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azathioprine

azathioprine

introduction

  • azathioprine (Imuran) is a imidazole 6-mercaptupurine derivative immunosuppressant.

uses

adverse effects

  • hypersensitivity
  • bone marrow suppression
  • alopecia
  • pancreatitis
  • hepatotoxicity
  • cholestasis
  • gastrointestinal upset
  • increased risk of infections
  • increased risk of neoplasia / cancer / tumours such as skin cancer, lymphoma
  • Stevens-Johnson syndrome and toxic epidermal necrolysis
  • very rarely, pneumonitis

contraindications

  • hypersensitivity to 6-MP
  • previous rheumatoid arthritis Rx with alkylating agents
  • live vaccines
  • pregnancy

precautions

  • monitor FBE, LFT
  • possible neoplasia / cancer / tumours potential - esp. watch for skin cancers (and minimise UV exposure), cervical cancer and non-Hodgkin's lymphoma
  • avoid pregnancy (including while males are on Rx)
  • avoid exposure to varicella virus
  • avoid abrupt withdrawal
  • care in renal/hepatic impairment
  • care in dental Rx as bacteraemia risk
  • hypersplenism, myasthenia, dermatomyositis, lactation, Lesch-Nyhan syndrome.

dosing

oral tablets

  • should be taken with food
  • tablets are usually 50mg in packs of 100
  • transplantation dose: up to 5mg/kg initial dose then 1-4mg/kg/day maintenance
  • other indications: initially 1mg/kg/day and increase slowly over several weeks by 0.5mg/kg/day as needed to max. 2.5mg/kg/day
  • lower dose in elderly

iv dosing

  • usually only used when oral dosing impractical.
  • slow iv or infusion
azathioprine.txt · Last modified: 2011/04/15 14:01 (external edit)