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6mp dose

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Posted 7/23/2015 2:19 AM (GMT -5)
Hi everyone I just got back from the Dr. And I've now been on 6mp for 8weeks I started on 75mg then after 3weeks up to 100mg and now after 8 he is putting me up to 150mg. I weigh 84kg. And all my blood tests have been perfect. My question is from reading all over the place 150 seems to be very high dose for 6mp. Normal for imuran but I'm taking 6mp. Dr thinks the recommended dose for 6mp is 2.5mg/kg. But every where I read it is 1.5mg/kg? What are your thoughts.
Posted 7/23/2015 4:34 AM (GMT -5)
Yeah, 1.5mg/kg is correct for 6mp, though it is best to monitor TPMT to see how you metabolize the drug.
So that gives max dose of 125mg for you.
If you feel 100mg is doing the job, and blood tests confirm it, I would suggest you stay on that dose. Check that doc has correct dosing.
Good luck
Posted 7/23/2015 6:23 AM (GMT -5)
Ambling is correct. 1.5 mgs per kilogram (or 125 mgs per day for your weight) are the suggested maximum daily dose for 6mp.

You can have a thiopurine metabolites blood test done (offered by Prometheus labs and generically by quest diagnostics, labcorp, and other labs) to see how well your body is handling it. It's a good guide on proper dosing.
Posted 7/23/2015 1:45 PM (GMT -5)
1.5mg/kg sounds correct. I weigh 165lbs and was on 75mgs - recently reduced to 50mgs due to my wbc count getting too low.
Posted 7/23/2015 4:30 PM (GMT -5)
Yeah i just messaged my Dr and he said 2.5mg/kg is max dose for 6mp so looks like im going to be on 200mg 6mp
Posted 7/24/2015 9:10 AM (GMT -5)
Make sure hes monitoring your liver enzymes VERY closely. I dont think Ive ever heard of anyone on that high dose of 6MP. All of the best practice papers Ive read recommend 1.5 as you and others have mentioned. We usually start off with low doses and work our way up as needed.
Posted 7/24/2015 2:45 PM (GMT -5)
What Marauder said! I would be VERY cautious with this and get a second opinion (medically). 6MP is no joke, it requires close and regular monitoring and that is why the normal protocol is to start the patient out on a low dose and only increasing to the therapeutic dose when months of blood tests confirm you can handle it.
I started at 50mg with blood tests every two weeks - and some GI's test weekly - for several months before going up to 75mg.
Posted 7/24/2015 3:02 PM (GMT -5)
"Severe adverse effects, apart from bone marrow suppression, are seen only rarely if the AZA/Imuran dose does not exceed 2.5 mg/kg daily or the 6MP dose does not exceed 1.5 mg/kg daily."

I'd challenge your doctor, 6mp sounds risky over 1.5 mgs/kilogram. 2.5 is only for Imuran/aza...
Posted 7/24/2015 8:57 PM (GMT -5)
Very strange I challenge him and he assures me 2.5 is the safe dose and on the 6mp data sheet it says 2.5 is max dose aswell I started on 75 then he upped to 100 now I'm on 150 all up I've had 3blood tests all came back fine. Next blood test is in 4weeks I will see him again after that but I don't think his position will change. It's ok atm im on 150 which is 1.78x 85kg
Posted 7/24/2015 9:00 PM (GMT -5)
Might also add his plan is to have me solely on 6mp no remacade or any other meds. Don't know if that changes the dose
Posted 7/25/2015 3:10 AM (GMT -5)
That is the max dose given for leukaemia, not for iBD, which is what the data sheet is referring to. Keep an eye on things and you will be fine.
All the best Josh.
Posted 7/25/2015 6:39 PM (GMT -5)
Thanks all
Posted 8/3/2015 8:34 PM (GMT -5)
For what it's worth, my doctor recently told me that the practice used to be to start on the lowest dose possible to achieve remission. However, he said now there is evidence that you go ahead an start at the maximum therapeutic dose possible (either you are able to take it or you are not) rather than have to continually increase your dose over time and wait 3+ months each time for the new dose to kick in.
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