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Unit 2E Stollery Children's Hospital

8440 112 St NW, Edmonton, AB T6G 2B7

pedsibd@ualberta.ca

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Immunomodulators

Azathioprine (Imuran)/ 6-Mercaptopurine (6-MP)

OVERVIEW: Azathioprine and 6-MP change the body’s immune response thereby reducing the overactive inflammatory response seen in IBD. Mantoux Test needs to be completed prior to starting the medication to ensure safety. If a person was to have tuberculosis and start this medication, they could become very ill.

Lymphoma is one of the side effects that often creates most concern. However, the increased risk of lymphoma that is associated with taking Azathioprine and 6 TG is still very LOW. Please discuss this risk further with your GI doctor.

 

Blood work is done every week for 6 weeks and then monthly once starting on this medication. This is to ensure the safety of the drug. Often changes can be noted in the blood work prior to the patient having symptoms. Therefore, doses can be adjusted or the medication can be stopped if necessary.

WHEN DO WE USE IT: It is used for treating both Crohn Disease and Ulcerative Colitis.

HOW IT'S USED: It is given once per day. It is started at a lower dose and then titrated up to full dose. A schedule will be created for you by your nurse or doctor on how to take the medication.

DURATION OF TREATMENT: Imuran is a maintenance treatment used long term. 

SIDE EFFECTS: 

  • Rash

  • Headache

  • Nausea

  • Low immune system, less ability to fight everyday infection

  • Changes in the liver

  • Pancreatitis

  • Lymphoma

  • Non-melanoma skin cancer.

Methotrexate

OVERVIEW: Methotrexate changes the body’s immune system and thereby reduces the overactive inflammatory response seen in IBD.

 

WARNING: Causes birth defects. Not to be used by women who wish to come pregnant, are pregnant or breastfeeding. Not to be used by men who are hoping to get someone pregnant in the immediate future. If someone was to become pregnant on MTX, it would be recommended that they terminate the pregnancy due to potential birth defects.  This is not to say that people who have taken MTX can never have children- they can but they have to allow a wash-out period prior. Please discuss this further with your doctor or nurse if you are considering starting a family.

 

Ondanestron is an anti-nausea medication that can be prescribed if nausea is experienced.

 

Patients on MTX, need to take 5mg (less for small children) of folic acid 3 days after taking MTX. This helps to reduce the side effects of the MTX and to help replenish the body’s folic acid stores.

 

Blood work needs to be done every 2  week for 6 weeks and then monthly after starting this medication. This is to ensure safety of the medication.

 

WHEN DO WE USE IT: It is used for treating both Crohn Disease and Ulcerative Colitis.

 

HOW IT'S USED: It is given only once per week. It can be taken either orally or as a subcutaneous injection (we will explain the advantages of each option to you).

 

DURATION OF TREATMENT: It is a maintenance treatment used long term. 

 

SIDE EFFECTS: 

  • Nausea

  • Increased/abnormal liver function

  • Lower immune system