Azathioprine (Imuran vs.Methotreate (Rheumatrex,Trexal

**Red** · 05-07-2011, 02:41 AM

Just seen my rumy blood work good urine blood neg protein neg. one more iv cytox monday mabe more he say eye flair any thoughts dr says he will start me on Methotrexate or Azathioprine.

**Red** · 05-09-2011, 01:29 AM

Anybody have any thoughts on what drug better or not ?

**Jack** · 05-09-2011, 02:30 AM

Azathioprine worked for me (eventually) with no side effects that I noticed, but that was 20 years ago and I don't think there were any alternatives then as a first step down from CTX. For me the Aza was a stepping stone on the way down to Neoral, a drug you don't seem to hear much about these days. Perhaps because it did not work too well!

**marta** · 05-09-2011, 04:08 AM

I have the same question as Red, my rheumy gave me a homework assignment: read up on both and decide which one I think would be better for me, so I'm looking forward to hearing some feedback. I haven't heard too much negatives about AZA but have heard of yucky side effects with MTX - everyone on it seems to get a kick in the but a day or two after taking it, and the stomach issues with it (I'm a total 'stomach issue' whimp - I'll take ten head colds over a stomach flue any day). What do you mean by 'eventually' Jack? Did you have problems when you first started taking it?

**pberggren1** · 05-09-2011, 05:25 AM

I have decided on Imuran this time as a maintenance drug. I was on mtx 2 times before and we are not certain that it had anything to do with the hearing loss but I suspect it did considering how the loss went it is ototoxic as well. And I have flared twice while on Cellcept. I have been on Imuran before as well and tolerated it quite well.

**Jack** · 05-09-2011, 06:42 AM

Due to relapses, I went back onto ctx a couple of times before the aza seemed to be capable of holding the Wegener's back. I then did the aza to Neoral shuffle a few times until I was used in a trial for Mycophenolate which worked a treat.

**Sangye** · 05-09-2011, 08:16 AM

I was only on mtx for 2-3 months before I got the allergic reaction to it (pneumonitis) and had to stop. I was on 25mg injections and didn't notice any side effects at all.

**drz** · 05-09-2011, 10:32 AM

Originally Posted by Red

Anybody have any thoughts on what drug better or not ?

It might depend upon your general health issues and history. I had been on RTX, CTX IVs, and oral Cytoxan before my doctor recommended switching to azathioprine since CTX kept knocking down my WBC real low and it didn't seem to be holding the WGs back anymore anyway. You need a lab test that takes awhile to be sure it is safe for you to take azathioprine so be sure to get that first. If you are lacking or low in a certain enzyme Imuran is not an option.

**Chris G** · 05-09-2011, 10:54 AM

I've been on mtx for 6 months. At 20mg oral, I had no side effects at all. When I was increased to 25mg oral, then 30mg, then 30mg injectible, I began to have "mental" side effects the day after - horrible trouble concentrating, felt drunk, like someone had slipped me some narcotics, also feel very restless, and I get headaches. I'm still on it, but now at a slightly lower dose - 25mg injectible. The day after is still no picnic, but it's manageable for now. I'm not sure what doses they use for remission maintenance, but 20mg was really no problem for me at all.

I've tried aza briefly, and apparently I lack the enzyme necessary to break it down (my levels were 14 - in the "ambiguous" range), or maybe my stomach just didn't like it, as I had VERY undesirable side effects - no nice way to put this.......horrible, painful, embarrassing GAS

Do some people take Cellcept as a maintenance drug? How does that work for those that do???