What are alternatives to azathioprine?

Unfortunately, I've had Aza stopped after only 10 days - ended up at hospital on Saturday (raised temp, vomiting, pain everywhere, bladdy bla). Dr treated me for infection (some sign of urine infection on dipstick test), but also gastritis/oesophagitis due to being on pred for months. I kind of agree with dx, but I so wanted the Aza to work as very keen to get prednisolone dose down (still on 20mgs per day). Dr did say they may restart Aza in a few weeks, but I feel so much better not on it, after only a day, I do wonder if it disagreed with me more 'systemically'. I am really dismayed by all this, and a tad scared as to how they can treat me if I can't tolerate Aza (to stop progression of 'AI cholangiopathy'). Don't worry, as I told the frowning nurse on Sat night, nobody's heard of it!! I've been started on Ranitidine too, for my stomach, so that might help in longer term.

Anyway, just curious really. I do have to see GP for a review tomorrow, so more info then, I hope, but now I'm home I have all these questions. Still feeling quite ropey but so glad to be home and on oral meds. The 10 days on Aza was awful, with nausea mounting by the day. But I'm left with all this prednislone, which I don't like either .....

8 Replies

  • My daughter used to take Aza for her AIH but it affected her white cell count.She is now trying mycophenlare as an alternative. She also has omeprazole due to taking Pred to help combat stomach acid.

    Think there are other alternative too, hope this helps.

  • Hi wichiegirl,

    I also had to stop taking Azathioprine after only a short period and that was because it affected blood cells. Since then I have been on Mycophenolate Mofetil ( 2 grms) daily and that seems to work fine. Some people do have stomach upsets but I understand many UK doctors advise this can be eliminated or reduced if the tablets are taken with or immediately after food despite what the patient information leaflet says. I have usually taken with food and no stomach problems thus far.

    Good luck

  • Brilliant! That's the drug I was thinking of but couldn't recall name. Off to see what Dr Google has to say about it! I had bloods done on Friday and they/white cell count 'weren't too bad' apparently, so it's more the stomach irritation and infection (which will be the same whatever immunosuppressant I am on). Already in a few months I've had shingles and two 'atypical' long bouts of bacterial infection, on steroids, when normally I am quite healthy. Yes, really! It's all a bit of a drag. I just want to feel well and get on with things.

  • There's also Mercaptopurine which people on the AIH forum call 6MP. Also known as Purinethol. Seems many of them take this if they get gastric problems with the aza.

  • I have been on azathioprine for just over two years for AIH. I have always taken mine at bedtime and have been lucky to have no side effects. If your consultant suggests taking it again try at bedtime it might then work for you. Good luck with sorting your mess out.

  • I have taken prednisolone since diagnosis in 1999 with the dose for the majority of that time being 15-20mg. I have finally come down to 12.5mg! I was first put on azathioprine too but reacted badly to that, then mycophenolate and reacted to that. I am now taking prograf/ advagraf also known as tacrolimus. The prograf version is one that is taken twice daily and I believe may be more effective than the advagraf which is a slow releasing one taken once a day. Doses are adjusted to make sure that whichever one you take, you will be taking the right amount and it will be beneficial. Added to the standard AIH blood tests, I also have a 'tacrolimus level' taken to make sure that the dose is right. Hope this helps. Also, if you do not have cirrhosis, an alternative to prednisolone could be budesonide though this may be mainly for AIH...

  • Thanks for further responses. It's really for the AIH part of my condition this treatment is being used, I think, so all this AIH stuff relevant to me. Still haven't looked up drugs as our 'interweb' playing silly buggers, so I'll try again today. It's good to see there are a few option still.

  • Well, at GP's suggestion, I gave Aza another try end of week there, had another bad reaction, and that's it stopped now. GPs aren't convinced it is AZA doing the bother; I am. I was there! Seeing my usual GP this week, and they are getting in touch with specialist about alternatives. A bit fed up ....

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