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Crohn's Disease Forum » Parents of Kids with IBD » Azathriophine Dose Rate


09-09-2014, 09:57 PM   #1
Catherine
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Azathriophine Dose Rate

Wondering whether anyone here has been on a dose rate of azathriophine at over 3.5mg/kg?
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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)
09-10-2014, 06:31 AM   #2
Pilgrim
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No. We started last week at between 2 and 2.5mg/per kg.
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Mom to daughter,age 5, diagnosed at age 3 with Crohn's Disease
Current Treatment: Humira (started 12/2014) moved to weekly injections (07/2015), Back to 50% EN orally. Zinc supplements. Calprotectin through the roof.
Previous Treatment: Azathioprine (discontiued 09/14 due to Pancreatitis) Flagyl, Sulfasalazine, EEN, Iron,Vit D, Zinc, SCD
09-10-2014, 08:05 AM   #3
Catherine
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We started a 50mg, then 75mg, 100mg, 125mg, 150mg and now moving to 200 mg.
09-10-2014, 08:10 AM   #4
sleepallday
I'm currently on 2mg/kg, taking 125mg daily.

Does anyone else find that Azathioprine makes them nauseas, sensitive to smells and as a result have a loss of appetite?
09-10-2014, 08:28 AM   #5
Pilgrim
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It's been almost a week now and I haven't noticed any difference at all in our daughter. I know it's too early for benefits, but no adverse affects. Her dose is 40mg, but because she's little thats 2.2mg or so per kg.

I read somewhere on the forum that people will take Benadryl for the nausea.
09-10-2014, 09:28 AM   #6
Jmrogers4
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I think Jack was somebody will have to double check my math. He was 75 pounds/(so roughly 34.02kg) and at a dosage of 150 mgs. He was at that dosage for just a short time and I hadn't researched as much as I have since then but I freaked out a little since it was the same dosage his 200+ pound father was on. We dropped it down to 75mg and added allipurinol. I think the 75mg would have put it at between 2-2.25/kg
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Mom to Jack (18) dx Crohn's 2/2010
Vitamin D -2000mg
Remicade - started 1/9/14; 7.5ml/kg every 6 weeks
Centrum for Him teen multivitamin
Past meds: Imuran/Azathioprine; allopurinol; methotrexate; LDN; Prednisone; Apriso; Pentasa; EEN

Husband dx Crohn's 3/1993
currently none due to liver issues
09-10-2014, 10:47 AM   #7
Chester31
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My son started 2 weeks ago at 2mg/Kg.
09-10-2014, 10:55 AM   #8
SupportiveMom
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D is at 150 mg now but D is 105 lbs there is talk of increasing, but we want to give the Simponi some time 1st before increasing.
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Ileostomy surgery July 2015

Current Meds: None!
Previous Meds: Humira, Remicade, Methotrexate, Cipro, Flagyl, Zofran, Cortifoam, 5-ASA suppository, Questran, Mezavant, EEN (Peptamen Jr. 1.5) by NG tube, Antibiotic Cocktail (Vancomycin, Metronidazole & Doxycycline), Simponi, Prevacid, Imuran, prednisone
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09-10-2014, 11:00 AM   #9
Maya142
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M is on about 2mg/kg right now (75mg). Her GI did mention we could go up to 2.5-3.0 mg/kg.
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Juvenile Idiopathic Arthritis at 12
Juvenile Ankylosing Spondylitis at 16

Mom of S (23)
dx with JIA at 14
Ankylosing Spondylitis at 18
09-10-2014, 11:06 AM   #10
my little penguin
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http://www.drugs.com/dosage/azathioprine.html

Says you can go to 4 mg/kg
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09-10-2014, 11:13 AM   #11
Mehita
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How much does she weigh, Catherine?
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Mom of DS, age 17, dx Crohn's and Celiac Oct 2008
- Remicade, started Nov 2013, added Solumedrol June 2015
- added Methotrexate/Folate March 2016
- Multivitamins, Probiotics, Vit D
- Small bowel resection, Jan 2013
09-10-2014, 03:34 PM   #12
Catherine
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56kg
09-10-2014, 03:38 PM   #13
Chester31
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My son is around 55-56kg and on 100mg Azathioprine at the moment.
09-11-2014, 02:39 PM   #14
alex_chris
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I'm currently on 2mg/kg, taking 125mg daily.

Does anyone else find that Azathioprine makes them nauseas, sensitive to smells and as a result have a loss of appetite?
Those are symptoms that happen to quite a lot of people, but they usually subside - not sure how long you have been on aza now. I have been on it from 2003 to 2008 and again for the last 3 years+ and I only remember having trouble with aza the first few months.

To the OP, 3.5mg is pretty aggressive and can lead to a severe over suppression of the immune system. While azathioprine is generally "safe" to use in much higher dosages than it is used from Crohn's/UC (after all, it was originally used to suppress the immune system severely for organ transplant cases to avoid unwanted immune system reactions), the reason why docs usually do not go over 2.5mg/kg is because you easily get your white blood count below 4.0 this way and that is not what you want.
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09-11-2014, 06:45 PM   #15
Catherine
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Thanks Alex_chris

Her aza levels are low:-

6-TGN 211 (235-450 pmol/8x108 RBCs)
6-MMP 823 (<5,700 pmol8x108 RBCs)
Ratio 4 (<20 (11-20 'borderline')
09-12-2014, 01:54 PM   #16
David
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Thanks Alex_chris

Her aza levels are low:-

6-TGN 211 (235-450 pmol/8x108 RBCs)
6-MMP 823 (<5,700 pmol8x108 RBCs)
Ratio 4 (<20 (11-20 'borderline')
I'm amazed to see levels that low with that high of a dose. Does Sarah by chance drink a lot of milk or consume a lot of dairy products?
09-12-2014, 05:35 PM   #17
Catherine
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She does have milk with breastfast but less that half cup. We have just moved calcium tablet away from aza. Level was take while on 150 mg, now increasing to 200mg.
09-12-2014, 05:39 PM   #18
David
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I doubt it's the calcium tablet as the issue is with the xanthine oxidase in milk but who knows. My guess is it has to do with her genetic makeup and how she metabolizes the azathioprine.
09-12-2014, 05:48 PM   #19
Catherine
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Can't move the milk away from the aza otherwise she wouldn't eat. Moving aza to night time is not option due to problem with tablet taking a night.

We have just added Mesalazine. GI says the studies are split on whether this increasing aza levels.

I also think it just her with the levels, as they have always been low per dosage.
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