[Stellatum]

I'm taking 200mg a day. I have to believe it helped me this summer, because a month after going to that dose (from 150mg) I had a sort of remission for three months. Now I'm mildly relapsing. My doctor is reluctant to up the dose to 250. Is anyone on that high of a dose?

My labs have all been fine, and I don't notice any side effects from the Imuran. I am still, as I have been for years, very resistant to infection. I have seven kids. Sometimes everyone in the house has a horrible, messy cold, with a cough and sore throat, and I never catch it--or if I do, it lasts an afternoon and then it's gone. I just don't get sick. It runs in my family. That hasn't changed.

I see my neurologist on Monday. I am preparing my strategy to ask for the next intervention. Thanks.

Abby

[4-eyes]

I have a friend who has taken 350 for years and years--decades. No problemo.

[alice md]

This is the recommended approach to the treatment of RA.

(I am not aware of any specific guidelines in MG, but I do see any reason why it should be much different).

http://www.transplantbuddies.com/lib...l/azathio.html

Rheumatoid Arthritis: IMURAN is usually given on a daily basis. The initial dose should be approximately 1.0 mg/kg (50 to 100 mg) given as a single dose or on a twice-daily schedule. The dose may be increased, beginning at 6 to 8 weeks and thereafter by steps at 4-week intervals, if there are no serious toxicities and if initial response is unsatisfactory. Dose increments should be 0.5 mg/kg daily, up to a maximum dose of 2.5 mg/kg per day. Therapeutic response occurs after several weeks of treatment, usually 6 to 8; an adequate trial should be a minimum of 12 weeks. Patients not improved after 12 weeks can be considered refractory. IMURAN may be continued long-term in patients with clinical response, but patients should be monitored carefully, and gradual dosage reduction should be attempted to reduce risk of toxicities. Maintenance therapy should be at the lowest effective dose, and the dose given can be lowered decrementally with changes of 0.5 mg/kg or approximately 25 mg daily every 4 weeks while other therapy is kept constant. The optimum duration of maintenance IMURAN has not been determined. IMURAN can be discontinued abruptly, but delayed effects are possible.

[Stellatum]

Thanks a bunch. I just did the math, and I'm already at the maximum dose for my weight, so that explains my doctor's reluctance to push it higher. But I'll talk to him about it anyway. I don't know if there's really such a thing as being insensitive to drugs in general, but if there is, that's me.

Abby

Originally Posted by alice md

This is the recommended approach to the treatment of RA.

(I am not aware of any specific guidelines in MG, but I do see any reason why it should be much different).

http://www.transplantbuddies.com/lib...l/azathio.html

Rheumatoid Arthritis: IMURAN is usually given on a daily basis. The initial dose should be approximately 1.0 mg/kg (50 to 100 mg) given as a single dose or on a twice-daily schedule. The dose may be increased, beginning at 6 to 8 weeks and thereafter by steps at 4-week intervals, if there are no serious toxicities and if initial response is unsatisfactory. Dose increments should be 0.5 mg/kg daily, up to a maximum dose of 2.5 mg/kg per day. Therapeutic response occurs after several weeks of treatment, usually 6 to 8; an adequate trial should be a minimum of 12 weeks. Patients not improved after 12 weeks can be considered refractory. IMURAN may be continued long-term in patients with clinical response, but patients should be monitored carefully, and gradual dosage reduction should be attempted to reduce risk of toxicities. Maintenance therapy should be at the lowest effective dose, and the dose given can be lowered decrementally with changes of 0.5 mg/kg or approximately 25 mg daily every 4 weeks while other therapy is kept constant. The optimum duration of maintenance IMURAN has not been determined. IMURAN can be discontinued abruptly, but delayed effects are possible.

[alice md]

It's not always easy to decide when a patient does or doesn't respond to treatment.

And in an illness like MG, where you don't have very good parameters to follow and it can fluctuate so much any how, it is even harder.

My personal rule of thumb is that true improvement means that it lasts for more than 6 months. ( I have had so many short term improvements and worsening that I realized by now that it is just the "crazy" course of this illness).

The same applies for true worsening.
I nearly stopped taking mytelase, because I had a severe exacerbation (following a viral infection) that lasted for more than 2 months, which made me feel it wasn't really working that well any more. Fortunately, my neurologist insisted that I keep on taking it, as I didn't have any significant side effects and just felt it was useless, and I gradually went back to the improvement I had with it before that exacerbation.

As I said, it is not easy to know with this illness, and that is why it is good to have someone you can trust to help you with that.