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Crohn's Disease Forum » Treatment » Imuran/Azathioprine/6-MP » Should we increase AZA dose?


06-22-2013, 08:18 AM   #1
scooby100
 
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Should we increase AZA dose?

Hi All,
My daughter (15), was diagnosed with Crohn's ~6months ago.
She is on AZA for the last 2.5 months - on 100 mg dose.
As per blood tests AZA components didnt fully kicked in so the doctor wants to increase the dose to 125 - as per the max ratio according her body weight.
HOWEVER....to make the story more interesting....we started SCD /GAPS diet almost at the same time as the AZA- 2.5 months back.
Within days, her symptoms started to ease, started to gain weight, latest inflamation markers moved back to normal.
GI is aware of the diet, but wants as well to gain the most out of AZA.
our gut feeling, on the other hand - why to change a working formula...and be exposed to potential AZA side effects?

What would u suggest?

THX!
06-22-2013, 10:25 AM   #2
sfmreb2
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I'm with you. Why up the dose when things are going good. It sounds like a clinical thing, instead of going with what works. Maybe the Dr knows more than we do, but I'm not sure that is always the case. I was just reading the side effects and since you daughter is only 15 why mess with what works. I say go for your gut feeling, but I'm not an expert on AZA's.
06-22-2013, 11:24 AM   #3
Mehita
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She's not at therapeutic levels per the blood test?

I would be hesitant to change anything (at least for now) as well. Especially if all her other markers are normal.

I don't know much about this since DS has only been on Aza for 6 weeks, but I thought I read adding Allpurinol sometimes helps or even switching to 6MP instead of Aza can sometimes bring kids into the therapeutic range. Just things to ask about or consider without rocking the boat too much.

I hope she continues to feel well.
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06-22-2013, 08:42 PM   #4
Catherine
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My daughter is 17 years, currently on maximum dose for her weight

We are currently waiting on the blood to confirm we can move to a high dose. Sarah is symptom free but had one positive colonoscopy biopsy. Sarah also managed to develop a small to small bowel fistula while appearing to be in clinical remission.

This disease can be silently doing damage.
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Catherine
Mother of Sarah dx aged 16, Jan 2012
DX - CD 1/12, asthma
Small bowel to small bowel fistula

Meds: ), azathioprine 200mg, Mesalazine 1.2g x 2, seretide 250 x 2 (asthma), ventolin (as needed)

Currently no supplements.

Has previously taken Multi B, Caltrate, B12 & Iron

Prednisolone (from 30 mg 01/02/2012 to 17/06/2012, 30mg 24/10/12-28/12/12, 50mg 24/1/13-27/4/13)
06-23-2013, 02:54 AM   #5
alex_chris
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Hi All,
My daughter (15), was diagnosed with Crohn's ~6months ago.
She is on AZA for the last 2.5 months - on 100 mg dose.
As per blood tests AZA components didnt fully kicked in so the doctor wants to increase the dose to 125 - as per the max ratio according her body weight.
Do you know her weight? The maximum normal effective range is 2 to 2.5mg per kg body weight, which at 125mg would suggest your daughter is at list 50kg.

As to blood tests, do you know where her white blood count level is? Is it already near 4 or even below for several blood tests?

HOWEVER....to make the story more interesting....we started SCD /GAPS diet almost at the same time as the AZA- 2.5 months back.
Within days, her symptoms started to ease, started to gain weight, latest inflamation markers moved back to normal.
GI is aware of the diet, but wants as well to gain the most out of AZA.
our gut feeling, on the other hand - why to change a working formula...and be exposed to potential AZA side effects?

What would u suggest?

THX!
As to potential long term side effects of aza, it doesn't matter if its 100mg or 125mg. The right dosage really just is so the range of the WBC count is in the desire lower normal range or even slightly below 4 (but not close to 3 or even below that).

So my suggestion would be to increase the dosage if blood tests show the WBC count hasn't moved near the desire range and is still much too high.
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06-23-2013, 07:13 PM   #6
scooby100
 
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thx to all!
dont have her latest white cells count - but they are within normal ranges, the main parameter driving our GI to ask to increase the dose is low level of avtive 6-TGN from the Imuran - 224. Her weight is now 54 kg, so the new dose is well within the guidelines.

BTW - Alex_chris - why do u think that the dose doesn't impact long term side effects?
06-23-2013, 10:23 PM   #7
Catherine
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My experience with Sarah is our doctor does not want to be above 2mg without testing that a higher dose to necessary.

Sarah is currently 62 kg and on 125mg. Awaiting test results for the ok to go to 150 mg.
06-24-2013, 01:31 AM   #8
alex_chris
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BTW - Alex_chris - why do u think that the dose doesn't impact long term side effects?
Sorry, I should have been clearer. I meant it really doesn't make that much of a different whether the dose is 100mg or 125mg.
06-24-2013, 07:48 PM   #9
scooby100
 
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thx to all.
decided to increase the dose and keep an eye on the progress during coming few weeks / months
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