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Azathioprine

Molecule Description

Azathioprine is an ‘Immunosuppressant,’ which is used to treat organ rejection after transplantation and certain disorders that cause over activity of the immune system.

Uses of Azathioprine

  • Prevention of rejection of the organ by the immune system after transplantation surgery in patients who received organs such as kidney, liver, heart, lung or pancreas
  • Severe joint pains (rheumatoid arthritis) which is not responding to other treatments
  • Severe form of diseases that affect the lining of the intestines or cause ulcers (Crohn's disease, ulcerative colitis)
  • Conditions due to over-reactive immune system – skin rashes and muscle weakness (dermatomyositis)
  • An immune reaction that affects joints, skin, blood cells, brain, kidneys, etc. (systemic lupus erythematosus)
  • Liver disease due to immune disorders (auto-immune chronic active hepatitis)
  • Destruction of red blood cells (refractory warm auto-immune hemolytic anemia)
  • Easy bruising and purple spots on skin due to low platelet counts (chronic refractory idiopathic thrombocytopenic purpura)
  • Diseases of the arteries (polyarteritis nodosa)

Contraindications of Azathioprine

When should one not use Azathioprine

  • Allergy to Azathioprine or any of the components of the medicine or any other medicine of the same class
  • Severe infections
  • Severe liver or bone marrow diseases
  • Infections of the pancreas (pancreatitis)
  • Live vaccines (BCG or smallpox)

Side effects of Azathioprine

Common side effects of this drug are:

  • Reduction in bone marrow function (decrease in red blood cells, white blood cells and platelets)
  • Any viral, bacterial or fungal infections (due to decreased white blood cells)
  • Tiredness, shortness of breath, headache, feeling dizzy (due to decreased red blood cells), Liver problems with symptoms like pale stools, itching, jaundice (uncommon)
  • Stomach problems (loose motions, stomach pain, constipation, feeling sick), hair loss, sensitivity to skin, severe liver damage or cancers of the blood, lymph (a fluid made up of white blood cells) or skin (rare)
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  • Severe allergic reactions causing swelling of the skin of the face, breathing difficulty with or without rashes and itching, skin blistering, muscle and joint weakness, extreme tiredness, easy bruising, infections of the pancreas, lumps on the body or sudden deterioration of health (serious, but rare)
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Precautions and Warnings of Azathioprine

Pregnancy

Q:
Can I take Azathioprine during pregnancy?
A:
Azathioprine has the potential to harm the unborn baby and should be used in pregnancy only if the patient requires the medicine, and it cannot be substituted.

Breast Feeding

Q:
Can I take Azathioprine while breastfeeding?
A:
It is advised to avoid Azathioprine in breast-feeding women, as it is secreted in the breastmilk and can harm the baby.

Driving

Q:
Can I drive if I have consumed Azathioprine?
A:
Adequate data is not available. But as Azathioprine is used mostly in severe and delicate conditions, extreme caution is recommended, and it is better to avoid driving.

Alcohol

Q:
Can I consume alcohol with Azathioprine?
A:
Alcohol does not interact directly with Azathioprine and limited consumption of alcohol is permissible. But it is important to remember that alcohol affects the immune system and delays recovery.

Other General Warnings

Talk to your doctor if
  • A rare genetic disease that causes increased levels of uric acid in the body (Lesch-Nyhan syndrome)
  • Kidney or liver diseases
  • Azathioprine can increase the risk of tumors of the skin and the lymph nodes (avoid direct contact with light and using multiple immunosuppressant medicines together)
  • Excessive activation of white blood cells in patients with joint pains (macrophage activation syndrome)
  • Be watchful of any new growths or lumps on the skin or inside the body

Mode of Action of Azathioprine

How Does It Work?

Azathioprine works by reducing the production of some types of white blood cells (which cause the immune system to overreact in certain conditions) and thus suppress the immune system; this will decrease the immune response as well as the associated conditions.
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Interactions of Azathioprine

Interactions with other medicines

  • Medicines for gout (Allopurinol, Oxipurinol, Thiopurinol)
  • Muscle relaxants given during anesthesia (Succinylcholine and Tubocurarine)
  • Medications used to prevent blood clots (Warfarin etc.)
  • Penicillamine ( treats rheumatoid arthritis)
  • Co-trimoxazole (to treat infections)
  • Captopril, Furosemide (treats high blood pressure)
  • Cimetidine (reduces stomach acidity)
  • Indomethacin (pain killer)
  • Certain medicines used to treat immune system disorders (TPMT inhibitors - Olsalazine, Mesalazine, Sulfasalazine)
  • Avoid live vaccines such as BCG, smallpox, or yellow fever

Interactions with food items

Azathioprine must be taken with meals, along with a glass of water.

Dosage of Azathioprine

Overdose

Occasional overdose may not be life-threatening. But the common symptoms of high overdose are low blood count, fever, throat ulcers, increased infections, so you should seek medical attention without delay if you notice any of these symptoms.
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Missed a Dose

If you remember within 12 hours of your dose being due, then take your dose as usual. If it is more than 12 hours since your dosage is due, do not take it, and continue with your next dosages at the regular time. Do not take a double dose if you happen to miss a dose. Please visit your doctor if you are losing your dosages more frequently.
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Frequently Asked Questions (FAQs)

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Q: Are there any precautions I need to take before using Azathioprine?

A: Azathioprine is used for severe and delicate conditions involving the immune system. Hence, care and caution is warranted through the course of treatment with this medicine. As it causes changes in blood cells and platelets, regular blood tests may be required. Avoid direct exposure to the sun, wear protective clothing, and use sunscreen lotions. If you take multiple Immunosuppressants, it will increase your risk further. Azathioprine increases the risk of cancer. Do not stop taking medicine suddenly, as it may cause a flare-up of the immune system and lead to harmful reactions. Do not self-medicate with Azathioprine. Inform your doctor if you do not feel like taking this medicine. He will decrease the dose gradually and use other alternatives. Do not take any vaccines without the knowledge of your doctor.

Q: Does Azathioprine cause cancer?

A: Azathioprine does not cause cancer. But it can increase your risk for certain cancer of the skin or the immune system. You can take precautions as illustrated above (protective clothing, avoiding exposure to sun, etc.) and keep your risk to a minimum. Patients do take Azathioprine for long periods with excellent results. Exercise caution as there is a chance of risk due to its actions on the bone marrow causing a decrease in blood cell counts. You should do blood and kidney tests regularly for close monitoring. If you can be a bit careful, there is no need to avoid this medicine.
Last Updated on: 05 Oct 2020 | 10:47 PM (IST)

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Disclaimer
The information provided herein is accurate, updated and complete as per the best practices of the Company. Please note that this information should not be treated as a replacement for physical medical consultation or advice. We do not guarantee the accuracy and the completeness of the information so provided. The absence of any information and/or warning to any drug shall not be considered and assumed as an implied assurance of the Company. We do not take any responsibility for the consequences arising out of the aforementioned information and strongly recommend you for a physical consultation in case of any queries or doubts. Please click here for detailed T&C.
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