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Azathioprine & Liver Problems


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#1 Joelf

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Posted 25 February 2010 - 03:05 AM

Hi All

I thought I'd pick the brains of the experienced Scleroderma sufferers out there!! smile.gif

I have Limited Systemic Sclero and for the last 6 weeks I've been on Azathioprine (Imuran) 50mgs to start with and now the dose has been increased to 125mgs.

I've been having blood tests for kidney, liver and full blood counts every week since I went on to it (the human dartboard, that's me!! wink.gif ) and the last blood test threw up a problem with my liver (I'm not sure what but will be seeing my doctor to discuss it with her.) Also I've had a few different places on my body become very itchy; they come up and down and move around...very bizarre!! I'm wondering whether that has anything to do with the Azathioprine and whether anyone has experienced similar symptoms with the drug? I'm also on Prednisolone but I've been on it for 8 months without any problems so don't think it's that.

I'm quite miffed about it because up to now I have had no side effects at all and was feeling very smug!! wink.gifsad.gif


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#2 Shelley Ensz

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Posted 25 February 2010 - 03:45 AM

Hi Joelf,

I'm not too sure (because of course I'm not a doctor, although I am considering buying a cheap plastic stethoscope just for the medicinal allure) but I think that liver problems and itching often go hand in hand.

Regardless, whatever the cause, be sure to mention the itching to your doctor. I'm not sure how you'd refer to it, other than perhaps a "roving itch". But you need to report it right away in case it is leading to an adverse reaction of some sort.

Not to scare you, but my husband had an "odd itch" a few months ago and a little while later, he broke out in a antibiotic-induced rash literally from head to toe (even on the top of his scalp and the bottom of his feet) which took a full week to subside after the medication was withdrawn. That's a pretty rare reaction (and there was nothing to be done for it, except tolerate it and quit taking the medication) but it just goes to show that you might want to make sure you aren't developing a rash. But a new itch, in itself is enough to report.

Sometimes they expect a certain amount of "mild" side effects from some medications. They might tolerate temporary elevations in some blood work, or itches without a rash, or a little nausea, for example, but it is your doctor who needs to make the decision, regarding that particular medication and your own personal health history, with a full set of facts before them. So even if some of us chime in saying we've had the same thing, it doesn't matter half so much as what your own doctor thinks, of course. As you already know, I'm sure.

That's my disclaimer for this side-effects discussion, and I'm sticking to it. Now, where did I put my stethoscope? :blink:
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#3 Amanda Thorpe

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Posted 25 February 2010 - 06:35 AM

Hello Joelf

I'm sorry you may now be experiencing problems with your immunosuppressant, maybe a lower dose will be tried rather than taking you off of it completely? Let us know what your doctor says.

Take care.
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#4 Deb1million

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Posted 25 February 2010 - 09:18 AM

Hi Joelf,

I was on Azathioprine for over 3 years for Lupus, and I also have autoimmune Hepatitis, so my liver was already compromised, but the Azathioprine was still safe for me to take. I didn't have any skin itching, just dry skin I've always had.

I'm sure your doctor will explain the latest blood results to you, as that's the reason they do them so frequently when starting or increasing doses.

Please let us know how you get on? Good luck.

Best wishes,

Debs

#5 janey

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Posted 25 February 2010 - 12:44 PM

Joelf,

I'm sorry that you are having problems with itching and changes in your liver function. I was on Imuran (azathioprine) for 3 weeks, but couldn't handle the fatigue that it created. Some people handle it very well. I'm not sure about the liver function. I do know that my mother was on Imuran for several years when she was diagnosed with Autoimmune hepatitis. Her main side effects were nausea, but her liver enzymes did drop to normal. So please ask you doctor about the itching and changes in liver function. Both could be the result of several things, not just the medication.

I hope you get some answers soon. I know how itching can drive you nuts!
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#6 Sharon T

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Posted 26 February 2010 - 12:29 PM

I've been on Imuran (100mg) for about 6 months with no ill effects. Then I started on Ambrisentan and my liver enzymes went up significantly. Stopping the Ambrisentan didn't make the liver enzymes go back down. A liver ultrasound showed "fatty liver" (non-alcoholic). The doctors think it is probably caused by being overweight (I've gained 20+ pounds since starting all the meds for limited systemic sclero), and that it will be "cured" by (a) losing 10 to 15% of my body weight (which I'd love to do!) and (B) stopping alcohol use until liver resolves itself (which I'm really hating as I miss my daily 2 glasses of red wine). Oh, well. Anyway, the upshot is that both Imuran and Ambrisentan can cause liver issues, but even if they aren't the direct culprits, being overweight (even if caused by Sclero drugs) can also cause problems (I read somewhere that 1 out of every 4 overweight people probably has fatty liver disease).

I'd keep investigating this with your doctor, since eventually all liver problems can end up permanently damaging the liver, and you've only got one of them! :VeryHappy:
Sharon T.

#7 Joelf

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Posted 27 February 2010 - 06:44 AM

Hi All

Thanks so much for your very helpful and informative replies ( I knew I could rely on this forum for lots of reassurance and help!! :) :wub: )

I have yet another blood test on Tuesday followed by an appointment with my doctor and depending on the results we'll decide on a course of action. I shall most definately tell her about the itching and obviously I've knocked the G&T's on the head ;) ( we don't drink much anyway but I'm strictly TT for the time being!!! ;)) It would be rather a shame to sort my lungs out only to muck up my liver!! B)

I'll let you know what my doctor decides. :)

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#8 lizzie

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Posted 28 February 2010 - 07:45 AM

Hi Joelf, I'm on Methotrexate rather than Azathioprine, but can empathise with you on the liver problems. My liver enzymes have been raised for a few weeks, so had to temporarily stop the immunosupression - just started back on it a couple of weeks ago. I have been itching - but had put that down to the scleroderma. However during my heart echo three weeks ago it was noticed that my liver was enlarge, so have just been for a liver scan and am awaiting results. In the meantime the dr's have said that it is still OK to take the Methotrexate. Like you am on the wagon re alcohol!

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#9 pawndy

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Posted 28 February 2010 - 04:55 PM

I was on Cytoxin for over a year. Then I was put on Azathioprine. I have been on Azathioprine for a couple years. I was diagnosed with a fatty liver (NASH) about 8 years ago. I never drank alcohol; I never smoked; but I have been over weight most of my life. My liver tests are always off just a little but (according to the doctor) not enough to worry about. When I was put on Azathioprine the only thing the doctor told me to watch for new growths. He has never mentioned anything about watching my liver. Probably because he was already doing that.

So I am really interested in finding out what the doctor tells you. I will hope your news will be good.
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#10 Joelf

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Posted 05 March 2010 - 06:59 AM

Hi All

I had a blood test last Tuesday and saw my general practitioner yesterday. Thankfully my wonderful consultant at The Royal Brompton Hospital had sent detailed instructions to her in the event of the Azathioprine not suiting me and she suggested that I lower the dose to 100mgs and then have another blood test next Tuesday (rather as you suggested, Amanda!! ;) ) Apparently the normal liver count is 45 and mine was 60; not enough to panic but enough to monitor it very closely and if it reached 120 then I would have to come off it and try something else, possibly Mycophenolate (although in theory I suppose that could also upset my liver! :rolleyes: )

Unfortunately I have to take some sort of immune suppressant as the fibrosis on my lungs is quite aggressive even though it was much improved by the Cyclophosphamide. :( I suppose there is quite a bit of trial and error involved in the getting the dosage correct; enough to keep the Scleroderma at bay but not so much that the rest of my organs are put under so much stress that they give up the ghost!! :unsure: :lol:

Ah, well.......onwards & upwards!!! ;)

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