Azathioprine
About Azathioprine
Azathioprine is used to prevent rejection of kidney transplants. It is also used to treat symptoms of active rheumatoid arthritis (a condition in which the immune system attacks the joints, causing pain and inflammation).
Azathioprine contains Azathioprine (an immunosuppressant), which works by calming the immune system. It prevents certain white blood cells (especially T and B cells that attack foreign invaders and defend the body against harmful cells) from proliferating excessively. As a result, Azathioprine helps prevent the body from attacking a transplanted organ and reduces inflammation in joint tissues.
Take Azathioprine exactly as prescribed by your doctor. Swallow it whole with a glass of water, and do not crush or chew it. Azathioprine may cause common side effects, including nausea, headache, vomiting, diarrhoea, dizziness, loss of appetite, increased liver enzymes, reduced resistance to infections, and leukopenia (decreased white blood cell count). Please consult your doctor if these side effects persist or worsen.
Do not take Azathioprine if you are allergic to any of its ingredients or if you are pregnant, planning to become pregnant, or breastfeeding. Azathioprine should not be given to children, as its safety and efficacy have not been established. Inform your doctor before taking Azathioprine if you have any bacterial, fungal, or viral infections, liver or kidney problems, or are taking other immunosuppressant or chemotherapy medications.
Uses of Azathioprine
Medicinal Benefits
Azathioprine offers the following medicinal benefits:
- Suppresses the immune system to help prevent rejection of newly transplanted organs, such as kidneys.
- Relieves joint pain and inflammation while slowing joint damage and disease progression in patients with rheumatoid arthritis.
- May help control an overactive immune system in various autoimmune conditions (such as ulcerative colitis, lupus, and autoimmune hepatitis)
- May decrease the need for long-term steroid use in patients with severe inflammatory skin disorders.
Directions for Use
- Azathioprine can be taken with or without food. However, if you experience stomach upset, take it with food. Avoid taking it with milk or dairy products, as they may reduce its effectiveness.
- Your doctor will determine the dosage and timing of this medication based on your medical condition. If taken regularly, it is typically recommended 1-2 times daily.
- Swallow Azathioprine as a whole with a glass of water.
- Do not crush, chew, or break it.
Storage
Side Effects of Azathioprine
- Nausea
- Headaches
- Vomiting
- Diarrhoea
- Unusual fatigue
- Dizziness
- Headache
- Loss of appetite
- Increase in liver enzymes
- Lowered resistance to infections
- Tingling sensation
- Stomach pain
- Leukopenia (decreased number of white blood cells)
- Sore throat
Medicines Containing this Salt
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Drug Warnings
- Do not take Azathioprine if you are allergic to any of its ingredients or other immunosuppressant medications.
- Let your doctor know before taking Azathioprine if you have liver or kidney problems, serious blood disorders, immune system problems, bone marrow problems, serious infections, or immunodeficiency syndrome.
- Do not take Azathioprine if you are pregnant or planning to become pregnant, as it may cause serious congenital disabilities in the unborn baby.
- Avoid taking Azathioprine while breastfeeding, as it can pass into breast milk.
- Azathioprine should not be given to children, as its safety and effectiveness have not been established.
- Azathioprine may cause dizziness and drowsiness, so drive with caution.
- Using Azathioprine for a long time may increase your chance of getting certain types of cancer, such as lymphoma (cancer of the spleen, thymus gland, and bone marrow), leukaemia (blood cancer), and skin cancer.
- Avoid excessive exposure to sunlight; wear protective clothing; and apply a high-SPF sunscreen while using Azathioprine.
Drug Interactions
Drug-Drug Interactions: Azathioprine may interact with certain medicines, potentially increasing side effects or altering their effectiveness. Inform your doctor if you are taking any of the following:
- Drugs used to treat gout (Allopurinol, Febuxostat)
• Potential effect: May increase the blood levels and effects of Azathioprine. - Immunosuppressants (Cladribine)
• Potential effect: May increase the risk of serious infections and certain cancers (such as skin and lymph gland cancer). - Disease-modifying anti-rheumatic drugs (Adalimumab, Baricitinib, Tofacitinib)
• Potential effect: May increase the risk of serious infections. - Drugs used to treat multiple sclerosis (Fingolimod, Teriflunomide)
• Potential effect: May increase the risk of developing anaemia, bleeding issues, and infections. - Anti-cancer medications (Mercaptopurine)
• Potential effect: May increase the risk of side effects.
Drug-Food Interactions: Avoid consuming alcohol while taking Azathioprine, as it may cause increased dizziness.
Drug-Disease Interactions: Azathioprine should be avoided or used with caution in people with:
- Bone marrow depression (a serious condition in which the bone marrow produces fewer blood cells or platelets)
- Serious bacterial, fungal, or viral infections
- Kidney dysfunction
- Liver disease
Drug-Drug Interactions Checker List:
Safety Advice
Alcohol
cautionYou are recommended to avoid alcohol consumption while taking Azathioprine. It could lead to increased dizziness and drowsiness.
Pregnancy
cautionAzathioprine is a Category D pregnancy drug that is not recommended for pregnant women or given only under the strict guidance of the doctor, as there is no clinical data available on use in pregnant women.
Breast Feeding
cautionIt is not recommended to take Azathioprine while you are breastfeeding. Azathioprine passes into breast milk.
Driving
cautionAzathioprine may cause dizziness, drowsiness, and tiredness; do not drive or operate heavy machinery if you feel dizzy.
Liver
cautionTake Azathioprine only as prescribed by your doctor, especially if you are dealing with Liver diseases/conditions, as your doctor may adjust the dose as required.
Kidney
consult your doctorPlease consult your doctor if you have kidney impairment before taking Azathioprine.
Children
unsafeAzathioprine should not be used by children below 18 years of age, as its efficacy and safety have not been established.
Habit Forming
Diet & Lifestyle Advise
Healthy diet:
- Eat foods rich in antioxidants, such as berries, spinach, kidney beans, and dark chocolate.
- Consume foods containing flavonoids to help reduce inflammation, such as soy, berries, broccoli, grapes, and green tea.
- Avoid alcohol consumption.
Physical activity and exercise:
- Maintain a healthy weight by engaging in regular low-impact exercise and eating a healthy diet.
- Physical activity helps strengthen muscles and relieve joint stiffness. Gentle activities like 20-30 minutes of walking or swimming would be helpful.
- Practising yoga may also help improve joint flexibility and manage pain.
Rest and recovery:
- Get adequate sleep, as rest can help reduce inflammation and swelling.
- Apply cold or hot compresses to the joints for 15-20 minutes regularly to reduce swelling.
Stress management and therapies:
- De-stress by meditating, reading, taking a warm bubble bath, or listening to soothing music.
- Acupuncture, massage, and physical therapy may also be helpful.
Special Advise
- Use sunscreen while taking Azathioprine, as it can increase skin sensitivity to sunlight and may increase the risk of skin cancer.
- Long-term use of Azathioprine may increase your risk of developing cancers like blood cancer, skin cancer and immune system cancer (lymphoma).
Patients Concern
Disease/Condition Glossary
Kidney transplant rejection: When you get a new kidney transplanted to your body, your body recognises it as a foreign element and tries to attack and reject it because it is not originally part of your body. Immunosuppressant drugs, such as azathioprine, are administered to patients to prevent the immune system from attacking a newly transplanted kidney.
Rheumatoid arthritis: It is an autoimmune disease (the body's immune system attacks its tissue) that leads to joint pain and damage. Symptoms of rheumatoid arthritis include joint pain and inflammation, difficulty moving, and swelling.
FAQs
Azathioprine is used to prevent kidney transplant rejection. It is also used to treat symptoms of active rheumatoid arthritis (a condition in which the immune system attacks the joints, causing pain and inflammation).
Azathioprine causes leukopenia (decreased number of white blood cells) and hence may make you more susceptible to infections. Consult your doctor if you develop any signs of infections such as fever, sore throat, breathlessness, jaundice, unexplained bleeding, or bruising.
Azathioprine acts as an immunosuppressant, which helps in reducing inflammation and preventing joint stiffness, thereby providing relief from rheumatoid arthritis.
If you miss a dose of Azathioprine, take the missed dose as soon as you remember it. However, if it's almost time for the next dose, do not take a double dose to make up for a missed one.
Diarrhoea might be a side effect of Azathioprine. Drink lots of fluids and eat food rich in fibre if you experience diarrhoea. If you find blood in your stools (tarry stools) or experience excess diarrhoea, consult your doctor. Do not take anti-diarrheal medicine on your own.
Azathioprine is a Category D pregnancy drug that is not recommended for pregnant women or given only under the strict guidance of the doctor, as there is no clinical data available on use in pregnant women.
Azathioprine starts to work gradually. It can take up to 12 weeks of taking the right adjusted dose before you notice any benefits.
If you miss a prescription dose, take it as soon as you recall and resume your regular routine. If you are near the next dose, skip the missing dose and resume your regular schedule. Do not take a double dose to make up for a forgotten dose.
It depends on your individual medical condition and response to the medication. Your doctor will determine the appropriate duration of treatment based on your specific needs.
Taking Azathioprine for a long time can increase your risk of developing some types of cancer, including skin cancer. As a result, avoid direct sunlight, apply sunscreen (SPF 30 or higher), and wear clothes that shield your arms and legs.
You'll have regular blood tests while taking azathioprine. These tests will ensure that any concerns or problems are found quickly.
Azathioprine may have an effect on your liver, kidneys, or bone marrow. Before you begin taking this medication, you will undergo blood tests to assess your liver function, renal function, and blood count. From week one to week eight of your treatment, you will undergo at least one blood test every week.
Yes, taking Azathioprine for a long time can increase your risk of developing some types of cancer, including skin cancer. Seek medical attention if you experience any changes in your body.
Using Cyclosporine together with Azathioprine may decrease the effects of cyclosporine. Caution is advised if Cyclosporine must be taken with Azathioprine. You may need a dose adjustment or a special test if you use both medications.
Alcohol does not affect the way azathioprine works. However, both azathioprine and alcohol can affect your liver. For this reason, limiting or avoiding the consumption of alcohol is recommended.
Common side effects of Azathioprine may include nausea, headache, vomiting, diarrhoea, unusual fatigue, dizziness, loss of appetite, increased liver enzymes, lowered resistance to infections, tingling sensation, stomach pain, leukopenia (decreased number of white blood cells), and sore throat. Most of these side effects do not require medical attention and will resolve gradually over time. However, you are advised to talk to your doctor if you experience these side effects persistently.
