Medication du jour - Imuran

I take 1 - 50mg tablet of Imuran 1xday. It's not nearly as cumbersome as the Pentasa. Small pill about like taking an asprin. The fact I only have to take it once a day is very nice. I do have to go once a quarter for them to check my liver enzymes - just bloodwork, to make sure my body isn't doing something crazy on this medicine.

Here's some more details from GI Health

All About Imuran (azothioprine)
Many patients are not as well informed about prescription medications as they ought to be. We believe the more you know about your medications, the better. This article has been written to help you understand more about what Imuran is and the importance of taking it properly. If any of the information causes you special concern or if you want additional information about your medicine and its use, check with your doctor or pharmacist.

If any of the information in this article causes you special concern or if you want additional information about your medicine and its use, check with your doctor or pharmacist.

Remember to keep all prescription drugs out of reach and sight of children when not in use. Store Imuran in the original labeled container in a cool dry place. Protect from light. Always read the label before using.

What is Imuran?
Introduced in 1968, Imuran is a powerful drug that weakens the immune system. It is often used to prevent rejection of kidney transplants. It is also used to treat severe cases of rheumatoid arthritis, systemic lupus, polymyositis, Crohn's disease, ulcerative colitis, and other "autoimmune" disorders. Its use is usually confined to patients who have failed to respond adequately to simpler treatment.

The generic name of Imuran is azothioprine (ay za THYE oh preen). Each tablet contains 50 milligrams and is easily broken in half when dosage adjustments are needed. Imuran, itself, does not act against IBD. After being absorbed by the intestines, it is changed in the liver to a chemical called 6-mercaptopurine, or 6-MP. This form of the drug is also available by prescription and sold as Purinethol.

What Imuran is not.
Imuran is not the same as the prednisone. But, Imuran depresses the immune system as does prednisone. This usually allows your doctor to reduce your dose of prednisone resulting in less side effects.

Imuran is not habit-forming. It does not cause drowsiness and will not affect your driving or working. It does not cause sexual impotence. There are no restrictions on exposure to sunlight.

How does Imuran work?
Immunomodulating agents, or drugs that suppress the immune system, such as Imuran have become important tools in the long term treatment of inflammatory bowel diseases such as Crohn's disease and ulcerative colitis. Although the exact mechanism of how Imuran works is not known, it is felt that by inhibiting the immune system, this drug suppresses the "overactive" immune reaction that is responsible for such disorders as Crohn's disease and Ulcerative Colitis.

Taking Imuran properly
1. Imuran is best taken with food. Imuran can irritate the stomach lining and therefore should be taken with food which serves as a buffer and reduces the irritation. The tablets may be crushed if necessary. There are no food or beverage restrictions. Imuran can be taken with milk. It does not interact with alcohol or tobacco.

2. Take the dose as prescribed once daily. There is no fixed rule for the correct dose of Imuran. The average dose is one or two tablets daily, but each case is different. Your doctor will determine what initial dose is best for you depending on the activity of your disease, your age, weight, any other medical conditions you may have, and your response to treatment - do not alter the dose on your own. The goal, of course, is to control your illness with the lowest effective dose of Imuran possible. Your doctor will routinely reassess what dose is necessary for you. The tablets may be crushed if necessary. If two tablets are prescribed, they may be taken at the same time once daily.

3. If you forget a dose, take the normal dose of the medication as soon as you remember and resume your normal schedule the following morning. If you do not remember until the next day, skip the missed dose.

4. Do not expect immediate results. Imuran does not work right away. In fact, it may take more than 3 months to show a beneficial response. You can plan to be on this drug anywhere from 3 months to several years.

5. Keep all your appointments. Imuran is only given under close supervision because of the risk of serious adverse effects. Periodic blood tests are mandatory for the safe use of this drug. Report for examinations as directed.

6. Be sure all of your doctors know that you are taking this drug. This is a good general rule, but it is especially important for you to remember if you are away from your doctor and require major surgery or develop a severe infection. If you are to be on Imuran for a long period of time, carry a reminder with you on a Medic-Alert bracelet or in your wallet. (Medic-Alert Foundation can be contacted at their toll-free number 800-344-3226)

What are the side effects?
This is the main concern. When taken over a long period of time (months to years) Imuran can cause many side effects. But when Crohn's disease or ulcerative colitis become difficult to control with prednisone, the benefit of Imuran far outweighs the potential risks. For difficult to manage conditions, Imuran can be a miraculous medication. In general, the risk of side effects depends on the length of time you take Imuran and the amount you take.

These side effects can occur with short term use but fortunately are usually reversible as the dose of Imuran is decreased:
skin rash
loss of appetite
nausea, vomiting
diarrhea These side effects are more serious. They usually occur after long term usage.

Immediately report any of these symptoms to your doctor:
>Bone marrow depression
severe fatigue
weakness
fever
severe sore throat
abnormal bleeding or bruising
sores on lips and in mouth
>Liver damage
yellow eyes and skin
jaundice
dark-colored urine
>Drug-induced pneumonia
severe persistent cough
shortness of breath
Pancreatitis
severe stomach pain
nausea and vomiting

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor, nurse, or pharmacist.

You can help limit side effects by taking the medication exactly as prescribed and reporting any problems to your doctor. Report promptly any indication of a developing infection - fever, chills, lip or mouth sores, etc.

What about cancer?
Some doctors feel that there may be a slightly increased risk of some cancers such as lymphoma or Hodgkins disease after long-term use of Imuran. But , a scientific study done at the University of Pennsylvania in 2001 studied 1467 patients with Ulcerative colitis or Crohn's Disease and found no increased risk of lymphoma in patients who took Imuran. However, there is still some controversy about this point - so you must be willing to accept this possible risk if you take Imuran. Again, this powerful drug is only used as a last resort in patients with severe inflammatory bowel disease who do not respond to conventional treatment. In general, it is felt that the benefits of Imuran in this difficult situation outweigh the risks.

Monitoring Imuran
Each patient is different and the optimum dose of Imuran varies from one individual to another. There is sometimes a narrow range between the most effective dose and a toxic dose. The doctor determines the best dose based on age, weight, response to treatment, and monitors symptoms and blood tests for side effects.

Technology is also now available that allows for more accurate dose adjustment. The metabolites of Imuran called 6-TG and 6-MMP can be directly measured in the blood. Higher 6-TG levels correlate with clinical response to Imuran but also the risk of bone marrow suppression. Higher 6-MMP levels correlates with liver toxicity. These special blood tests may be requested from Prometheus Laboratories to help the doctor determine the proper dose. Studies at the Cleveland Clinic have suggested that 6-TG levels greater than 260 are necessary for a clinical benefit and 6-MMP levels over 5700 have been associated with liver toxicity.

Precautions
Do not take Imuran if you are pregnant or plan to become pregnant in the near future. Birth defects have been reported in animals that received large doses of Imuran during pregnancy. This drug also has the potential for producing birth defects in human offspring. Use of this drug is not recommended during pregnancy. There is a possibility that birth defects may occur if either the mother or father is using Imuran at the time of conception. Use of birth control is recommended while taking this drug. Do not breast feed while on this drug.

Notify your doctor if you recently had chickenpox or shingles. Be sure to inform him if you are taking allopurinol (Zyloprim), Dilantin, Rifampin, or phenobarbital. These drugs may increase the blood levels of Imuran, which can lead to serious side effects. Tell your doctor if you have any kind of active infection, have a history of bone marrow disorders, severe liver or kidney disease, or are pregnant or plan to become pregnant in the near future. Be aware that Imuran can lessen the effects of the anticoagulant drug Coumadin.

Remember
Imuran is a very powerful drug with many helpful properties, but as with all potent medications, side effects may occur. You can best limit problems with this medication by taking it exactly as prescribed. If you have any questions or concerns, please discuss them with your doctor.

Medication du jour - Pentasa

So I'll go first with the meds. I take 2-500mg capsules 4x a day. These are big blue pills (as opposed to the little blue pills) that are not for the faint at heart to take. My wife calls them horse pills. They are by far the largest medication that I have ever taken.

Here's the stuff from their website: www.pentasaus.com
What is PENTASA?
PENTASA is an anti-inflammatory drug containing mesalamine, which helps to reduce inflammation in the intestine. Specifically, PENTASA is approved for the induction of remission and for the treatment of mildly to moderately active ulcerative colitis.

PENTASA Features an Innovative Drug Delivery System
PENTASA delivers mesalamine to your small and large intestine in a special way. Here’s how it works:

Each PENTASA capsule has a gelatin-like coating. Once inside your stomach, the coating dissolves, releasing tiny semiporous spheres. These spheres help deliver the mesalamine to your small and large intestine. Water found inside your intestine flushes mesalamine out from the spheres. Once the mesalamine is released, the drug is free to help reduce the inflammation.

PENTASA 500-mg Capsules May Relieve Your Symptoms with Fewer Capsules
PENTASA helps to bring your symptoms under control. In a clinical study, PENTASA significantly reduced the severity of the most common signs and symptoms of ulcerative colitis (compared with a sugar pill), including:
Bleeding from the rectum
Stomach cramps
The urge to go to the bathroom
The number of trips to the toilet each day

PENTASA 500-mg capsules provide symptom control and relief with only 8 capsules a day. That’s half the number of capsules compared with the 250-mg formulation.

So that's a synopsis from their site. Go there if you want to read more. I did find it interesting to read that they have a Patient Assistance Program for free or low cost medication for low income families or those with no insurance.

Pros: Well, I do notice that I do not go to the bathroom as much as I did before I was taking it, which is always positive.
Cons: I can't for the life of me remember to take this medication every time I'm supposed to. Even with setting an alarm to help me remember, I still don't take it as prescribed. Maybe they'll read this and take a suggestion - get it down to taking just once a day. I would take all 8 of them in the morning, if it meant I didn't have to take them all day.

Hope that gives you some insight. Until next time...

Medication du jour

Ok, so I thought we might do each other a faover and talk a little about the medications we are currently taken or maybe have taken in the past.

To our writers: If you write something about your medication, make sure to give us the pros and cons of the medications for you personally, not the legalease that you get in with the medications. Real life, real world stories of what these medications do for you personally. Also, if the medication has a website, make sure to include a link so we can go there and check out more info.

To our readers: We want your input. So please comment about the medications we write about. Tell us your stories. And as always - if you want to write a post, shoot me an email & we'll be glad to add you in.

How do you remember???

As Crohn's patients, we all inevitably take a lot of medication. I remember when I was first diagnosed I had to take medication on an empty stomach when I woke up, then with breakfast, the on an empty stomach after beakfast, empty stomach before lunch... on and on it went.

Fortunately, now most of the medication I take is first thing in the morning, with or without food (my preference). But I take Pentasa 4 times a day. So I have to spread it out even through the day. The trick for me is remembering to take it each and every time. So I have an alarm set on my watch for 4 different times during the day to remind me to take my medicine. Most of the time I'm pretty good about taking it when the alarm goes off, but there are times when I just don't feel like it. It get so sick and tired of taking medications.

Luckily for me, my youngest daughter has also become part of my alarm system. She knows now that my alarm is set to remind me to take my medicine. So every time my alarm goes off, I hear this sweet little voice saying "Medicine time daddy." Who can resist? Not me.

So here is my question - how do you remember to take ALL of your medicine EVERY day? Please do share.

Until next time...

Cimzia® Approved in the US for the Treatment of Moderate to Severe Crohn's Disease

Found this on the web tonight - thought I would pass it along. It came from the website - http://www.ucb-group.com/media_centre/3384.asp

Administered every four weeks, UCB's pegylated anti-TNFα offers new treatment option for patients with moderate to severe Crohn's disease.
Cimzia® will be available in the US within the next 48 hours.

Brussels (Belgium) - April 22, 2008 - 19.30 CET
UCB announced today that the US Food and Drug Administration (FDA) has approved Cimzia® (certolizumab pegol), the first and only PEGylated anti-TNFα (Tumor Necrosis Factor alpha) antibody indicated for reducing signs and symptoms of Crohn's disease and maintaining clinical response in adult patients with moderate to severe active disease who have an inadequate response to conventional therapy.

"The approval of Cimzia® in the United States is a significant milestone for both UCB and our Cimzia® team, but especially for people suffering from Crohn's disease," said Roch Doliveux, Chief Executive Officer of UCB Group. "Cimzia® is a UCB biological innovation that will provide a monthly treatment option for patients suffering from Crohn's disease. Cimzia® will be available to doctors and Crohn's patients in the United States, which represents 70% of the world Crohn's anti-TNF market, within the next 48 hours."

The approval of Cimzia® was based on safety and efficacy data from clinical trials in more than 1 500 patients with Crohn's disease. Each pivotal study demonstrated that a statistically significant greater proportion of moderate to severe Crohn's disease patients achieved and sustained clinical response with Cimzia® for up to six months, compared to placebo. These data also showed that of the patients who were in remission after initial dosing, the majority maintained remission with no dose escalation.

Cimzia® is the first and only PEGylated anti-TNFα. Cimzia® is dosed subcutaneously every four weeks after initial dosing, making it a convenient option for people with moderate to severe Crohn's. Cimzia® has demonstrated a low incidence of injection site reactions and injection site pain in clinical trials. The most common reported adverse events in the pivotal studies were upper respiratory tract infection (cold, flu), urinary tract infection (bladder infection) and joint pain. As seen with the use of the other anti-TNFα agents, serious, but infrequent infections and malignancies have been reported.

"The clinical trials program has shown Cimzia® to be an effective subcutaneously-administered treatment, with a low rate of injection site reactions," said Stephen Hanauer, M.D., Professor of Medicine and Clinical Pharmacology at the University of Chicago. "The approval of Cimzia® provides a new option for people with Crohn's disease to achieve relief from this debilitating condition with a convenient, stable administration once every four weeks."
About Cimzia® (certolizumab pegol)

Cimzia® is the first and only PEGylated anti-TNFα (Tumor Necrosis Factor alpha). Cimzia® has a high affinity for human TNFα, selectively neutralizing the pathophysiological effects of TNFα. Over the past decade, TNFα has emerged as a major target of basic research and clinical investigation. This cytokine plays a key role in mediating pathological inflammation, and excess TNFα production has been directly implicated in a wide variety of diseases. UCB is developing Cimzia® in Crohn's Disease, RA and other autoimmune disease indications. For additional information, including safety information, please refer to the Cimzia® factsheet in the "News" section of UCB's website (http://www.ucb-group.com/).

Medications. Medications. And more Medications!!!

I thought it might be interesting to talk about all the different medications that we take as Crohn's patients. I know there is lots of different stuff out there, and what works for one of us may not work for another. But it would still be an interesting excercise to see what everyone is currently taking and how you are doing with it, what you have taken in the past that maybe didn't work and why, or is there some new stuff out there that you intend to ask your doc about trying.

Currently, I'm on 1000mg of Pentasa 4 x day, 50mg of Imuran 1 x day, and 40mg of Omeprazole 1 x day. For me, this is probably the least amount of medications I have taken since I was diagnosed 15 years ago. When I was first diagnosed, I was taking about 40 pills a day. My medication now is primary preventative maintenance medication, since my Crohn's is currently in remission.

Share with us as much info as you want about your current medication. Themore info we have, the better it is for everyone.