methotrexate and azathioprine

Hi, has anyone been prescribed Azathioprine along with Methotrexate. I've just been to see Rheumy today and he is thinking of possibly introducing a low dose Azathioprine along with my 25mg Methotrexate next visit if I can't stabilise lupus symptoms on less than 10mg Prednisolone which we have been trying unsuccessfully to reduce over the last year. I've not come across this combination before, it has always seemed to be one or the other not both at same time so am interested to know if anyone else has had this combination suggested.

6 Replies

  • Hi Mysti

    It's interesting your Rheumy wants to prescribe an additional immunosuppressive. I was on two for a couple of years, Azathioprine and Mycophenolate!. It did help me reduce the steroids as like you I'd found it so hard!. I was concerned about taking two but was told they were targeting different parts of the immune system and my Rheumy at the time had other patients taking two and said it can work well. Hope that's helpful and good luck with it. X

  • Hi misty14, thank you for your reply, it is very helpful.I'm glad to hear you had success with your combination...did you manage to completely stop prednisolone..I would really like to get off it now if I can but just seem to hit brick wall as soon as try and get below 5mg even at a 1mg drop per is so frustrating at times..I am a little concerned about taking adding to the mix I already take but if it can help control things better I'm willing to give it a try if he thinks it's necessary..xx

  • Hi Mysti

    I completely understand how you feel about taking two immunosuppressives as I felt the same, was scared of the side effects but didn't have a problem and bloods were closely monitored. I didn't come off steroids, was able to reduce them to a lower dose. You should do well as you only need to reduce by 5 mg, would be fab to be off them wouldn't it?.

    Your right to go by your Rheumy's advice as they don't propose these things for nothing!. Ask me anything else you want as it's a big step!. Good luckX

  • I take 150mg of Azathioprine a day and 10mg of Methotrexate once a week. I don't take prednisolone any more. I find this combination has eased the pain I had but I am getting more viruses and infections, had a cough for the last few weeks, keeps me awake at night - very flemmy (sorry), but not as much pain. Its the devil and the deep blue sea!!!!! Gook luck and gentle hugs xx

  • I thought I was able to do without meds for a while as have a high tolerance to pain after years of it and hate taking pills. Big mistake as hydroxychloroquine had served me well and was probably the reason I've been OK for years.

    Ended up with a big flare and now take an increased dose of hydroxychloroquine and Naproxen, which have worked brilliantly and pain manageable. I thought I had got off lightly compared with other people's experiences of medication. I'm now concerned that doctor wants to put me on Azathioprine too. I looked it up on internet (to find out why I needed a blood test first) and it mentioned all sorts of nasties from infection from cuts and skin damage to increased risk of skin cancer. I know these are probably very limited risks but I would rather have some pain than have yet another illness to worry about. Is that a choice we have to face or do we have no choice at all if we want to control SLE?

  • Hi spamula, thank you so much for your helpful reply. Sorry to hear of your lingering problems hope the cough doesn't go on too much longer. The higher risk of infection is a bit of a concern of mine as I seem to have been picking up a lot of bugs n viruses this year anyway which keeps me continually exhausted and struggling in general...I do understand both these meds tackle things from a slightly different angle so appreciate his reasons for wanting to try them together. My rheumy says he finds methotrexate very good for joint pains and I have to agree that mine have improved greatly since increasing it to 25mg. The azathioprine I hope will help sort out everything else.. Take care..xx

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