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Crohn's Disease Forum » Treatment » Imuran/Azathioprine/6-MP » Is it worth increasing my dose of Aza?


11-03-2013, 06:33 AM   #1
zilla7777
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Is it worth increasing my dose of Aza?

Hey,

Recently I seem to be showing symptoms of my second flare on Aza, and my doctor is pushing for me to increase my dose from 125 to 150mg of Azathioprine, claiming that my bloods show the dose I'm currently on is barely in the therapeutic range.

Being the second flare, is it worth seeing how this goes, or should I be asking to move on to a different medication? Has anyone had positive experience increasing doses? I feel as though I may just be negative given that it hasn't really worked so far.

Thanks!
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Diagnosed mid 2009
Past Tx: Prednisolone, Enteral Nutrition
Current: Azathioprine, Omeprazole, EN supplements, Small bowel resection to remove 2 strictures.

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11-03-2013, 07:04 AM   #2
kh216
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How long have you been on Aza? Aza generally takes about 3 to 6 months to work.

Your doctor's suggestions sounds reasonable. I know that others have been taking 150mg of Aza so this dosage is not uncommon.
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11-03-2013, 07:37 AM   #3
zilla7777
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I've been on it since about March 2012, so it has been a substantial amount of time since I have begun. So about 20 months. It kinda freaks me to know I've been on it that long!
11-03-2013, 02:07 PM   #4
kh216
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I still would suggest you following your doctor's advice, unless you want to get testing done to see if the inflammation has increased. You could ask to have the C Reactive Protein blood test done. There are also the more invasive tests, such as a colonscopy, Small Bowel, Follow Through or the GI series. If the Aza doesn't work or you really wish to switch, then your next step would most likely be one of the biologic meds-Remicade, Humira or Cimzia.
11-03-2013, 04:00 PM   #5
SarahD
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Hi Zilla,

If you're barely in the therapeutic range you might find Allopurinol in addition to a greatly reduced dose of Aza helps get you into the right range and into remission - you might be shunting the Aza and producing too much 6MMP and not enough 6TGN. I was taking 125mg Aza daily and was just below the lower boundary of what the doctors consider to be the therapeutic range for 6TGN, but my 6MMP level was too high for me to be allowed to increase my Aza dose further. It was clear after several months that I wasn't improving so 6 weeks ago I started 100mg Allopurinol with 25mg Aza daily. I had another metabolite blood test last week to find out if this new regime is working and I should get the results by the middle of next week. The early signs are looking promising, my pain levels are down and my inflammatory marker from my blood tests have reduced a little too.

It's worth asking your doctor before considering moving to a much stronger type of medication. It will depend on how you're metabolising the drug but it sounds like it could be an option for you.

Sarah
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Symptoms from the age of 12. Mis-diagnosed with UC at the age of 13, and later diagnosed with Crohn's in January 2012 at 24 years old. Disease mainly in terminal ileum.


Current meds:
Azathioprine, Allopurinol, Calcichew D3-Forte, Fortijuice, Alendronic acid, Ranitidine

Previous meds:
Augmentin, Doxycycline, Lansoprazole, Asacol, Pentasa, Prednisolone, Entocort, Cipro, Flagyl, Elemental Extra 028
11-03-2013, 09:47 PM   #6
Catherine
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Zilla777

Have you had testing done for the AZA levels?

My understanding is this test is not performed as much is Australia. The test is no approved by medicare and is a such a private test. If the test is done through a hospital testing centre you may get for free.

But as by daughter uses a private GP, we using Dorevitch for the blood test they quote the lowest price for the test.

Sarah's results come back as out range much too low and her aza was increased to 150mg per day. She seems to doing well at the higher dose. It took us 21 months to get Sarah's levels in range.

Hope your exam went well this morning.
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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)
11-04-2013, 08:20 AM   #7
zilla7777
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Wow, 21 months is a very long time! I guess if it may help eventually then it does seem worth another shot to see if it will work. Maybe I'm just impatient I guess (no pun intended?)

I haven't really noticed too much about the AZA tests or anything, so I'm assuming they aren't being done. My next blood test tomorrow is testing for the following: FBE, U & E, LFT, CRP, Vit D, B12 and Iron (I'm anemic at the moment.)

I've been having a few little issues with my current specialist. I haven't even really been told whether he is a private or public specialist, and things I'd generally get covered as a public patient with my last specialist (Who I cannot see any more as he is a pediatric) I'm now getting invoices for despite being assured by the office admins that it'd be covered by Medicare. It's a little bit odd at the moment.

Allopurinol does sound like an interesting medication, but I guess that will depend on whether the Aza is actually proving to be effective.

I appreciate the responses! It's nice to hear an outside opinion.
11-06-2013, 06:09 AM   #8
Catherine
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This maybe of interest to you. The article is by a top Melbourne researcher.

http://www.healio.com/gastroenterolo...-monitor-patie
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