Imuran and vomitting

[mrtmeo]

My mom took 50mg 2x's per day imuran for over a week one month ago and didn't have any nausea or vomitting.
She had to stop it due to too much bone marrow suppression.
I tried starting her on 50mg once per day and she threw up 2 hrs after one.
Her dr wants her back on it now that her hemoglobin is up to 11.7.
She took it with food.

Anyone have issues with taking it a 2nd time?

[gilders]

No issues with vomiting with me. Over the last 20 years I've been on imuran for about 14 years in total, on and off. So don't think it's anything to do with imuran.

[me2]

I did not have that problem when I took Imuran but of course we all react differently to different meds.

It sounds like vomiting might be fairly common with Imuran. I found this on a search :

1. 
   
   
   
   
   
2. Imuran Overview - Patient Information: Side Effects. You may experience stomach/intestinal symptoms such as nausea, vomiting, diarrhea, or loss of appetite. If these effects persist or worsen, notify your doctor immediately. These symptoms may be reduced by taking the medication after meals.
   
   
3. Side Effects of Imuran (Azathioprine) Drug Center - RxList
   
   www.rxlist.com/imuran-side-effects-drug-center.htmRxList
   
   
   
   
   
4. 
   
   
   

Hopefully she might do better taking it AFTER food rather than with.

[mrtmeo]

She is much better today, but even after eating food, she wasn't feeling better yesterday.
It only lasted a day, so will hold off on imuran.
She had rtx so, she shouldn't need the imuran until she reaches remission or after 6 months.
She is still in the 3rd month from her first rtx infusion.

[Rose]

I had a similar experience with imuran. I am one of a small percentage of people who cannot metabolize the drug because the enzyme required to do so is missing. There is a blood test available to check for this enzyme and infact some doctors will not put a patient on imuran without doing this test first. Please google for more info. "Imuran blood test" should turn something up
I should also mention that I was taking 100mg daily for 5 weeks with no apparent ill effects when suddenly the vomiting started. The drug was not being metabolized and after 5 weeks my body let me know. I stopped the drug for about 10 days and restarted it thinking maybe it was not that ( as I had been ok for5weeks) but within a few hours the severe vomiting started again.

Prose

[mrtmeo]

I had a similar experience with imuran. I am one of a small percentage of people who cannot metabolize the drug because the enzyme required to do so is missing. There is a blood test available to check for this enzyme and infact some doctors will not put a patient on imuran without doing this test first. Please google for more info. "Imuran blood test" should turn something up
I should also mention that I was taking 100mg daily for 5 weeks with no apparent ill effects when suddenly the vomiting started. The drug was not being metabolized and after 5 weeks my body let me know. I stopped the drug for about 10 days and restarted it thinking maybe it was not that ( as I had been ok for5weeks) but within a few hours the severe vomiting started again.

Prose

It looks like it is the TPMT enzyme.
Thiopurine methyltransferase (TPMT) is the main enzyme responsible for inactivating toxic products of azathioprine (AZA) metabolism.
Should we test TPMT enzyme levels before starting... [Hematology. 2007] - PubMed - NCBI

I have read something about this in the literature, but my mom was never tested for it.
I will ask her dr.

Thanks Prose!

[mrtmeo]

Prose,
What alternative immunosuppressant did u use if u couldn't use imuran?

[Rose]

Because my kidneys had been affected and that I had a bout of drug induced hepatitis , methotrexate was not suitable. The next alternative was cellcept. I started on that in January 2009 and it has done its job very well. It is very expensive and I battled to get the medical insurance to pay at first. After a few months on it generics came on to the market and the insurance insisted that I take them. Luckily the ones that I was prescribed work for me but I do know that all generic cellcept is not the same and some work for some people but that may not work for another. Better to stick with the brand one if possible.

Rose.

[mrtmeo]

Because my kidneys had been affected and that I had a bout of drug induced hepatitis , methotrexate was not suitable. The next alternative was cellcept. I started on that in January 2009 and it has done its job very well. It is very expensive and I battled to get the medical insurance to pay at first. After a few months on it generics came on to the market and the insurance insisted that I take them. Luckily the ones that I was prescribed work for me but I do know that all generic cellcept is not the same and some work for some people but that may not work for another. Better to stick with the brand one if possible.

Rose.

Thank you Rose.
I was considering cellcept but didn't see much success with it.
Thanks for the info on getting the standard brand instead of generic.

[mrtmeo]

Because my kidneys had been affected and that I had a bout of drug induced hepatitis , methotrexate was not suitable. The next alternative was cellcept. I started on that in January 2009 and it has done its job very well. It is very expensive and I battled to get the medical insurance to pay at first. After a few months on it generics came on to the market and the insurance insisted that I take them. Luckily the ones that I was prescribed work for me but I do know that all generic cellcept is not the same and some work for some people but that may not work for another. Better to stick with the brand one if possible.

Rose.

What dose of cellcept were you on?
Did you start off on a low dose and work up?