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What is concidered long term use of azathioprine?

Hello,

I was diagnosed with Crohn's disease in the summer of 2011. Since then I have been battling bleeding, and flares that come once a year, well since my diagnoses. I started on Asacol (Mesalamine), and did fine for almost a year. Then during my second bad bleeding flare, I went on Prednisone for a few months and was placed on azathioprine 100mg a day then 150. Then felt almost normal again for a year. Now, in December of last year 2012, a week after thanksgiving, I had my third bad flare. Of course again, bleeding is my main symptom, along with mucus and frequent urges, and diarrhea. Went back on Pred upped my azathioprine to 200mg ( my body weight is 215 because I'm tall), and now not having urges, but still bleeding a small amount with semi formed stools...which is totally depressing. My main question is...what is considered long term use of azathioprine? I keep hearing and reading about the cancer risks for young men. I am 30, and I just feel depressed as it is, and now I am not wanting to take Azo anyway, because it feels like its not working. I am very glad I became a member of this site. I don't have anyone to learn from, and unfortunately, my doctor is almost top secret about anything I ask him. I don't want things to get worse on this immune suppressant. Someone with any knowledge please in-lighten me. Thank you.
 

Angrybird

Moderator
Location
Hertfordshire
Hello and welcome to the forum.

I would consider anything over a year potentially long term, I have seen some here who have been on the Aza for years without issue. I would agree though that if you have been on the 200mg since December and you're still having symptoms then it may no longer be the med for you. When are next due to see your doc for a check up? Have your vitamin levels ever been checked at all? Do you notice whether certain foods make your tum worse?

AB
xx
 
I was on Azathioprine for about 8 years straight. Until I had a call from the doctors surgery telling me to stop taking it immediately as my bloods were showing that it had started to affect my liver function.

The possible side affects are always scary. But these days I've decided Crohns is scarier and I would take anything to keep it suppressed. You just have to weigh up your risks, if your crohns goes untreated is it going to get worse?
 
G'day Crubio, I've been on it for years, dose 200, usually with pretty good results, in conjunction with Prednisolone, Dose 10 a 60 mg per day. Not that flash at the minute but hey sometimes life is shit! My Doc is looking at my metabolites as a small percentage of those on Imuran don't break it down properly and need another drug, Allopurinol, added to the mix. Johnwc
 
Hello all,

Thank you for your replies. @Angrybird I have been on it since December, at the 200 dose, but since last year around Feb, at the 150 dose. I am pretty tall at 6'4 and muscular, and the Doc really assures me I'm at a safe dose, but as I mentioned, and as you mentioned...I am still showing symptoms. And of course...bleeding. Which I think is a terrible symptom! :/ Just tapered off Pred after 3 months too on top of all that. I am determined to beat this disease you guys. This is not optimal for me. Nor is it acceptable. There is gotta be something for us. For our TNF, for our inflammation, and our immune systems. This can't be the way for us with all these terrible and uncertain meds... I don't want cancer, and I don't want blood toxicity, and organ failure. There is one natural supplement I keep reading and reading and reading about. Colostrum... I don't want to jinks it, but I am willing to try it. You guys, thanks for the welcoming. Cheers to us! To our health!
 
The effective dosage for aza is 2mg to 2.5mg per 1 kg bodyweight or 0.9mg to 1.1mg per lbs body weight. The problem with aza is that its effect is not 'gradual' in the sense that 0.5mg per lbs body weight will help you about half as much as 1mg and 2mg per lbs helps you double. The long term dosage shouldn't be lowered below the 2mg per kg or 0.9mg per lbs (that is for you the 200mg dosage) except if your white blood count (leukocytes) is consistently below 4000 per 1microliter blood. Having said that, I would check with your doc again why he has reduced the dosage - especially if you still got symptoms.

I have been on aza from 2003 to 2008 and since 2010 again. When I was first started I was told that after 4-5 years you should phase it out again, if you are in remission at that point and see what happens. Aza enhances your cancer risk (it basically doubles it from 2 in 10,000 to 4 in 10,000 cases for certain types of cancer). The other severe side effect is potential liver damage (that's why you do the blood tests). Normally doctors (and patients for which aza works) think these are acceptable risks - even long-term.
 

Angrybird

Moderator
Location
Hertfordshire
Are you able to get in contact with your doc or a GI nurse about the ongoing symptoms? Did any testing get done during your last flare to check on what was happening inside?
 
@Alex_chris Thanks again. And, @Angrybird, yeah I forgot to mention I had a recent colonsocopy. My 2nd since my diagnosis back in '11 Before I completely was out. I remember my intestines looking pretty good on camera. I even asked the Dr doing the procedure. " Is it me, or does everything look pretty good? " She replied " It really does, but you we gotta see where and why this bleeding is continuous." I woke up, and had a prescription for Mes-suppositories. ( This was in April) That was it, and I haven't heard back about the biopsies or any concerns. My Dr last checked my blood, and inflammatory markers, and white blood cells, and ext in Late Feb. Says everything is looking sharp. As for vitamin check, and other tests...not so sure. I did notice I was semi low in D. Which I take now, along with Multi, and Omega, and Calcium, and iron for my lowered hemoglobin. I work out everyday, and have a great diet. We will see folks, we will see.
 
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