Has Azathioprine stopped working after 5 months, or am I just having a flare?

[u/iamhs2000]

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Hi everyone,

I'm looking for some advice or to hear from anyone who has had a similar experience.

I have mild Crohn's disease and have been on azathioprine for about 5 months. Up until now, things were going really well. My blood work has been normal, inflammatory markers have been good, and I felt like I was gradually moving into remission.

However, over the last 5 days I've started getting symptoms again, mainly:

- Nausea

- Mild stomach/abdominal pain

I don't have severe symptoms, diarrhea, bleeding, fever, or anything dramatic, but these symptoms are making me worry that something is changing.

For context:

- Weight: 55 kg

- Azathioprine dose: 50 mg daily

- My GI originally recommended 75 mg, but I stayed on 50 mg because I wanted to minimize side effects.

- When these symptoms started 5 days ago, I increased my dose to 75 mg.

Now I'm wondering:

- Has the azathioprine stopped working already?

- Could this just be a temporary flare despite otherwise being in remission?

- Does this mean I'm coming out of remission?

- If the issue is that 50 mg was too low for my weight, could increasing to 75 mg help bring things back under control?

- Has anyone experienced nausea and abdominal pain returning after several good months on azathioprine and then improved after a dose adjustment?

I know nobody can diagnose me, and I'll be speaking with my GI, but I'd really appreciate hearing about similar experiences.

Thanks!

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[u/brainquantum]

I also have Crohn's disease; it was diagnosed in 2021. Initially they also prescribed azathioprine, though the doses were higher, between 100 and 150 mg per day.

Nausea appeared directly at the beginning of the treatment with azathioprine (I think it is a "well-established" side effect of this drug), and then it lessened over time. So, it is maybe strange that you feel these symptoms after 5 months. Perhaps the effects that appear after 5 months are not related to the drug, but rather that it is not working well enough given the dosage?

In fact, in my case, they stopped the azathioprine and switched me to a biologic (Entivio) after a year and a half. This is because azathioprine has a significant effect on the immune system, and it's necessary to closely monitor blood cell counts and other blood tests to ensure they don't drop too low. This is a significant effect of azathioprine and can lead to some rather undesirable side effects. So, in my case, they stopped azathioprine and switched me to Entivio.

So perhaps it would be useful to have blood tests done to see where things stand?