- Location
- Northern California, USA
This is information I have posted in the past on another forum regarding 6-MP. It may be helpful for those with children on or starting 6-mp or Azathioprine (AZA) or Imuran or Purinethol - all are different formulations of the same basic drug.
Patricia
6-MP: Good Things to Know
Compiled from directions received from physicians and supplemented with information from various medical and drug websites for personal use in managing dosing/administration of 6-MP for treatment of my child’s Crohn’s illness. As always, this is not a substitute for medical advice and you should follow your doctors directions.
This med has a long list of drug interactions and you should use a drug interaction checker to double check this, especially if your child is having elevated liver enzymes. Among the listed common drug interactions are the 5-ASA meds commonly used to treat Crohn’s and UC (Mesalamine formulations like Pentasa, Asacol, Rowasa, Lialda)
For those with Lactose allergy/intolerance note that this med contains Lactose
Adminstration (ideal):
Same time each day
On empty stomach 1 hour before meal or 2 hours after meal
May be taken with food if needed to avoid nausea;
May be given at bedtime to reduce mild nausea
Do not give with milk or milk based products
(there’s an enzyme in milk products that breaks down 6-MP)
Missed dose: give within 12 hours otherwise wait for next regular dose
If the child vomits after taking it:
If it is within 15 minutes give a second dose
If it is more than 15 minutes wait for next regular dose
Call doctor and report:
Vomiting
Rashes
Unusual bruising
Chicken pox exposure
Call the doctor for fevers:
If 101.5 or higher once within 12 hours
If 100.5 twice within 12 hours
Side effects may include nausea, hair loss, rashes, low blood counts, liver damage, pancreatitis
Handling Precautions
Women of child-bearing age/pregnant should take precautions when handling this medication. At the minimum, wash your hands thoroughly following direct contact with the medication. Ideally, use gloves when handling the medication or have another person dispense it. Avoid exposure as much as possible. For example, do not crush the medication without taking precautions to prevent breathing in airborne particles.
Monitoring (labs)
Expert recommendation (Dubinsky) regarding how often to monitor for low blood counts with CBC w/diff:
every 2 weeks x 2 then
every 4 weeks x 3 then
every 8 weeks x 4 then
every 3 months
Dubinsky recommends following the same schedule for liver panel (ALT, ALP, AST, Billirubin, Albumin, Total protein and possibly GGT); others check liver function less frequently once dose titration is finished but most watch liver function closely during dose titration.
Theraputic/toxic ranges of prometheus values for 6-TGN (therapeutic metabolite) and 6-MMP (potentially toxic metabolite) are generally quoted as:
6-TGN below therapeutic range <235
optimal range of 235 to 450
toxic range >450
6-MMP below 6000 generally believed to be OK
above 6000 generally viewed as potentially toxic levels
Not all doctors agree that Prometheus metabolite testing is needed and not all insurance companies approve this testing.
Allopurinol:
Some doctors use allopurinol in combination with Imuran to boost 6-TGN levels without stressing the liver. It is one strategy used when regular dosing causes elevated liver enzymes even though therapeutic levels of 6-MP have not been reached.
Allopurinol blocks one of the pathways for inactivation of 6-TGN thus increasing the amount of circulating 6-TGN. When used in combination with Allopurinol, the Imuran dose must be reduced to 1/3 to 1/4 of usual prescribed levels.
Milk Thistle (natural herb not to be confused with milk from cows):
There is mixed research evidence showing that Milk Thistle reduces elevated liver enzymes in a variety of clinical populations. In the only pediatric research that has been reported, pediatric cancer patients receiving 6-MP as part of their chemo regimen had significantly lower levels of AST and trends toward lower ALT and Bilirubin after 56 days of treatment with Milk Thistle. There is lots of anectdotal reports of Crohn’s patients finding this successful. So you may want to talk to your doctor about using this supplement.
Patricia
6-MP: Good Things to Know
Compiled from directions received from physicians and supplemented with information from various medical and drug websites for personal use in managing dosing/administration of 6-MP for treatment of my child’s Crohn’s illness. As always, this is not a substitute for medical advice and you should follow your doctors directions.
This med has a long list of drug interactions and you should use a drug interaction checker to double check this, especially if your child is having elevated liver enzymes. Among the listed common drug interactions are the 5-ASA meds commonly used to treat Crohn’s and UC (Mesalamine formulations like Pentasa, Asacol, Rowasa, Lialda)
For those with Lactose allergy/intolerance note that this med contains Lactose
Adminstration (ideal):
Same time each day
On empty stomach 1 hour before meal or 2 hours after meal
May be taken with food if needed to avoid nausea;
May be given at bedtime to reduce mild nausea
Do not give with milk or milk based products
(there’s an enzyme in milk products that breaks down 6-MP)
Missed dose: give within 12 hours otherwise wait for next regular dose
If the child vomits after taking it:
If it is within 15 minutes give a second dose
If it is more than 15 minutes wait for next regular dose
Call doctor and report:
Vomiting
Rashes
Unusual bruising
Chicken pox exposure
Call the doctor for fevers:
If 101.5 or higher once within 12 hours
If 100.5 twice within 12 hours
Side effects may include nausea, hair loss, rashes, low blood counts, liver damage, pancreatitis
Handling Precautions
Women of child-bearing age/pregnant should take precautions when handling this medication. At the minimum, wash your hands thoroughly following direct contact with the medication. Ideally, use gloves when handling the medication or have another person dispense it. Avoid exposure as much as possible. For example, do not crush the medication without taking precautions to prevent breathing in airborne particles.
Monitoring (labs)
Expert recommendation (Dubinsky) regarding how often to monitor for low blood counts with CBC w/diff:
every 2 weeks x 2 then
every 4 weeks x 3 then
every 8 weeks x 4 then
every 3 months
Dubinsky recommends following the same schedule for liver panel (ALT, ALP, AST, Billirubin, Albumin, Total protein and possibly GGT); others check liver function less frequently once dose titration is finished but most watch liver function closely during dose titration.
Theraputic/toxic ranges of prometheus values for 6-TGN (therapeutic metabolite) and 6-MMP (potentially toxic metabolite) are generally quoted as:
6-TGN below therapeutic range <235
optimal range of 235 to 450
toxic range >450
6-MMP below 6000 generally believed to be OK
above 6000 generally viewed as potentially toxic levels
Not all doctors agree that Prometheus metabolite testing is needed and not all insurance companies approve this testing.
Allopurinol:
Some doctors use allopurinol in combination with Imuran to boost 6-TGN levels without stressing the liver. It is one strategy used when regular dosing causes elevated liver enzymes even though therapeutic levels of 6-MP have not been reached.
Allopurinol blocks one of the pathways for inactivation of 6-TGN thus increasing the amount of circulating 6-TGN. When used in combination with Allopurinol, the Imuran dose must be reduced to 1/3 to 1/4 of usual prescribed levels.
Milk Thistle (natural herb not to be confused with milk from cows):
There is mixed research evidence showing that Milk Thistle reduces elevated liver enzymes in a variety of clinical populations. In the only pediatric research that has been reported, pediatric cancer patients receiving 6-MP as part of their chemo regimen had significantly lower levels of AST and trends toward lower ALT and Bilirubin after 56 days of treatment with Milk Thistle. There is lots of anectdotal reports of Crohn’s patients finding this successful. So you may want to talk to your doctor about using this supplement.
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