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Old 03-18-2005, 10:34 AM   #1
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Question Azathioprine (Imuran) in Pregnancy/Lactation

Does anyone have any advice/experience of taking Azathioprine in pregnancy/lactation?

I have been taking this drug for 4 years to control Crohn's Disease related problems. This seems to have worked, but I have recently found out that I am pregnant and am concerned about the effects on the baby.

I understand that it may be safe to take in pregnancy but there are risks in breast feeding. If so, what are the risks and what are my chances of my doctor agreeing for me to stop taking the Azathioprine 4-6 weeks before the baby is due so that I can breast feed?

Rebbie

Last edited by RebbieO; 04-13-2005 at 05:51 AM.

 
Old 03-18-2005, 10:02 PM   #2
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Re: Azathioprine in Pregnancy/Lactation

I am taking that also, and even though it is considered a class D drug, most all of the drs I have talked to said it really does not cause that many problems. I am taking 4mg of folic acid to help against birth defects, talk to your dr about that. The major risks are cleft palate and low brith weight. It can cause spinal problems. Here is what the dr. told me about it causing spina bifida (I think these numbers are right, but if not, you can at least get the idea of the increase in percentages it causes)
Everybaby in the world has a .05% chance of getting spinabiphida. If you are on immuran (same drug, just easier to spell!) the chances go up to .10. HOwever with lots of folic acid, you can reduce your chances back down to .065. So it's not that big of a diff. I hope i got the numbers exactly right, but i am not positive, anyway it's not that big of a difference. I have ulcerative collitis, and all my drs agreed that a flareup was WAY more dangerous for the baby than the drug.
As for the breastfeedign thing, I have been wondering too. It takes 3 months for immuran to get out of your system though, and you have to wean off of it. I am not sure about chrons' but I have heard that alot of women with other stomach and intestinal problems experince flareups after birth. So, it may be best for you to stay on it. Especially since you would have to be off it for those last couple of months in pregnancy and you could have a flareup then.
Good Luck! Hope all goes well!
Oh by the way, I am 27 weeks, and so far we have no problems! We have seen him kicking his legs and moving his arms, so that means no paralysis, his spnie looks great, he is actually a little ahead growth wise, and no sign of cleft palate!

 
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Old 03-19-2005, 06:55 AM   #3
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Re: Azathioprine in Pregnancy/Lactation

Hi,
I was taking Imuran for close to two years before I went off of it to become pregnant. It actually takes 6 monthes to get out of your system(about the same it takes for it to start working when your first put on).
It is a class D drug,but mostly because there are no woman willing to put their babies into a study for this drug...as with many other drugs. So,it is unknown what kind of effects,including long term it may cause. I have heard the baby may be more supseptible to cleft palate as mention above already. But like also mentioned it is better to be on a drug that you really must be on to remain healthy throughout your pregnancy. A flare up could be so much worse.
You should already have folic acid in your prenatal vitamins,so I dont think it is truly necassary to increase that amount. Although your doctor may want you too,talk to him/her about that. I was taking folic acid for about two monthes before becoming pregnant and was told by my OB to discontinue the folic acid because I had enough in my prenatal vitamin(but she was very glad I took it before becoming pregnant).
I dont think coming off the drug for 4-6 weeks will help at all,because it will still be in your blood stream. Talk more to you GI and OB about what you need to do if you want to breastfeed. Remember that it can be excreted through breastmilk,and you may not want your baby to consume this drug. It does have many dangers to it. I wish you and your baby well.

Last edited by Emily'smama; 03-19-2005 at 06:57 AM.

 
Old 03-22-2005, 11:03 AM   #4
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Re: Azathioprine in Pregnancy/Lactation

Thanks for your advice.

This is my third attempt at replying to you. Hope it works this time!

I've been taking Folic Acid since I started trying to get pregnant about 3 years ago, so hopefully that will help to reduce the risks of Spina Bifida. I didn't know about the increased likelihood of a hare lip occuring. Oh well, we'll have to deal with it when the baby is born, if that is the case. There are far more serious things to worry about, I think.

I really can't afford to be ill once the baby is born, so maybe I'll have to take the doctor's advice and stay on it, even though my instinct is to wean myself off it, particularly as I've had long periods of remission in the past before I had the really bad flare up which preceded me taking this drug.

 
Old 03-22-2005, 02:31 PM   #5
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Re: Azathioprine in Pregnancy/Lactation

I understand what you mean,I have been in remission for over a year now. I am sooo worried that I will get sick after the baby comes...I certainly hope not!!! I had my first flare(intial dx) after my daughter was born,and it was really hard with a small baby and being sick,then being put in the hospital. I wish you the best and hope you continued health throughout. Take care,do whats best for you.

 
Old 03-22-2005, 09:15 PM   #6
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Re: Azathioprine in Pregnancy/Lactation

I am worried about the flare up too, but mine always seem to get better with fluids and some IV steroids, so since i will already be in the hospital, it shouldnt be that big of a deal, the previous two times I was sick for at least a month, two months last time, before I coudl get admitted! Anyway, i am thinkign of coming off of it after the baby comes, and all settles down, I have also been takign asacol, and it has far less side effects than immuran.
As for the cleft palate, most meds have that side effect, but that is nothing at all to worry about! We talked to the dr about it, and if it happens, a plastic surgeon will look at it, and when the baby is a little older will fix it, very simple operation!
you will probably also get extra ultrasounds,to check for growth of the baby. and if they haven't done the test that monitors if your body is handling the immuran right, they may do it. I had already had it, so I didn't have to, but they said something about needing to take it if I hadn't!
Good luck!

Last edited by cattieos; 03-22-2005 at 09:17 PM.

 
Old 04-13-2005, 05:50 AM   #7
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Re: Azathioprine in Pregnancy/Lactation

I saw my consultant today and we have come to a compromise which I am happy with. He says that it takes 8 weeks for the drug to get out of your system, so has agreed for me to wean myself off it about 2 months before the due date, as long as everything is OK Crohn's wise. I know the timing doesn't agree with what you said, but I'll take his word for it. Even if it is not completely out of my system by the time the baby is born, it will still be quite diluted by then.

I am also taking Pentasa/Mesalazine, which is safe to take whilst breast feeding, so this will hopefully help to keep things under control. I'm under no illusions that there are risks, but with careful monitoring, hopefully everything will be OK for both me and the baby.

I was interested in Catios's comment about the test which monitors if your body is handling the Immuran right. I have not had any tests other than monthly blood tests. Can you tell me anything about this? I meant to ask my doctor about it yesterday, but forgot.

Thanks again for your advice.

 
Old 04-13-2005, 10:32 AM   #8
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Re: Azathioprine in Pregnancy/Lactation

I know what you mean about the blood test that tests the levels of the Imuran that is right for you. My GI had to send it out to California and it was very expensive(insurance didnt cover it). Basically you wont have to do weight based dosage,you doctor can allow whatever is best for your condition.

I would consider asking another GI about the amount of time it takes for the Imuran to get out of your system. Unless you fully trust you GI. I have had two seprate GI's and my family doctor tell me 6 monthes for it to get out of my system. But,I suppose if you have taken it the entire time you've been pregnant,it really wont matter anyway.

 
Old 04-14-2005, 11:11 AM   #9
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Re: Azathioprine in Pregnancy/Lactation

As I live in England and am being treated on the NHS (National Health Service - private healthcare is the exception rather than the rule in the UK), I don't get to choose my doctor, although I could ask for a second opinion. Unfortunately (or possibly fortunately) my consultant is probably the person with the most expertise on this matter in the area where I live.

On the other hand, I don't have to pay for any healthcare or tests, so this is a definite bonus. This is all paid for from National Insurance contributions deducted from your salary, whether you use the NHS or not. In my case, I've definitely had my money's worth over the years!. This includes all ante-natal appointments, monthly visits to the Inflammatory Bowel Disease clinic and the delivery and aftercare of my baby. In the past it has also included hospital stays and major abdominal surgery. Additional benefits for pregnant women are free prescriptions and dental care during the pregnancy and for a year afterwards.

 
Old 04-14-2005, 07:30 PM   #10
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Re: Azathioprine in Pregnancy/Lactation

I can't remeber the name of the test but they send it to Promethus Labs in CA here. It may not be available in England. It is a pretty important test to take though, cause some people don't metabolize Immuran correctly and it can cause some serious problems, even though you dont' really show any symptoms. Also you should be sure that your GI dr is checkign your liver functions and white blood cell count regulary, one of the side effects from immuran is lymphonia. The test cause me 490.00, and insurance paid for half! But luckily you only have to have it once! As for how long it takes to get out of your system, I would ask too, because I have always been told three months, but you have to start weaning off it, and depednign on your dosage, that can take about three months, which would make the six months emilys mama talks about. It will take you a while to get off of it, so even starting to wean off of it two months before hand wouldnt give you the eight weeks, and from what I have been told, if you quit taking it suddenly it can cause some very very serious problems, manily with the thyroid, but also with other things. I don't know exactly how much of it passes into the breast milk, but I did ask about it today, and they said absolutley not! No way could you take it and breast feed. I really think you should ask for a second opinion.
Good luck!

 
Old 04-15-2005, 06:45 AM   #11
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Re: Azathioprine in Pregnancy/Lactation

I know that the regular blood tests I am having check for effects on the liver and kidneys and they always seem pretty interested in my white blood cell count.

There is no-one that I know of that I can ask for a second opinion, but I will definitely ask my consultant to justify his reasoning on the 8 week period he has suggested on my next visit.

In case you're interested, my dosage is 125 mg per day.

I'm quite keen on breastfeeding, if only for the convenience factor. I'm also going to have to get over my hatred of the smell of milk as I'm going to have to get used to it for a while, whether I breast feed or bottle feed.

 
Old 04-15-2005, 07:01 AM   #12
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Re: Azathioprine in Pregnancy/Lactation

Catteios,
You mentioned something about thyroid problems in your last post(referrring to Imuran and coming off of it). I wouldnt have thought twice about it until I read that. A couple monthes ago my family doctor tested my thyroid because I was having such severe fatigue(more than normal,and more than normal in pregnancy). My t4 count was pretty low,but he didnt want to put me on anything because of my pregnancy(he knows I hate taking meds,and being pregnant doesnt help). Anyway,I have to go back this month and be re-tested and see if there was any change...wonder if it could have something to do with taking the Imuran? I personally never liked taking the drug because it really didnt help me anyway,I stilled flared while on it and my immune system was so low I got a terrible case of the Shingles. I know it is one drug I will not resume taking after I have the baby. But,it does help some people and it's considered a "miracle" drug.

 
Old 04-15-2005, 07:13 AM   #13
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Re: Azathioprine in Pregnancy/Lactation

It doesn't sound like Imuran is working very well for you, Emily's Mama. I was told that Imuran actually suppresses an overactive immune system, which is why it is also used on transplant patients to stop them from rejecting organs. This may be why your resistance to other infections is low.

Sorry to sound as if it's all me, me, me, but it really helped me. I had gone for about 4 months with persistent problems with abscesses, taking antibiotics and painkillers almost all of the time and also having some surgery. The Imuran settled it down in a few weeks and I haven't had any flare-ups at all in almost 4 years (touch wood). Nevertheless, I still think it has done the job it was intended for and am willing to take the risk of weaning myself off it for the sake of the baby.

Rebbie (no need for the O, really - it's just that someone else on this site had already chosen Rebbie as a username)

 
Old 04-15-2005, 12:36 PM   #14
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Re: Azathioprine in Pregnancy/Lactation

Rebbie,
I say whatever works,go for it!!! I think anything that gets you into remission is worth taking,and I am really glad it helps you. The Imuran got me into remission,but 6 monthes for me to acheive that...and I was already scheduled for the j-pouch surgery because I was giving up. It kept me in remission for two monthes and then I got sick again for another 5 monthes. I swear by Colazal and Entocort,but others dont react good to those and wont take them. This DD stinks and it's different for everyone.

Yes,Imuran is an immune suppressant and that's why I was sick alot while taking it,including why I contratced the Shingles. I just dont wanna go back to that again. But,I dont wanna flare either...I have had increased bowel movements these past few weeks and last night I had a really bad scare that reminded me of when I was flaring. I just fear getting sick again. My daughter wasnt even one when I was dx with UC and being in and out of the hospital,dragging her with me to all my doctors appointments and being to sick some days to even play with her really gets you depressed. She is the sweetest little girl and is sooo understanding of people when they dont feel good...but I cant help but feel a little quilty for her seeing her Mommy sick so much. Having a baby is hard on anyone,but to get sick on top of it is just really hard.

Ohhhh....it's just one of those days. After last night I have just been thinking about it alot. Dont mean to ramble,sorry.
Nichole

 
Old 04-15-2005, 06:45 PM   #15
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Re: Azathioprine in Pregnancy/Lactation

EmilysMama-I don't think that the immuran helps me much either, I always had mini flare ups when I was just on it. When I started taking the asacol though, i was much better. I was going to try to get off of the immuran, but the baby came along as a very welcome suprise! And the drs thought it worse to chance it, especially since it would take so long to get out of my system. I am sorry that you got shingles, they are soooo awful! I had them when I was little. Immuran has such bad side effects, I think it is part of hte reason I feel so worn out all the time and so nauseaus, if you read the side effects those are some of them. I don't know if actually taking immuran can cause thyroid problems. But when I was in the hospital I wanted to quit taking it, and they didn't want me too right then, so I said, fine I will just quit taking it anyway. And the dr. said, well you can, but if you dont' taper off of it correctly you will really mess up your thyroid (he explained it better, but I was really really sick and dont' remember much) Then I thought about it, and decided i would just stay on it for a while. But that could have something to do with it. I think that after the baby comes and I see if I am still doing ok, I am going to quit taking the immuran. I am worried about having problems though and trying to take care of a new born. It scares me! I undersatnd your ramble, I know how depressing it is.
Rebbie-Your dosage is higher than mine, mine is 100 a day. It's good that they are monitoring your blood levels. The smell of all milk, or just formula makes you sick? I am just curious. And I am trying to find my paper they gave me about tapering off of the medicine, or something else on it, and will post it if I find it!

 
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