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08-12-2014, 12:04 PM   #1
Magnolia24
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Lower dose of Imuran?

Wondering if anyone has successfully lowered their dose of Imuran while still maintaining remission? The increasing hair loss after showers is starting to freak me out a little bit. I also have my doubts about how much my remission is really due to Imuran because I felt such improvement starting SCD (before Imuran reached therapeutic dose).
08-27-2014, 09:20 AM   #2
scooby100
 
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We are facing a similar dilemma with my daughter. Scd worked much earlier than imuran even started to be active. Even now AZA active levels are pretty low. ..
09-25-2014, 01:12 AM   #3
4peace
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A little late replying but.....I recently lowered my dose (with our consulting GI) and unfortunately I am paying the price....feels icky this week. Going to bump it back up to prescribed dose. My hair falls out too! Is your scalp sore by any chance? Mine has become very tender since being on Imuran.
09-25-2014, 03:15 PM   #4
alex_chris
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For me it is the other way around, azathioprine (imuran) did little to keep me in remissiom at a dosage of 1.5mg per kg. A GI explained that to me 6 years ago. Azathioprine and 6mp work a bit like an inverse jump starter of an engine - if the jump starter is too weak, then the engine just doesn't start, or in other words even if say 3/4 of the normal jump starting power is used, the effect is still 0, the engine does not start. Similarly, the bone marrow suppression from azathioprine needs to suppress the white blood cell count to the lower limit of the normal range. A dosage that is too weak does little to actually suppress the immune system enough to "protect" patients from over reactions that lead to inflammation.

If you really have problems such as hair loss, have you considered to switch to biologics?
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09-26-2014, 07:40 AM   #5
MissCadenza
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It worked for me - I dropped from 75mg to 50mg at the beginning of this year and have stayed in remission ever since. My hair has regained its bounce and my skin has improved, plus I've been less ill with colds etc since the dose was dropped and my bloods are all fine, according to my entirely useless GP that I am going to change...

Maybe I'm magical and the exception. I don't know lol.
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10-05-2014, 10:16 PM   #6
Magnolia24
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MissCadenza, are you following any sort of restricted diet like SCD or paleo, or just doing the 50 mg of Imuran?
10-09-2014, 07:11 AM   #7
MissCadenza
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I don't know what either of those are - all I do is steer clear of foods I know are triggers such as alcohol, spicy food and milk. I know what I can eat and what I can't eat (after a bit of trial and error) so I just work from the not very long list of safe food.

This seems to be working rather than jumping on some daft diet that a 'nutritionist' thinks will work. I don't believe in 'diets'. I've become very good at creating relatively interesting meals from seriously boring ingredients. Ask me about my flaked salmon potato salad, it's really good and very gut-friendly, at least for me I also take a multi-vitamin and a fish oil supplement daily.
10-11-2014, 01:20 PM   #8
Magnolia24
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Update - Saw my doctor yesterday and based on my lack of crohn's symptoms, hair thinning and persistent colds he advised me to cut back the Imuran to 50 mg and begin taking Asacol. If I continue to feel well, he may support cutting out the Imuran entirely. Feeling hopeful.
10-11-2014, 01:37 PM   #9
alex_chris
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Update - Saw my doctor yesterday and based on my lack of crohn's symptoms, hair thinning and persistent colds he advised me to cut back the Imuran to 50 mg and begin taking Asacol. If I continue to feel well, he may support cutting out the Imuran entirely. Feeling hopeful.
Magnolia, just so you know, at 50mg (which I assume is less than 1mg per kg bodyweight), you could potentially even stop taking imuran (azathioprine) altogether. At this level, the immunosuppressive effect of azathioprine is marginal at best (or in other words, if you cut from 100mg to 50mg, the drug won't be half as effective, but due to the mechanisms of azathioprine in the body as a purine structural analog, it will be a lot less effective than "half").

Have you read up on 5-ASA (Asacol is a brand name including this drug) on here? It would be good to read the various threads about it. 5-ASA works well for UC, but unfortunately does not have a very good statistical track record for Crohn's.
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