Imuran

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Olivia-Micro-Colitis
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Imuran

Post by Olivia-Micro-Colitis »

so I had another apt with my GI this past friday. he told me that i stil ldon't seem to be responding to any meds...So he wants me to continue with Entocort for 4 more weeks then he wants to do ANOTHER colonoscopy! GRR! He also wants to start me on Imuran. I'm a lil worried once i looked up the side affects. has anyone else taken this? if so what was your symptoms while on it and did it help you? Thanks guys!
-Olivia
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Joefnh
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Post by Joefnh »

Hey Olivia My GI has mentioned the same with me as an option because of both the my combination of MC and Crohns disease. If the combo of the diet and Entocort do not work he wants to look at that possibility. Like you I am not sure.

The doc is also talking about another colonoscopy and endoscope late in the summer.

I do have 2 friends at work with Crohns who have been on Immuran for several years with no issues seen.

Overall i really want to manage this without the need for heavy duty meds. Natural is always better; but if best efforts of natural fail I am not sure what to do. For the moment I am following the strict GF/YF/LF/DF diet that Gabes had posted and it does seem to help.

So how have you been Olivia and how was your walk.

--Joe
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Gloria
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Post by Gloria »

Hi Olivia,

I believe that Pat was on Imuran for a while. Also another member who doesn't post anymore, Moosely Immune. If you do a search for Imuran using the search (option below the heading of this page), you'll see the threads discussing it.

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tex
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Post by tex »

Imuran works by slowly shutting down the immune system, (which, IMO, is definitely not a good thing for someone so young). It was developed to prevent the rejection of organ transplants, so it has to have powerful effects, in order to accomplish that. Those "Big-Gun" drugs should only be considered as a last-resort option, for someone with MC, IMO.

Pat took Imuran for over a year, I believe, without success.

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It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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Post by Pat »

Yes, I took Imuran. It didn't work. I also was taking Entocort and that helped some, but only some. I have not been posting much because I have been wedding planning. Our daughter was married on June 12. It was beautiful but wow the details that went into that! I am still undoing and finishing up newspaper articles etc. I do believe diet is the key - its just finding what you need to eliminate. And don't take antibiotics unless tested and positive for infection! It took 3 years for me to "get over" the antibiotics even with probiotics.

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Post by Gabes-Apg »

Olivia
i cant help re the imuran, i am keen to hear how you are? has the bleeding in the BM stopped? are you able to eat without too much D?
Gabes Ryan

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Post by Polly »

Good Morning!

I'll weigh in with those who say not to jump to Imuran until every other avenue has been exhausted. Remember, it takes lots of time to undo the gut damage we have. With Entocort it may take minimally 6-12 months to go into remission, and with diet even longer - I believe it took CA Mary about 15 months to see results from the GF diet (it took me 9 months). Of course, the more food intolerances one has, the longer it may take to figure them all out and eliminate them. Even with Entocort and diet together, it may take at least 6 months to see results. Of course, some see results much more quickly, but many do not.

Patience is the name of the game with MC. I know how difficult it is to be patient - with a symptom like constant diarrhea, we want it to be gone yesterday. As Tex said, Imuran is a "big gun" and should only be used as a last resort.

Love,

Polly, who isn't shy about putting in her 2 cents worth on this issue!
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Post by adelie »

For Polly, Tex and others that are much more experienced than I...

Is there an "intermediate gun" between Entocort/diet and the "big guns" like Imuran? The doctors seem to pick options that undertreat or overtreat, so I'm wondering if there's something in the middle to try that I don't know about.

Thanks,
Karen
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Post by tex »

Karen,

There is really nothing in between, that I'm aware of. Entocort is considered by many GI docs to be a potent drug, the rough equivalent of prednisone. It's usually considered to be a big step above the "starting drugs", such as the 5-ASA drugs, (Asacol, Pentasa, Lialda, Colazal, etc.). As you are aware, the corticosteroids are considered to be mild to moderate immune system suppressants, (when used on a long-term basis), the way that azathioprine, (Imuran, Azasan), is normally used, though they are certainly not as potent as azathioprine, for immune system suppression.

The active ingredient in Entocort EC, budesonide, is a true corticosteroid, and it is capable of the same side effects, and the same long-term risks, as prednisone, when delivered the way that prednisone is normally delivered. The enteric encapsulation provided with Entocort EC, prevents the budesonide from being aggressively absorption into the bloodstream, thus significantly limiting it's risks of causing side effects similar to prednisone. If prednisone were delivered the same way, (with an enteric coating), it would probably show absorption dynamics very similar to the budesonide in Entocort EC. IOW, it's the encapsulation provided by Entocort EC that makes budesonide a superior product. Without the encapsulation, budesonide is just another corticosteroid.

The anti-TNF drugs are another option, but these are a step above azathioprine, IMO, though they are being prescribed more and more to treat the IBDs. They are also dedicated immune system suppressants. One of the problems with the anti-TNF drugs, of course, is their risk of causing serious side effects, (including carcinogenic events).

The corticosteroids, (including Entocort EC), are not connected with any carcinogenic events, as far as I can determine. On the other hand, Wikipedia has this to say about azathioprine, (Imuran):
Azathioprine is however a particularly dangerous drug, with great potential for inviting a host of potentially fatal infections, and is also listed by the FDA as a human carcinogen.
This risk appears to apply to any of the more powerful immune system suppressants. If you do a search of adverse events connected with the anti-TNF drugs, it becomes pretty clear that any of the powerful immune system suppressants carry a significant risk of very serious, (deadly), adverse consequences.

That leads me to believe that Entocort EC is the most powerful "safe" drug available, for treating MC, and the other IBDs. I could be wrong, but IMO, Imuran is probably a riskier drug than most of the anti-TNF drugs, even though it is probably not as effective, in most cases.

At least that's the way I see it.

Tex
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It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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Post by tex »

Karen,

There is really nothing in between, that I'm aware of. Entocort is considered by many GI docs to be a potent drug, the rough equivalent of prednisone. It's usually considered to be a big step above the "starting drugs", such as the 5-ASA drugs, (Asacol, Pentasa, Lialda, Colazal, etc.). As you are aware, the corticosteroids are considered to be mild to moderate immune system suppressants, (when used on a long-term basis), the way that azathioprine, (Imuran, Azasan), is normally used, though they are certainly not as potent as azathioprine, for immune system suppression.

The active ingredient in Entocort EC, budesonide, is a true corticosteroid, and it is capable of the same side effects, and the same long-term risks, as prednisone, when delivered the way that prednisone is normally delivered. The enteric encapsulation provided with Entocort EC, prevents the budesonide from being aggressively absorption into the bloodstream, thus significantly limiting it's risks of causing side effects similar to prednisone. If prednisone were delivered the same way, (with an enteric coating), it would probably show absorption dynamics very similar to the budesonide in Entocort EC. IOW, it's the encapsulation provided by Entocort EC that makes budesonide a superior product. Without the encapsulation, budesonide is just another corticosteroid.

The anti-TNF drugs are another option, but these are a step above azathioprine, IMO, though they are being prescribed more and more to treat the IBDs. They are also dedicated immune system suppressants. One of the problems with the anti-TNF drugs, of course, is their risk of causing carcinogenic side effects

The corticosteroids, (including Entocort EC), are not connected with any carcinogenic events, as far as I can determine. On the other hand, Wikipedia has this to say about azathioprine, (Imuran):
Azathioprine is however a particularly dangerous drug, with great potential for inviting a host of potentially fatal infections, and is also listed by the FDA as a human carcinogen.
This risk appears to apply to any of the more powerful immune system suppressants. If you do a search of adverse events connected with the anti-TNF drugs, it becomes pretty clear that any of the powerful immune system suppressants carry a high risk of very serious, (deadly), adverse reactions.

That leads me to believe that Entocort EC is the most powerful "safe" drug available, for treating MC, and the other IBDs. I could be wrong, but IMO, Imuran is probably a riskier drug than most of the anti-TNF drugs, even though it is probably not as effective, in most cases.

At least that's the way I see it.

Tex
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It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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Post by Gloria »

Tex wrote:it's the encapsulation provided by Entocort EC that makes budesonide a superior product. Without the encapsulation, budesonide is just another corticosteroid.
This makes me wonder about the budesonide that others are purchasing from Canada and other countries overseas. I assume that they are encapsulated, too?

Also, a while back you mentioned that the patent on Entocort expires next year, but a generic version may not be encapsulated. In that case, the non-insured would still have to purchase it outside of the country.

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tex
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Post by tex »

I think that both your observations are correct.

Ant should be able to confirm or deny the encapsulation situation with the imported Budez CR. I would assume that the CR stands for controlled release. Of course, In House Pharmacy sells genuine Entocort EC, supposedly manufactured by AstraZeneca

Tex
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It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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Post by Stanz »

Olivia,

Don't take Imuran, listen to what Polly said. I know you're in a hurry, but IMO you're already treading on dangerous waters with Entocort.
Resolved MC symptoms successfully w/L-Glutamine, Probiotics and Vitamins, GF since 8/'09. DX w/MC 10/'09.
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Post by Gloria »

Stanz wrote:IMO you're already treading on dangerous waters with Entocort.
Oooh, I hate to read that statement. There are a lot of people here who would disagree with you and would have a pretty miserable life without Entocort. I don't know of any study that has shown Entocort to be dangerous. I believe it has a pretty good track record. All drugs have their side effects and warnings and will not agree with some people (including L-Glutamine), but that's not a reason to completely write them off.

You're entitled to your opinion of course, but there have been many on this board, including myself, who have taken it for years without a problem. That said, I probably would be more hesitant if I were younger and of a child-bearing age.

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Post by Gloria »

Olivia,

Your doctor should give you a reason for the colonoscopy, if you've had one recently. My GI wants me to have another one, too, but before I consent to one, I'm insisting that he tell me why and how it will change his treatment (which has only been to suggest Pepto-Bismol or Entocort).

You probably know more about your MC than he does. He's probably guessing.

Entocort should begin working for you soon. I know that it gets discouraging when you don't see much progress, but as Polly said, be patient. Diet is truly the key and it should be strictly followed along with Entocort...no cheating allowed. :smile: I had to wait three months this time to see an improvement in my BMs, even while following a very strict diet and taking 9 mg. Entocort a day. I've never had to wait that long before (four weeks was the longest), but I think my colon was very damaged from doing the chicken-rice elimination diet. Unbeknownst to me at the time, I am intolerant to chicken.

Gloria
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