test results and I assume what are the next steps to take in regard to medication.

Yes I have definitely found the more plain and neutral the food I eat the better, It is very difficult changing my diet as I was very used to eating a high fibre diet of whole grains, fruit and veg and they also don't go down very well anymore.

Anyway, i will keep you posted as to what the outcome is from my Appointment tomorrow with bad rash reaction I have had from either Imuran or the Sulfasalazine or both.

 

[Su-bee]

I think a rash allergy is pretty common with the sulfasalazine. My doctor said so after I had the same reaction myself after a few weeks of taking it. It was a pretty bad rash on my arms, legs, and tummy. After going off the medicine it went away pretty quickly. Let us know how it goes.

 

[Webby1980]

Saw GI today and blood tests came back ok, He cannot determine if the rash was a result from the sulfasalazine or the azathioprine, so subsequently I have been taken of sulfasalazine and I am on 40mg of prednisone until my rash subsides and my flare up has hopefully settled down. GI then prescribed me with 50mg of Mercaptopurine which I am to start in a weeks time and then reduce my prednisone down to 30mg. Hopefully no side effects this way. The only thing that concerns me is when I do eventually start tapering the prednisone down from 30mg I won't be on anything that will be effective to treat my arthritis.