Tapering Cytoxan

[drz]

drz - How long have you been doing the low dose Imuran and has it kept the WG in-check?

I only did that till test results on enzyme came back and they said it was OK to increase it. I went up slowly to 150 and stayed there awhile. They increased it to 200 when i had a flare in March and that is my current dosage. However, my liver enzymes have tripled so they may need to change something again if tests next week are too high. I did cut back on pravastatin to lower cholesterol since that also loads on the liver and the azathioprine is considered more important right now for my over all health.

[pberggren1]

I make the switch next week from 75mg of ctx to 150mg of Aza. I have been on the ctx for 3 months now. All my blood work has been looking good for the past 4 or 5 weeks. My doc says it is better to start out at higher dose of Aza than a lower one because it usually results in a better remission in the end. He based the dose on 2mg per kg of body weight.

[Jules]

Daggar, I now have a vision of a room full of Weggies doing yoga, assuming the 'Pretzel' position!!! I think you've found a niche in the market!

Phil, my Rhumy advised me that 2mg per kg was how the calculation is made too . . . in my case he is either lousy at maths (but I won't hold it against him as 100mg works in my favour!!) or he is taking the gentle approach with a view to upping it if necessary.

[NicShaf]

No taper, either. I've never heard of tapering ctx. It doesn't really make sense, as it's not therapeutic below a certain dose.

Does anyone know what level the Ctx stops being therapeutic? My Rheumy switched me from 150mg Ctx to 100mg Ctx daily last week. I'm just a little worried about it since it sounds like it isn't the normal course of treatment? I don't really feel any different, and I go in for blood work this weekend. Hopefully everything is still on the up and up.

[pberggren1]

Nicole, how long have you been on ctx and that dose of 150mg? Did your doc say why to drop to 100mg?

[NicShaf]

I've been at 150mg for 6 months. My lungs have healed, and all my Wegs symptoms have pretty much gone, so he told me I could reduce my Ctx to 100mg until I see him again in 4 weeks at which time we will start looking at maintainence meds...I think we're going with Mxt.
My fear is that if I did all this work for 6months,and I drop my Ctx it willl stop treating me the way it has been and I'll have a flare.

[Psyborg]

You should be fine. I was on CTX for 3-4 months and dropped immediately to MTX which is considerably milder stuff. You will feel signficantly better as well. I'm no Dr of course

[pberggren1]

6 months sounds too long to be on ctx. I would be pressing to switch to another like aza or mtx or cellcept right away. How much pred are you on Nicole? My doc only likes to keep patients on ctx for no longer that 3 months. He only goes longer if it is absolutely neccessary. Do you see a Wegs specialist Nicole?

[Sangye]

Phil, 6 months is the usual length of ctx treatment. Some people can get off of it in 3 months but that's pretty short considering it takes 4 weeks to start working. Longer than 6 months becomes more controversial.

Nicole, I think what your doctor is doing sounds reasonable. The 100mg would not be enough to get highly active Wegs under control (unless you weighed very little and that was the right dose for you). But a subtherapeutic dose of ctx is probably about the same strength as the milder drugs. It sounds like he's testing the water to make sure you will tolerate a switch to a milder drug. In the waiting period of 4 weeks, he could increase the ctx dosage if you started having trouble. That would be faster and more effective than being caught out on a milder drug.

For what it's worth, I was tapered down on ctx while transitioning to mtx.

[drz]

My dosage was adjusted downward several times due to my low WBC from CTX. It seemed to stopped working for me at around 50 MG and I was then switched to azathioprine and this was gradually increased up to 150 mg and then up to 200 when I flared about three months ago.