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Crohn's Disease Forum » Treatment » Imuran/Azathioprine/6-MP » Intolerance to Azathioprine


03-08-2016, 10:20 AM   #1
Charlotte.
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Intolerance to Azathioprine

Hi guys,

I tried Azathioprine for just three days and was advised to stop (25 mg per day).
I took it after dinner and from the next morning on I felt and still feel extremely nauseous all day, on day 2 I could barely eat or drink due to the nausea, at the same time after each meal, even if it was very small I would have very bad stomach pain and could only eat very little. In addition I have had (and still have, but it's getting better very slowly) very bad headache.
My doctor checked my blood but it came back fine.
Now we decided to wait a week until it has disappeared and try 6mp instead.

Has anyone else had so severe symptoms (I have never felt that nauseous ever before) right from the beginning on? I can't believe that such a tiny dose can cause these side effects!?

I read different numbers regarding the tolerance of 6mp for those who did not tolerate Azathioprine: It says 50 %, some sources say a slightly higher percentage might tolerate 6mp.
Is there anyone out there who does well on 6mp but did not get along with Azathioprine at all?
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Crohn's Disease: diagnosed 2014 (at 24), symptoms for 10 years now
Enteropathic Arthritis, Sacroliitis, Osteopenia

Stelara; Uceris; Lansoprazole; Domperidone.

Previously: Remicade, Humira, Simponi, Azathioprine, Methotrexate, Sulfasalazine, Entocort, Uceris, Prednisolone, TPN, EEN, different alternative treatments.
03-10-2016, 02:05 PM   #2
fuzzy butterfly
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Hi I was on azathioprine for 6 months then developed an intolerance to it. Made me sick after taking it. I have not been on 6mp so I'm afraid I can't help there. I will try and make this thread into a sticky which may get you more help and information. Best wishes to you 💕
Sorry its not giving me the option on ththis thread..
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Last edited by fuzzy butterfly; 03-10-2016 at 02:09 PM. Reason: Was trying to sticky the thread
03-10-2016, 10:54 PM   #3
Maya142
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My daughter also had nausea with Azathioprine, but definitely not as bad as yours. In her case, she was (and is) nauseous every time we increase the dose - so she was very nauseous when we went from 25mg to 50mg, and 50mg to 75mg. She had an especially hard time going from 75 mg to 100 mg - we had to cut the pill into 1/4 and raise it by 12.5 mg over two weeks.

She was also nauseous all day when she has nausea from Imuran. However, in her case, she was able to stick with it and within a few days, the nausea settles. She is on Azathioprine for the second time now and we have gotten up as far as 75mg, but every time we try to add 1/4 of a pill more, she is too miserable to stick with it.

She has Zofran for nausea so she takes that.

In her case, we found splitting the dose of Imuran helped - she currently takes 25mg in the morning and 50 mg at night. She also takes it with a snack.

I hope you are able to tolerate 6MP! We can definitely sympathize - Imuran is no fun. I will say that once she was able to get up to the full dose, she had no side effects and no nausea, so hopefully you will have a better experience with 6MP.
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Mom of M (20)
diagnosed with Crohn's Disease at 16
Juvenile Idiopathic Arthritis at 12
Juvenile Ankylosing Spondylitis at 16

Mom of S (23)
dx with JIA at 14
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03-14-2016, 07:44 AM   #4
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I also had severe side effects when I took azathioprine. At 50 mg I was ok, but once we upped the dose to 100mg, I got really sick (during Christmas, imagine..). Very nauseous, weak, feverish, pain everywhere... I also got erythema nodosum, but that might have been unrelated.

Had my blood tested soon after, and the lab results for liver function were through the roof. So I had to stop taking azathioprine immediately.

The doctor put me on 6MP a few weeks after that (I wasn't having severe symptoms of Crohn's at the time, so we decided to give my liver some 'rest' first). And I don't have severe side effects from 6MP Been on it for about 3 years now. I do have some side effects that might or might not be related to 6MP (hard to tell sometimes: tiredness, some skin problems (could also be the remicade, or just my nature...), etc.).
I did turn out to have an incredibly high dose of the stuff that causes the side effects in my blood, and too little of the stuff that's supposed to make you feel better, so they also put me on allopurinol a few weeks back, and the levels are already back in balance

So in summary: yes, I'm allergic to azathioprine but not to 6MP
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03-14-2016, 01:12 PM   #5
hcrum87hc
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I've been on Imuran for a year previously, and I've currently been on it for three months. I started at 100mg and am at 150mg now. It doesn't seem to give me any issues, but I do get the occasional queasiness. Whether this is from my Crohn's or the Imuran, I can't say.
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Officially diagnosed with Crohn's Disease in June, 2014 2 weeks before 27th birthday after ER visit due to partial blockage (stricture).

Current Meds:
Humira-40 mg every other week
Imuran-150 mg/day

Surgeries: Ileocecectomy 7/13/16 removed 60cm of small intestines.

Status: All inflamed and strictured intestines removed. All remaining intestines are currently healthy.
03-20-2016, 04:43 PM   #6
JaimeM
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I just started azathioprine a week ago and am super nauseated. Glad to see its not just me. I'm on 200mg. I didn't start feeling crappy until last night. I started on Tuesday. My right sided abd pain has been worse but I feel like I'm constipated all a sudden. Maybe bc I'm too nauseated to drink much besides Sprite
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Diagnosed Terminal Ileum Crohns 2008
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Back to Remicade and added Azathioprine 2016
03-20-2016, 04:48 PM   #7
fuzzy butterfly
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Hi jaime mention it to your doc he may be able to give you some anti sickness pills to help. Hope you lose the nausea soon 💕
03-20-2016, 06:16 PM   #8
JaimeM
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I thankfully still have some zofran so have been using that
03-20-2016, 06:29 PM   #9
Eridon2002
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Jaime-Did the docs have you gradually up the dose or just start at 200mg? I'm nervous since I'll be starting on Imuran after my reversal surgery.

I wonder if anyone has seen a difference between the generic Azathioprine and brand Imuran? The difference in my insurance comes out to $100/90 days so I'd rather go generic unless there is a quality difference.
03-20-2016, 09:10 PM   #10
JaimeM
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I just started at 200mg right away. It really isn't so bad. But def need the zofran. I'm making it through call this weekend and have been somewhat steady so it's not the worst thing I've endured. Not exactly my idea of a party though either.

I paid $25 for a month supply of azathioprine. 50mg tabs.
03-20-2016, 10:05 PM   #11
Crohns and AS
 
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I was on 50mg at first once they increased my dose to 200mg I got sick. I would throw up and feel flu like within an hour or so after taking it. My Specialist took me off of it and put me on a different treatment plan.
03-20-2016, 10:49 PM   #12
JaimeM
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I start my remicade April 1st too. And I have to take 3 weeks of Cipro and flagyl when I start that as well as a few days of prednisone. Trying to get ahead of those forming fistulas.. If I still feel like this and add flagyl on. I'm gonna lose my cookies for sure(if only I could tolerate eating the cookie haha). I keep telling myself this will make me better and I tend to tough things out instead of notifying my dr right away.. I'm a bad patient haha medical field person. We are awful.
03-21-2016, 08:33 AM   #13
Eridon2002
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I start my remicade April 1st too. And I have to take 3 weeks of Cipro and flagyl when I start that as well as a few days of prednisone. Trying to get ahead of those forming fistulas.. If I still feel like this and add flagyl on. I'm gonna lose my cookies for sure(if only I could tolerate eating the cookie haha). I keep telling myself this will make me better and I tend to tough things out instead of notifying my dr right away.. I'm a bad patient haha medical field person. We are awful.
Hope the nausea goes away for you soon and that Remicade works well for you!
03-22-2016, 11:21 AM   #14
Charlotte.
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Thank you all for sharing your experience!
JaimeM, I hope you feel better soon!

I haven't started 6-MP yet and I don't know if I want to try it. It turned out that I have gastritis again (first diagnose in 2014, symptoms disappeared and came back a few times) and I don't need any side effects at the moment. When I decide to give 6-MP a try, I give you an update.
03-22-2016, 08:50 PM   #15
JaimeM
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Jaime-Did the docs have you gradually up the dose or just start at 200mg? I'm nervous since I'll be starting on Imuran after my reversal surgery.

I wonder if anyone has seen a difference between the generic Azathioprine and brand Imuran? The difference in my insurance comes out to $100/90 days so I'd rather go generic unless there is a quality difference.
I talked to my dr today and they said if I wanted to I could drop my dose to 50mg and work my way up to my 200. However I pretty much am just determined at this point to tough it out.
03-23-2016, 08:08 AM   #16
Eridon2002
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I talked to my dr today and they said if I wanted to I could drop my dose to 50mg and work my way up to my 200. However I pretty much am just determined at this point to tough it out.
You're a tough cookie! Is the nausea easing for you at all? I can usually tough things out if there is a tread in the positive direction.
03-23-2016, 10:58 AM   #17
JaimeM
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well i didn't throw up yesterday, so that's something haha. It is easing up a little, it's still pretty bad however. I got an rx for 8mg of zofran and that's been extremely helpful. I made it through a 9 hour work day and an entire night of call with traumas and everything last night, so it's tolerable right now. I've had an increase of my crohns site pain and I cannot go to the bathroom for the life of me.. I've been taking miralax and everything and there's no improvement. I'm kind of thinking that may be adding to my nausea.

I should add that I did have my blood work done, you'll have a lot of blood work the first few months.. Everything looked good for me

Last edited by JaimeM; 03-23-2016 at 11:28 AM.
03-23-2016, 12:58 PM   #18
Eridon2002
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Hi Jamie-Not going will cause nausea. I had a partial obstruction a week before my resection surgery. I had nausea and horrible cramping pain. I stupidly had eaten a cup of white bean chili that clogged me up. I ended up going liquid diet only and very low residue. Finally after a week (of hell) it passed. Glad to hear it's at least easing up a little bit. How long have you not gone? It can be serious if it goes on too long. Are you able to pass gas?
03-23-2016, 01:10 PM   #19
JaimeM
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I haven't gone since Friday. My nausea started saturday, so yeah all of this could definitely be related to a partial obstruction.. I can pass gas with a lot of effort.. So, the usual. I'm not cramping super bad yet, so I'm gonna hold off for a short while on informing my dr. I start my cipro and flagyl up tomorrow and remicade is next week. I will try to make it until then. I am actually feeling much better today however.. I had one episode where I thought I was going to throw up, but it passed.. The feeling that I have to use the bathroom has also eased up a bit. So maybe the gates will open soon and I'll be in the clear.

Work has been super crazy today though too, so I haven't had much time to think about it.. Which is awful/nice.. Thankfully I'm feeling better or I probably couldn't have done today.
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