immune suppressant dosing

[mrtmeo]

I have noticed that my mom has blood in her urine and dumps more protein when at the higher dose of Mofetil 1gm per day versus 750mg per day.
She got sick again after 16 days at 1gm, so had to reduce the dose to 750mg and she has not thrown up, yet.
Her urine dipstick shows no blood and lower protein now.

Has anyone else notice improvement with disease activity at different dosings?

[Pete]

I would expect that in most cases, a higher dosage would lead to decreased symptoms followed by reduced dosage, and so on. I'm wondering if your Mom is having an adverse effect from mofetil.

[mrtmeo]

I would expect that in most cases, a higher dosage would lead to decreased symptoms followed by reduced dosage, and so on. I'm wondering if your Mom is having an adverse effect from mofetil.

I wonder if it is interfering with the rituximab.
I haven't heard of anyone with MPA that took rtx and I don't know of anyone that took a maintenance drug with rtx to induce remission.
She had the same reaction to imuran and I have never read of anyone having this reaction to both.

[Pete]

I was on mtx for about 16 months before I got rtx. I continued mtx through the infusions (Oct '13) and continue on it still. I got rtx to knock down some beginnings of kidney involvement. Kidney problem resolved about 6 weeks after rtx. It's been smooth sailing since.

I haven't researched drug interactions, but yours is an interesting hypothesis. Good luck to your Mom!

[mrtmeo]

I was on mtx for about 16 months before I got rtx. I continued mtx through the infusions (Oct '13) and continue on it still. I got rtx to knock down some beginnings of kidney involvement. Kidney problem resolved about 6 weeks after rtx. It's been smooth sailing since.

I haven't researched drug interactions, but yours is an interesting hypothesis. Good luck to your Mom!

Hi Pete,
Thanks for your experience and am so glad you got your kidney function back.

My mom just had blood work done to get her Epogen shot and she should have needed a shot.
She always gets one every other week, but her hemoglobin was 11.4 this time!
She has not had any working epogen in her blood for a week and I have not given her any extra protein, so either her kidneys are producing more erythropoeitin or she had an internal bleed that stopped.
I couldn't believe it because her nephrologist said she would need the epogen the rest of her life.
The mofetil must be working or the acupuncture she just started is helping.

[mrtmeo]

She got nauseaus last night on this lower dose, so I am lowering it again.
Perhaps, even at 6 months, the Rtx is still working and the Mofetil is too much suppression?
Her nephrologist has not given her any plan on tapering the prednisone and maybe with the 7mg prednisone the immune suppression is too much?