Imuran (azathioprine)

Here's some reading material on the new drug that my Doctor has put me on.  I highlighted a few areas of concern that I have. I have been fighting taking this medication for almost a year now but I just want to be healthy and live a "normal" life like everyone else.  I don't know what the future holds and this isn't the direction that I wanted to go... but I'm trusting that there is a reason for all of this and that everything I am going through has a purpose.

Warnings:

Azathioprine may increase your risk of developing certain types of cancer, especially skin cancer and lymphoma (cancer that begins in the cells that fight infection). If you have had a kidney transplant, there may be a higher risk that you will develop cancer even if you do not take azathioprine. Tell your doctor if you have or have ever had cancer and if you are taking or have ever taken alkylating agents such as chlorambucil (Leukeran), cyclophosphamide (Cytoxan), or melphalan (Alkeran) for cancer. To decrease the risk that you will develop skin cancer, avoid prolonged or unnecessary exposure to sunlight and wear protective clothing, sunglasses, and sunscreen. Tell your doctor immediately if you notice any changes in your skin or any lumps or masses anywhere in your body.

Some teenage and young adult males who took azathioprine alone or with another medication called a tumor necrosis factor (TNF) blocker to treat Crohn's disease (a condition in which the body attacks the lining of the digestive tract causing pain, diarrhea, weight loss, and fever) or ulcerative colitis (condition in which sores develop in the intestines causing pain and diarrhea) developed hepatosplenic T-cell lymphoma (HSTCL). HSTCL is a very serious type of cancer that often causes death within a short period of time. Azathioprine has not been approved by the Food and Drug Administration (FDA) for the treatment of Crohn's disease or ulcerative colitis, but doctors may sometimes prescribe azathioprine to treat these conditions. If you develop any of these symptoms during your treatment, call your doctor immediately: stomach pain; fever; unexplained weight loss; night sweats or easy bruising or bleeding.

Azathioprine can cause a decrease in the number of blood cells in your bone marrow, which may cause serious or life-threatening infections. The risk that the number of blood cells that you have will decrease is highest if you have a genetic (inherited) risk factor. Your doctor may order a test to see if you have this risk factor before or during your treatment. Taking certain medications may also increase the risk that your blood cells will decrease, so tell your doctor if you are taking any of the following: angiotensin converting enzyme (ACE) inhibitors such as benazepril (Lotensin), captopril, enalapril (Vasotec), fosinopril, lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), Ramipril (Altace), or trandolapril (Mavik); trimethoprim and sulfamethoxazole (Bactrim, Septra); and ribavirin (Copegus, Rebetol, Virazole). If you experience any of the following symptoms, call your doctor immediately: unusual bleeding or bruising; excessive tiredness; pale skin; headache; confusion; dizziness; fast heartbeat; difficulty sleeping; weakness; shortness of breath; and sore throat, fever, chills, and other signs of infection. Your doctor will order tests before, during, and after your treatment to see if your blood cells are affected by this medication.

 What special precautions should I follow?

Before taking azathioprine,

• tell your doctor and pharmacist if you are allergic to azathioprine, any other medications, or any of the ingredients in azathioprine tablets. Ask your doctor or pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention the medications mentioned in the IMPORTANT WARNING section and any of the following: allopurinol (Zyloprim); aminosalicylates such as mesalamine (Apriso, Asacol, Pentasa, others), olsalazine (Dipentum), and sulfasalazine (Azulfidine); and anticoagulants ('blood thinners') such as warfarin (Coumadin). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have any type of infection, or if you have or have ever had kidney disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. You should use birth control to be sure you or your partner will not become pregnant while you are taking this medication. Call your doctor if you or your partner become pregnant while you are taking azathioprine. Azathioprine may harm the fetus.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking azathioprine.
• do not have any vaccinations during or after your treatment without talking to your doctor.
 

What side effects can this medication cause?

Azathioprine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea
• vomiting
• diarrhea

Some side effects can be serious. If you experience any of the following symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately.

• rash
• fever
• weakness
• muscle pain

Azathioprine or 6‐mercaptopurine for maintenance of remission in Crohn's disease

 

Azathioprine (1.0 to 2.5 mg/kg/day) used among patients with non‐active Crohn's disease is effective for reducing the risk of disease recurrence over a 6 month to 2 year period. Higher doses of azathioprine (2.5 mg/kg/day) are more effective than lower doses (1.0 or 2.0 mg/kg/day) for preventing disease recurrence. There is also evidence that azathioprine may reduce the need for steroid treatment which could help reduce steroid related side effects.  Azathioprine appears to be more effective than 6‐mercaptopurine but this may be due to the relatively low dose of 6‐mercaptopurine (50 mg/day) used in the one study assessing this drug.  The long‐term effectiveness of azathioprine and 6‐mercaptopurine is unclear due to the short duration of the studies (6 months to 2 years). Azathioprine and 6‐mercaptopurine appear to be slow acting drugs. They are associated with some uncommon but serious side effects. These include suppression of the body's ability to produce white blood cells (which fight infection) and platelets (which allow blood clotting to occur), inflammation of the pancreas and an increased risk of lymphoma. Patients who may benefit from this therapy include those whose Crohn's disease is chronically active or flares frequently. Azathioprine or 6‐mercaptopurine may also benefit patients who are dependent on steroids but have experienced steroid side effects, or for whom steroids no longer work. The choice to use azathioprine or 6‐mercaptopurine should be made after careful consideration of the risks and benefits of using these drugs.

Has It Already Been a Year?!?!

It's crazy to think that it's been over a year since my last post!!!  There are SO many changes in my life since my last post that I'll try and sum it up as quickly as possible so I can move on to life as I know it today... there still so much going on!

2011

* Had setons removed because my body seemed to be healing.
* Aug 15th, I was admitted to the hospital for yet another abscess drainage and spent my mother's birthday having surgery.  As a result, we stopped the Humira injections because they were obviously not working to stop the fistulas and abscesses.
* Returned to the hospital again on October 25th and spent my sister's birthday having surgery for ANOTHER fistula and abscess drainage.
* Less than a month later on November 16th, I was back for my 3rd surgery in 4 months and my fourth for 2011... and again for the same reasons.

I returned back to work after each surgery as soon as I thought I could... but definitely didn't take the time that I should have.  Call it being stubborn, a Taurus, my mother's child... I am all of the aforementioned. I mostly did it because I felt like I was a burden to my co-workers.  My body was exhausted and was not getting enough time to heal in between attacks even without returning to work. It was a ROUGH and EMOTIONAL time for me!!!

My husband, doctors, and I decided that we should give the Humira another try but decided that this time we would change my injections to once a week instead of two injections every two weeks.  Same amount of medication but more frequent injections.

2012

* January/February - Said "See you later" to some of my best friends from work due to position eliminations, retirements, and new jobs.  The hubby also moved 3 hours away from me to take a new job.
* March - Humira seemed to stop working as well again.  By the end of the month I was having full blown reactions to the injections (it looked as if baseballs were trying to come out of my skin!!!).  That was the end of my Humira injections.
* April - Started the month off right by taking a week off to spend up north with my husband, celebrating our 3rd wedding anniversary and 14 years of being together.  Much needed!!! The day before I returned to work we started the loading doses for Remicade and I started packing to move out of our apartment to parts unknown.  By the end of the month it was clear that I needed to focus on myself and be close to my husband.  The day that I decided to give my notice, I was actually called into the office to be told that my position was eliminated.  That night I turned in my keys to our apartment and closed the chapter of our lives in Vancouver.
* May - Moved 3 hours away from my family to join my husband in the 2 family home he was renting with his brother and his family but returning every few weeks for my iron infusions and Remicade doses.
* June - Was blessed with the birth of a new nephew but also lost my grandmother to cancer.  Her passing was one of the hardest things that I have ever had to endure... even through my Crohn's battles.  My grandfather told me at her graveside service that she left me all of her strength to help me get through this and trust me, when I am down, I remember those words!!!
* July - Enjoying life but my health is not getting better.  Spent most of the month in A LOT of pain.  Finished my loading doses for the Remicade but already not seeing the results that we'd hoped for.

And here we are all the way to August...  I welcomed another nephew, this one from my own sister :)  Also, visited my GI doctor who agreed that our results are not what she'd hoped for as well and would like to run tests to see if I have enough Remicade running through my system.  She also started me on another medication called Imuran along with the Remicade to see if we can hit this harder.  I took my first dose tonight... but that's a whole other post that I'll have to save for tomorrow :)