What is an Azathioprine?
Azathioprine, also known as Imuran, is an immunosuppressant that helps treat autoimmune diseases like rheumatoid arthritis, Crohn’s, and ulcerative colitis. It’s also essential in the prevention of kidney transplant rejections. This medication is a valuable option for patients who need a little extra help managing these conditions.
How Does Azathioprine Work?
Azathioprine is a unique medication that works inside your body to activate its immunosuppressant properties. It’s a purine analogue and derivative of mercaptopurine, which might sound complicated, but it simply means that it’s designed to inhibit the synthesis of DNA, RNA, and proteins. This process reduces the number of active B and T lymphocytes, which are key players in immune responses.
The interesting part about azathioprine is that it blocks the CD28 signal, which is essential for the full activation of T lymphocytes. By inhibiting this, it causes the cells to undergo apoptosis, or programmed cell death. So, in essence, it’s a clever medication that helps your body control its immune reactions, making it a valuable tool for treating autoimmune disorders and ensuring that your body doesn’t reject a newly transplanted organ. Azathioprine is a handy medication for helping your body reset its immune system when it’s acting up.
How to use Azathioprine Tablet?
Azathioprine is a convenient medication that we can tailor to your individual needs. It’s available as oral tablets or injectable solutions, which we can do according to your condition and its severity. The beauty of this medication is that it’s designed to fit your schedule. Typically, we recommend taking it once or twice each day, but always remember to keep the tablets whole and swallow them with a glass of water. It’s best to have them during a meal, so they’re easy to digest.
We start with a low dose and gradually increase it over time, ensuring that we find the right balance for our body. For those who’ve had a kidney transplant, the usual dosage is between 1 and 2.5 milligrams per kilogram of body weight. If you’re taking it for other conditions, the starting dose can be slightly higher, ranging from 1 to 3 milligrams per kilogram.
Results may take a little time, so we ask for a bit of patience. You’ll start to notice improvements within three months, but make sure you take it regularly as directed. Don’t worry if you occasionally miss a dose but remember to continue your regular schedule as soon as possible. We want to ensure that your medication is stored properly, so keep it at room temperature and away from direct sunlight. Azathioprine is a straightforward and effective solution that we can use to help your body reset its immune responses.
What are the Side Effects of Azathioprine ?
The most common side effects of azathioprine are related to the gastrointestinal system, including nausea, vomiting, and diarrhoea. These tend to occur when first starting treatment and usually resolve within a week. Taking the drug after meals may help to alleviate these symptoms.
Azathioprine also increases the risk of infections, including viral, fungal and bacterial infections. It may also affect the blood, causing anaemia and a decrease in white blood cell and platelet counts. This can lead to bruising and bleeding.
More rarely, it may cause hypersensitivity reactions, liver irritation, and skin changes such as hair loss. Azathioprine has been reported to cause atrial fibrillation in some patients.
The drug’s immunosuppressant effects mean that women who are pregnant or planning a pregnancy should discuss this with their doctor. Azathioprine may also increase the risk of certain cancers, including skin cancer and lymphoma, particularly after an organ transplant.
This is not a complete list of azathioprine’s side effects. Patients should speak with their doctor if they experience any symptoms that concern them.
What are the Warning and Precautions of the Azathioprine?
Azathioprine is a highly beneficial medication, but it does come with some important warnings and precautions that you should be mindful of. We want to ensure that you stay safe while taking it, so here are some key things to remember:
Azathioprine can increase your risk of certain cancers, especially skin cancer. Please be cautious of sunlight exposure and avoid any tanning booths or sunlamps. If you notice any changes in your skin, such as new moles or lumps, please see your doctor right away.
This medication lowers your immune system’s resistance, so it’s best to avoid close contact with sick individuals. If you notice any signs of infection, like a sore throat or fever, let us know immediately.
It can also cause a decrease in blood cell counts, which might lead to bruising and bleeding. We’ll keep an eye on this with regular blood tests, and we ask that you let us know about any unusual bleeding, pallor, or fatigue you experience.
If you’re pregnant or breastfeeding, we need to discuss this medication further. Azathioprine may harm the fetus, so reliable birth control is essential during treatment.
Lastly, azathioprine doesn’t play well with some medications, including ACE inhibitors, allopurinol, and angiotensin-converting enzyme inhibitors. Please let us know all the medicines you’re currently taking, including any vitamins or supplements, so we can ensure they mix well with azathioprine.
Being aware of these potential risks helps ensure that you’re on the right track with your medication. If any of these precautions apply to you, or if you have any concerns, please reach out to us so we can help.
How Does Azathioprine Interact with Other Medicines?
Azathioprine has been reported to have interactions with many other drugs.
The immunosuppressant effects of azathioprine are increased when combined with the following drugs, increasing the risk of infection:
- Abatacept
- Abiraterone
- Adalumimab
- Alefacept
- Anakinra
- Basiliximab
- Belatacept
- Canakinumab
- Etanercept
- Golimumab
- Hydroxychloroquine sulfate
- Infliximab
- Leflunomide
- Mycophenolate
- Ocrelizumab
- Sirolimus
- Tacrolimus
- Tofacitinib
- Tongkat ali
- Ustekinumab
This list is not exhaustive, and other drugs may also enhance the immunosuppressant effects of azathioprine.
Azathioprine also decreases the effectiveness of several vaccines and live attenuated vaccines, including:
- Adenovirus types 4 and 7 live oral vaccine
- Anthrax vaccine
- BCG vaccine live
- Cholera vaccine
- Diphtheria & tetanus toxoids/acellular pertussis vaccine
- Hepatitis A/B vaccine
- Influenza virus vaccine
- Measles, mumps and rubella vaccine live
- Meningococcal A C Y and W-135 polysaccharide vaccine
- Rabies vaccine
- Rotavirus oral vaccine live
- Smallpox (vaccinia) vaccine live
- Typhoid vaccine live
- Varicella virus vaccine live
- Yellow fever vaccine
- Zoster vaccine live
Azathioprine may also decrease the excretion rate of abacavir, increasing its serum level.
Co-prescription of azathioprine and allopurinol is dangerous, as allopurinol interferes with the metabolism of azathioprine. This can result in potentially fatal blood dyscrasias. If both drugs are necessary, the dose of azathioprine should be reduced.
The anticoagulant warfarin is also affected by azathioprine, which inhibits its effect. Patients taking both drugs may require a higher dose of warfarin.
Please speak with your doctor or pharmacist if you are taking any other medications, to ensure they are safe to use in combination with azathioprine.
What happens if I miss a dose of Azathioprine?
If you forget to take a dose of azathioprine, take it as soon as you remember, unless it’s almost time for your next dose. In this case, skip the missed dose and take your next dose at the usual time. Do not take two doses to make up for a missed one.
What happens if I overdose on Azathrioprine?
An overdose of azathioprine, whether accidental or intentional, is likely to result in gastrointestinal symptoms such as nausea, vomiting, and diarrhoea, as well as mild leukopenia and abnormalities in liver function.
More seriously, overdose may lead to marrow suppression, infection, bleeding, and death. Other symptoms of overdose may include fever, chills, sore throat, and low blood cell counts.
