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Allopurinol & Azathioprine Combo – Who Else is Doing This?

Meet Rachel:

I have had UC for 14 years now. I have had good, remission times and bad flare up times. My disease is located on the left side of my colon and has been diagnosed as mild with a couple of moderate patches.

Some more about Rachel:

I am from the UK and enjoy running, swimming and yoga 3- 4 times a week. I am a total foodie and love trying new cuisines. This is something that has had to take a back seat whilst getting my flare under control :(

Her Current Colitis Symptoms:

1-2 BM per day
loose, bloody stools with mucus
very mild left sided abdominal discomfort
General noisy colon noises!

Allopurinol & Azathioprine Combo – Who Else is Doing This?

I was diagnosed with UC at the tender age of 18. I had a pretty bad five years where I had flare up after flare up but they always seemed to be controlled well by Prednisolone and Asacol.

I had 7 wonderful remission years and then I suffered a miscarriage that brought back the awful symptoms again.

I was again in remission throughout my pregnancy but post-birth I have been having flare ups on/off. I have now been suffering from a flare since March and everything that worked before has stopped :( Even the prednisolone took about three weeks to kick in at a high dose. Anyway I was put on azathioprine (Imuran) and after three and a half months on that, the doctors realised I was not metabolising the drug correctly and so have added a drug called Allopurinol to the mix, which I started taking yesterday. Fingers crossed this treatment will work!

Have you heard of the term “you two were made for each other”?

Well my husband and I truly were

as we both suffer with UC

which we did not know

about each other when we met!

He has not been in complete remission for a while and is currently on Asacol. However his disease is currently limited to the rectum and sigmoid. So we are both aware of each other’s symptoms and the emotional and physical drain of the disease. However e is a little better at dealing with it than me :( My parents are very supportive but you can’t really understand the pain of this disease unless you have it.

I get worried about eventually needing surgery, even though my disease is mostly mild and my symptoms are not too bad even in a flare. I just think that my body seems to reject medication after I had the baby and I am running out of options.

I am still in the process of getting my head around dealing with the disease. I feel that I need to make my mind strong before I can tackle the other issues. But taking one day at a time at the moment and trying to keep my head above the water (even though there are days I feel like drowning!)

Currently on:

Medications History:

Asacol worked wonderfully in the past but is not helping me much now.
Pentasa granules and Colazol mesalamine tried and failed.

Azathioprine 125mg – failed – not metabolising properly and liver was getting close to becoming toxic. however I did notice a reduction in symptoms.

Allopurinol added as of yesterday – this should help me metabolise the Azathioprine correctly and get me in to therapeutic range without making my liver toxic. Hopefully this will work!

written by Rachel S

submitted in the colitis venting area

7 thoughts on “Allopurinol & Azathioprine Combo – Who Else is Doing This?”

  1. Hey Rachel

    Yes Me!

    I was on 100mg of 6MP which is the same as Azathioprine and had severe exhaustion and couldn’t go to work and do a full day.

    Gastroenterologist put me on allopurinol and halved my 6MP dose as allopurinol basically amplifies the Aza/6MP dose by 4 but does it differently so you don’t get as many side effects and it’s kinder to your liver.

    Long story short, i still don’t whether it worked as I couldn’t get off prednisolone and had surgery 6 months later. I did have Pancolitis though.

    Remember thoiopurines (6MP and Asathioprine) can take up to 3 months to fully take effect so I would start the clock from yesterday :)

    All the best

  2. Hi Rachel
    I take azathioprine 50mg (3 tablets a day) but have also become toxic in last 6 months. I have tried aullopulorinol but it makes me very ill, nauseous & fagued out. I have reduced my azathioprine to 2 tablets a day (no longer toxic) but am now experiencing a moderate flare & have been using salofalk enemas & suppositories , have u tried using these? If my symptoms don’t subside I’ll be back taking the dreaded prednisone!! My GI says my other choice is methotrexate, it sounds pretty scary, have u been offered this?
    Linda :)

  3. When was the last time you had full colonoscopy ? To see where the inflammation is and whether it is active ( you mentioned bloody stools, sounds like your colon is still in active stage of inflammation. By result of biopsy, it will tell how much damage or stage of tour disease.

    Don’t feel discouraged, this site is very supportive and you are not alone.

    Prednisone is generally not recommend for long term treatment due to its side effects. Does your GI doc mention about the need for Remicade or hurmia ?

  4. I had my last colonoscopy in June and it showed mild colitis in my descending colon only, with some moderate patches in my sigmoid and toward the top end of my descending colon. That’s when the aza treatment started. Since my post, my flare took a turn for the worse. I got a bad sickness and diaherrea bug and this really amped up the flare. I feel a may have been improving too :( my CRP level went from about 8 to 39 in two days! So lots of bloody stool now :( started course of steroids at 40mg and things are very slowly improving.

    I am very uncertain about biologic teary meant and don’t want to me bullied in to this by my GI just because it’s the next logical step in the medicine ladder. I have my own theory and it’s to do with the fact my UC is very hormone related. Whilst pregnant and on the pill I had a lovely med free remission for 7 years and I feel it’s to do with the high level of oestrogen that both are associated with. It kept my immune system happy all those years. Estrogen is linked closely to cortisol, the stress hormone that plays a part on UC flares.

    My plan is that I control the flare with pred for two months, making sure I keep an eye in the taper. I plan to get pregnant again next year if all is well with the UC and that usually keeps me well. Thereafter i plan to go straight on the contraceptive pill and basically never come off it! Lol!

    If my plan fails, then I think I that point I would be willing to consider biologics.

  5. Hi there. I have had colitis on the left side colon and sigmoid for 24 years. I was diagnosed when 11 years old. I have been on everything you have mentioned and more. Probiotics actually made me worse. And i can not take prednisone any more because it makes me sick. So i was on remicade for a bit but grew antibodies to it. So i am on asacol 400mg per day. Also im on a new medication that focuses on the gut only. Its called Vedolizumab. Its been good for the past year. So im hoping to continue on it. But i totally agree that the colitis reacts to the hormones for women. Almost EVERY time i have my period i get very gassy and some mucous and blood follow for a few days while menstruating. But i go right back to normal again. So of course i went to my OBGYN and asked about my period and went on the pill. But for me because i have endometriosis it didnt stop my periods but made me worse. So now that im 35 and done having children im going in for the histerectomy. Im hoping this will lesson the symptoms and help put me in full remission. But the good news is im down to a 2 for inflammation. Last year at this time i was a 9. Out of 10. So im doing alot better. Colitis is weird and different for everyone. I make notes on what to eat and not to eat. And make sure to lower stress and relax. Im a worry wart so its difficult for me… but it might do wonders for you. Hope you do better. Good luck. Message me anytime.

  6. I think it’s interesting how many women have had their symptoms reduce or go into remission while pregnant. I have noticed around the time of my period, my symptoms improve as well. I have been in this flare since Jan of this yr.. still on pred, can’t get off..incorporated 6mp 2 mo ago…no difference. I can’t wait for my period every month so I get 3 days of “normal”.

  7. I wish I could be pregnant all the time as it was the best I had felt in a long time (apart from the three months of morning sickness in the first trimester!) I know it is just a theory but I know that when it comes to this illness, it is so individual to everyone. I just feel that mine is somehow linked to my female hormones as it is a little coincidental how my flares have been made worse when there has been some sort of big drop in my hormones such as bad period pains, miscarriage an post-birth.

    April – were you on any UC meds whilst pregnant and did it have any effect on your pregnancy?

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