Discuss the risks and benefits of taking azathioprine with your doctor. Azelastine; Fluticasone: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. Acetaminophen; Ibuprofen: (Moderate) NSAIDs should be used with caution in patients receiving immunosuppressives as they may mask fever, pain, swelling and other signs and symptoms of an infection. Nonsteroidal antiinflammatory drugs: (Moderate) NSAIDs should be used with caution in patients receiving immunosuppressives as they may mask fever, pain, swelling and other signs and symptoms of an infection. Safety and efficacy have not been established. When biochemical remission is achieved, use the lowest dose necessary to maintain remission. TPMT activity has an inverse correlation with 6-TGN levels in erythrocytes and possibly other hematopoietic tissues, as these cells have little xanthine oxidase activity. This is not a complete list of Imuran side effects. Quinapril: (Major) The use of ACE inhibitors in hypertensive patients receiving azathioprine has been reported to induce anemia and severe leukopenia. Quinapril; Hydrochlorothiazide, HCTZ: (Major) The use of ACE inhibitors in hypertensive patients receiving azathioprine has been reported to induce anemia and severe leukopenia. Azathioprine belongs to a class of drugs known as immunosuppressants. Do not store in the bathroom. Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. Although documentation is lacking, use of echinacea during therapy with immunosuppressants like azathioprine is not recommended by some resources. Erectile dysfunction (ED) is often a symptom . How it works: . Imuran may also be used for purposes not listed in this medication guide. It is created by eHealthMe based on reports of 29,400 people who have side . Always tell your physicians or dentist that you are taking azathioprine prior to having surgery or dental procedures. The maximum clinical improvement may occur during the first two years of therapy. Keep all medical and lab appointments. What will it do for me? Those undergoing immunosuppressive therapy should not be exposed to others who have recently received the oral poliovirus vaccine (OPV). Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Use this medication regularly to get the most benefit from it. Drug information provided by: Merative, Micromedex US Brand Name. Disease-modifying antirheumatic drugs (DMARDs) are a group of medications that decrease inflammation and pain. who do not have cirrhosis, acute severe AIH, or acute liver failure. Most side effects do not require any medical attention and disappear as your body adjusts to the medicine. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Theoretically, this interaction could result in a higher risk of bone marrow suppression or other azathioprine dose-related side effects. Initially, 2 mg/kg/day PO; may titrate by 0.5 mg/kg as indicated/tolerated. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. Allopurinol: (Major) Concomitant use of allopurinol with azathioprine can result in a large increase in azathioprine activity and toxicity (e.g., bone marrow suppression, leukopenia, pancytopenia). Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. When concurrent azathioprine and ACE inhibitor therapy is necessary, the patient should be monitored cautiously for potential myelosuppression. Positive evidence of human fetal risk exists based on investigational, marketing, or human studies, but the potential benefit to the mother may outweigh the potential risks to the fetus in some circumstances/diseases. Brand names: Imuran, Azasan. Exact duration of treatment and need for long-term maintenance should be individualized based on clinical response and tolerance to therapy. Azathioprine is available on prescription only. While therapy is designed to take advantage of this effect, patients may be predisposed to increased immunosuppression and myelosuppression, resulting in an increased risk of infection or other side effects. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. You may report side effects to FDA at 1-800-FDA-1088. Azathioprine prevents rejection of kidney transplant and reduces the inflammation and pain in rheumatoid arthritis by suppressing the body's natural . Do not use medications containing mercaptopurine while using azathioprine. Perindopril; Amlodipine: (Major) The use of ACE inhibitors in hypertensive patients receiving azathioprine has been reported to induce anemia and severe leukopenia. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Increase the dose to 2.5 mg/kg/day after 2 weeks as tolerated. The inhibition of thiopurine methyltransferase activity, one of the enzymes responsible for azathioprine metabolism, by 5-aminosalicylates has been described via in vitro and in vivo study. This effect can cause anemia, decrease your body's ability to fight an infection, or cause easy bruising/bleeding. This combination should be avoided where possible. Further azathioprine dosage reduction or use of an alternative therapy is recommended for patients who have low or absent thiopurine methyltransferase activity, as both the thiopurine methyltransferase and xanthine oxidase pathways are affected. being able to get an erection sometimes, but not every time you want to have sex. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Notify your doctor if you have any signs of infection such as a fever or sore throat. Chlorpheniramine; Ibuprofen; Pseudoephedrine: (Moderate) NSAIDs should be used with caution in patients receiving immunosuppressives as they may mask fever, pain, swelling and other signs and symptoms of an infection. Other medications may interact with azathioprine and you should always discuss any prescription or over the counter drugs used with your physician and pharmacist. Ask your pharmacist how to dispose of medications that are no longer needed or have expired. Blood tests may also be performed to check levels of azathioprine . Oral and parenteral thiopurine immunosuppressive agent; metabolized to 6-mercaptopurineCommonly used in transplant patients but also is useful in RA, lupus nephritis, and psoriatic arthritisIn gastroenterology, used in the treatment of Crohn's disease and ulcerative colitis, Azasan/Azathioprine/Imuran Oral Tab: 50mg, 75mg, 100mgAzathioprine/Azathioprine Sodium Intravenous Inj Pwd F/Sol: 100mg. Brand Names: Azasan, Imuran Generic Name: azathioprine. Alpha interferons: (Moderate) Additive myelosuppressive effects may be seen when alpha interferons are given concurrently with other myelosuppressive agents, such as antineoplastic agents or immunosuppressives. Please tell your doctor if you are taking allopurinol so that the dose of azathioprine can be properly adjusted. Inosine monophosphate dehydrogenase (IMDH) is required for one of the metabolic pathways of azathioprine and ribavirin is known to inhibit IMDH, thereby leading to the accumulation of the azathioprine metabolite, 6-methylthioinosine monophosphate (6-MTITP). This medication may increase your risk of getting a rare but very serious (possibly fatal) brain infection (progressive multifocal leukoencephalopathy-PML). Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Not all possible drug interactions are listed here. Do not chew, crush or break it. Description and Brand Names. Have severe liver disease; Have kidney disease that requires dialysis; Side . If concurrent therapy cannot be avoided, closely monitor platelet and complete blood cell counts. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If more than one dose is missed, check with your prescribing physician for instructions. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch. Each scored tablet contains 50 mg azathioprine and the inactive ingredients lactose, magnesium stearate, potato starch, povidone, and stearic acid. Guidelines recommend thiopurines for maintenance of remission for persons with moderate to severely active ulcerative colitis after steroid induction. In a smaller study comprised of mostly treatment-resistant patients, a dose of 2.5 mg/kg/day PO resulted in greater than 25% improvement in 5/10 patients. As well, some forms of this medication may not be used for all of the conditions discussed here. Reconstitution:Reconstitute 100 mg by adding 10 mL of sterile water for injection to the vial to give a concentration of 10 mg/mL.The reconstituted solution should be clear and should be used within 24 hours. If you are taking pills more than once a day, skip the missed dose and go back to your regular schedule. Concomitant use may increase the risk for hepatotoxicity. HOW SUPPLIED. Diclofenac; Misoprostol: (Moderate) NSAIDs should be used with caution in patients receiving immunosuppressives as they may mask fever, pain, swelling and other signs and symptoms of an infection. The following regimen has been recommended: initially, 50 mg PO once daily for 1 week, then increase gradually to 2 to 3 mg/kg/day PO. Patients who were antibody-positive were more likely to have higher rates of infliximab clearance and reduced efficacy than were patients who were antibody negative. This combination should be avoided where possible. Azathioprine is an anti-inflammatory medicine used to treat rheumatoid arthritis and other inflammatory conditions. This document does not contain all possible drug interactions. Fludrocortisone: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. Guidelines do not recommend thiopurine monotherapy for induction of remission. It's not toxic to the liver when it's taken occasionally and within recommended dosages. Avoid sunlight or tanning beds. Budesonide: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. Counsel patients receiving azathioprine about the signs and symptoms of infections and avoidance techniques. The phase IV clinical study analyzes which people take Imuran and have Liver function test abnormal. A reduction in sperm viability and count and temporary decline in spermatogenesis has been reported in mice that received 10 times the human dose of azathioprine. Indomethacin: (Moderate) NSAIDs should be used with caution in patients receiving immunosuppressives as they may mask fever, pain, swelling and other signs and symptoms of an infection. Budesonide; Glycopyrrolate; Formoterol: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. Do not take two doses at one time. If it is time for the next dose, take both doses together, and then resume the normal schedule. Imuran can increase your risk of developing skin cancer. Tell your doctor if you are pregnant or plan to become pregnant. WebMD does not provide medical advice, diagnosis or treatment. They are often called immunosuppressants or immunomodulators because these medications hold back or change how your immune system your body's defense system works. Imuran (azathioprine) is an immunosuppressive antimetabolite used to prevent the body from rejecting a transplanted kidney. Imuran Tablet also relieves joint pain and inflammation in rheumatoid arthritis. It is used to prevent the rejection of kidney transplants and to treat severe rheumatoid arthritis that is not responding to conventional treatment. Limited data suggest doses of 1.5 to 3 mg/kg/day orally may be effective. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. Take your next dose at the regular time. When concurrent azathioprine and ACE inhibitor therapy is necessary, the patient should be monitored cautiously for potential myelosuppression. 200 cashback on paying via CRED pay UPI. Advise patients taking abatacept to seek immediate medical advice if they develop signs and symptoms suggestive of infection. There is insufficient experience to assess the safety and efficacy of this combination. Let us know if you have any questions regarding this information. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. When concurrent azathioprine and ACE inhibitor therapy is necessary, the patient should be monitored cautiously for potential myelosuppression. Concurrent usage is, in essence, a duplication of pharmacologic therapy and may lead to overdosage. Unusual bruising. AST 174 H 10-40 U/L. This has occurred mainly in teenagers and young men with Crohn's disease or ulcerative colitis. Contact your doctor immediately if you come into contact with someone who has chickenpox or shingles. A risk of added immunosuppression exists when upadacitinib is coadministered with potent immunosuppressives. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. Naproxen: (Moderate) NSAIDs should be used with caution in patients receiving immunosuppressives as they may mask fever, pain, swelling and other signs and symptoms of an infection. Etodolac: (Moderate) NSAIDs should be used with caution in patients receiving immunosuppressives as they may mask fever, pain, swelling and other signs and symptoms of an infection. Register Now. Your gift will support programming and fund cutting-edge research leading to better treatments and a cure for MG. Sipuleucel-T stimulates the immune system and patients receiving immunosuppressives may have a diminished response to sipuleucel-T. Many medications can cause side effects. Immunosuppressants help to calm or control your body's immune system. If you notice any signs of infection (e.g., fever, chills, cough, painful urination) or any other unusual symptoms, contact your doctor. Careful monitoring by your doctor may decrease your risk. Rheum.TV is an informational platform created to educate patients living with a rheumatic disease. The risk is typically related to the intensity and duration of immunosuppression Tofacitinib: (Major) Concomitant use of tofacitinib with azathioprine is not recommended because of the possibility of additive immunosuppression and increased infection risk. Azathioprine may harm an unborn baby. Drugs that may affect the production of leukocytes, including sulfamethoxazole; trimethoprim, SMX-TMP, may lead to exaggerated leukopenia, especially in patients who have received a renal transplant. Store at room temperature away from light and moisture. Ciclesonide: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. Avoid tanning booths and sunlamps. Azathioprine is a type of medicine called an immunosuppressant. Medically reviewed by Drugs.com on Jan 27, 2023. Limit your time in the sun. Patients who are steroid dependent should be started on thiopurines with or without anti-TNF therapy. Azathioprine is used to reduce signs and symptoms of rheumatoid arthritis, such as joint swelling, pain, tiredness, and duration of morning stiffness. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. Azathioprine is a type of medicine called an immunosuppressant. You should not breast-feed while you are using Imuran. It works by suppressing the blood cells that cause inflammation. 2 to 2.5 mg/kg/dose PO once daily. This combination should be avoided where possible. A greater than 75% improvement was reported in 13 patients and 6 patients exhibited greater than 50% improvement. Tell your doctor right away if you develop any of the following symptoms: unusual skin changes, change in the appearance/size of moles, unusual growths/lumps, swollen lymph nodes, swollen abdomen, unexplained weight loss, night sweats. This medicine is also used to treat symptoms of rheumatoid arthritis. Are there any other precautions or warnings for this medication? If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor. Increased susceptibility to a new primary malignancy, particularly of the skin, results from chronic immunosuppression with azathioprine. signs of a severe allergic reaction, e.g. After the transplant, tablets are used. The concurrent use of infliximab and immunosuppressants may also contribute to malignancy risk. Ibuprofen; Oxycodone: (Moderate) NSAIDs should be used with caution in patients receiving immunosuppressives as they may mask fever, pain, swelling and other signs and symptoms of an infection. Fosinopril: (Major) The use of ACE inhibitors in hypertensive patients receiving azathioprine has been reported to induce anemia and severe leukopenia. Inform patients about the malignancy risk, and instruct patients to limit sunlight (UV) exposure by wearing protective clothing and by using a sunscreen with a high protection factor. This combination should be avoided where possible. Consider azathioprine for recurrent mucocutaneous disease manifestations and recurrent and chronic articular disease manifestations. Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit. If you miss a dose and you are taking the pills once a day, do not take the missed dose at all, but go back to your regular dosing schedule. Increase dose to 2.5 mg/kg/day after 2 weeks if white blood cell count is 4 x 109 or more and has not decreased by more than 50% from baseline and liver function tests and amylase are not rising. The risk is typically related to the intensity and duration of immunosuppression. Ibuprofen; Famotidine: (Moderate) NSAIDs should be used with caution in patients receiving immunosuppressives as they may mask fever, pain, swelling and other signs and symptoms of an infection. This metabolite is associated with myelotoxicity (neutropenia, thrombocytopenia, and anemia). Consider thiopurine methyltransferase (TPMT) genetic or enzyme activity testing before initiating therapy; dosage adjustments may be necessary. Balsalazide: (Moderate) 5-aminosalicylates (e.g., sulfasalazine, mesalamine, olsalazine) may interact with azathioprine and increase the risk of azathioprine-related toxicity. This allows the neuromuscular transmission to function normally, resulting in a return of muscle strength. Maintenance dosage should be reduced by 0.5 mg/kg or approximately 25 mg daily every 4 weeks while other therapy is kept constant until the minimum effective dose is achieved. Drug information provided by: Merative, Micromedex US Brand Name. Typhoid Vaccine: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. 1 mg/kg/day PO once daily or divided twice daily; gradually increase dose to 2 to 3 mg/kg/day for several months. Turn Awareness into Action - MG Awareness Month 2023. This combination should be avoided where possible. The dosage is based on your medical condition, weight, and response to treatment. Trandolapril: (Major) The use of ACE inhibitors in hypertensive patients receiving azathioprine has been reported to induce anemia and severe leukopenia. Enter your medication into the WebMD interaction checker, B-Cell Therapy for Multiple Sclerosis : Be Informed, Neurologists and Others You'll Need for MS Care, treatment to maintain immunosuppression for lung transplant, liver inflammation resulting from an abnormal immune response, systemic lupus erythematosus, an autoimmune disease, inflammation of skin and muscles all over the body, chronic inflammation of muscles in the body called polymyositis, ulcerative colitis, an inflammatory condition of the intestines, pyoderma gangrenosum, a condition where large painful skin sores form, myasthenia gravis, a skeletal muscle disorder. We proof read and recheck at various steps to provide you the right medication in the correct form and dose, Most medicines cannot be sold without a valid prescription, as per the Drugs and Cosmetics Act, 1940 and Rules, 1945, We do not facilitate sale of this product at present. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. Vigabatrin: (Major) Vigabatrin should not be used with other drugs like azathioprine that are associated with serious ophthalmic effects (e.g., retinopathy or glaucoma) unless the benefit of treatment clearly outweighs the risks. tablet 25mg 50mg 75mg 100mg Typical dosing for Imuran (azathioprine) The dosing for this medication is different for everyone. Intramuscular injections should not be administered to patients with platelet counts < 50,000/mm3 who are receiving azathioprine. 1 to 2 mg/kg/dose (Max: 50 to 100 mg/dose) PO once daily, initially. It is important to take azathioprine exactly as directed by your doctor. Azathioprine medication uses Azathioprine is often prescribed so that doses of other immunosuppressant medications may be decreased and side effects may be less severe. While therapy is designed to take advantage of this effect, patients may be predisposed to increased immunosuppression and myelosuppression, resulting in an increased risk of infection or other side effects. Breast-feeding while taking Azathioprine is not recommended. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Therefore, your doctor will check blood tests . Perindopril: (Major) The use of ACE inhibitors in hypertensive patients receiving azathioprine has been reported to induce anemia and severe leukopenia. Select a condition to view a list of medication options. Drug classes: Antirheumatics, Other immunosuppressants. Renal transplant patients whose homograft is undergoing rejection may experience more severe toxicities. Take this medication by mouth as directed by your doctor, usually once or twice daily. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. Many drugs can affect Imuran, especially: This list is not complete and many other drugs may affect Imuran. Azathioprine is used to reduce signs and symptoms of rheumatoid arthritis, such as joint swelling, pain, tiredness, and duration of morning stiffness. Rilonacept: (Moderate) Patients receiving immunosuppressives along with rilonacept may be at a greater risk of developing an infection. When concurrent azathioprine and ACE inhibitor therapy is necessary, the patient should be monitored cautiously for potential myelosuppression. Organ rejection happens when the immune system treats the new organ as an invader and attacks it. Do NOT use azathioprine for the treatment of rheumatoid arthritis in pregnant women. Do not receive a "live" vaccine while using Imuran. 1 to 2 mg/kg/day PO plus tacrolimus and corticosteroids led to a survival free of graft loss in 89.6% and a survival free from rejection in 68.7% of 93 patients 2 years after transplantation, According to renal transplant guidelines, an antiproliferative agent such as azathioprine is to be used for initial maintenance immunosuppression with a calcineurin inhibitor such as tacrolimus plus or minus corticosteroids. Prepare in a biological safety cabinet or compounding aseptic containment isolator with a closed system drug transfer device. Loss of appetite. Consider genotyping or phenotyping for TPMT deficiency and genotyping for NUDT15 deficiency in patients that develop severe myelosuppression; this genetic testing should not replace complete blood count (CBC) monitoring during azathioprine therapy. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. 1 to 3 mg/kg/dose PO once daily. 25 mg PO once daily, initially. After the third month of treatment, laboratory monitoring may be increased to more than monthly if dosage or other therapy changes are necessary. Add azathioprine to prednisone after 2 weeks in persons with compensated cirrhosis, and consider addition of azathioprine after cholestasis is resolved in persons with . Azathioprine alone is not more effective than placebo to induce remission; however, it is effective for maintenance of remission in patients with Crohn's disease. Formoterol; Mometasone: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. However, some possible adverse effects are very serious and need prompt attention. Therefore, your doctor will check blood tests regularly to monitor for significant changes. Not a Member? Because of the poor prognosis of veno-occlusive disease, it is recommended that liver biopsies be performed at the first sign of hepatic dysfunction. Infliximab: (Moderate) Most infliximab recipients who developed serious infections were taking concomitant immunosuppressives such as methotrexate or corticosteroids. While on azathioprine your doctor may limit your alcoholic beverage intake. Do not dispose of medications in wastewater (e.g. Echinacea: (Major) Echinacea possesses immunostimulatory activity and may theoretically reduce the response to immunosuppressant drugs like azathioprine. For the treatment of arthritis, it may take up to 2 months before your symptoms get better. Azathioprine is a cornerstone of the therapy of Crohn's disease. Take the medicine regularly to get the most benefit and keep taking it even if you feel well. Your doctor has prescribed Imuran Tablet to stop the body from rejecting a transplanted organ (e.g. Basiliximab: (Minor) Because azathioprine is an immunosuppressant with myelosuppressive actions, additive affects may be seen with other immunosuppressives. ED is often a symptom of another health problem or health-related factor. Do not share this medication with others. Side effects can be mild or severe, temporary or permanent. Eye/face and respiratory protection may be needed during preparation and administration. Ask your doctor for details. You should take it along with food. Because of the possibility of hepatotoxicity, hepatic function should be carefully assessed in patients receiving azathioprine, especially in patients with preexisting hepatic disease. Keep all medications away from children and pets. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Dosage reductions recommended in patients with know heterozygous TPMT or NUDT15 deficiency. When used for the prevention of tissue rejection, azathioprine usually is administered in conjunction with local radiation therapy, corticosteroids, and other cytotoxic agents. Most side effects may go away as your body adjusts to the medication. Increase the dose to 1.25 mg/kg/day after 2 weeks as tolerated. The optimum duration of maintenance azathioprine has not been determined. Add azathioprine to prednisone after 2 weeks in persons with compensated cirrhosis, and consider addition of azathioprine after cholestasis is resolved in persons with acute severe AIH. Take with food if Imuran upsets your stomach. Azathioprine can lower your immune system and increase your risk of getting infections. 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Imuran may also be performed at the first two years of therapy adjusts to the medicine many other may... Titrate by 0.5 mg/kg as indicated/tolerated protection may be decreased, even despite alternate vaccination schedules more. Attention and disappear as your body adjusts to the medicine symptoms suggestive of infection such as a fever or throat! Is achieved, use the lowest dose necessary to maintain remission refer to the medicine as soon as you,! Discussed here severely active ulcerative colitis after steroid induction contraindicated ) live virus vaccines should generally be...