Azathioprine
About Azathioprine
Azathioprine is a prescription medicine used to prevent the body from rejecting a newly transplanted kidney. It is also prescribed to treat severe rheumatoid arthritis when standard treatments have not worked. By calming an overactive immune system, this medicine helps reduce swelling, pain, and tissue damage.
For this medicine to work properly, you must take it consistently every day at the same time as directed by your doctor. It is usually taken once or twice daily, and taking it with or immediately after a meal can help prevent stomach upset. Eating a balanced diet and avoiding raw or undercooked foods can further support your immune health while on this treatment.
While taking Azathioprine, you may experience some common side effects like mild nausea, decreased appetite, or temporary hair thinning. However, you must contact your doctor immediately if you develop serious symptoms such as a fever, sore throat, unusual bruising, or yellowing of your eyes or skin.
Before starting this medicine, talk to your doctor if you have liver disease, kidney disease, a history of cancer, or a genetic condition called TPMT deficiency. Do not take this if you have had a severe allergic reaction to it in the past, or if you are pregnant, as it can harm an unborn baby.
This medicine can interact with other drugs like gout medications, which can dangerously increase the levels of Azathioprine in your body. It is also important to talk to your doctor or pharmacist if you are elderly, planning a pregnancy, breastfeeding, or if you consume alcohol regularly, as these factors require special precautions.
Uses of Azathioprine
Medicinal Benefits
Azathioprine helps control an overactive immune system, reducing inflammation and preventing the body from attacking its own tissues or rejecting a transplanted organ. It supports long-term disease management and helps improve overall quality of life. Benefits may include:
- Helps prevent rejection of transplanted organs, such as a kidney transplant.
- Reduces joint pain, swelling, and stiffness in rheumatoid arthritis.
- Improves mobility and ability to perform daily activities more comfortably.
- Helps manage symptoms of inflammatory bowel disease, such as abdominal pain, diarrhoea, and intestinal inflammation.
- Reduces the frequency and severity of disease flare-ups.
Directions for Use
To get the best results from your treatment, follow these guidelines:
- Swallow the tablet whole with a full glass of water. Do not crush, chew, or break the tablet, as the active medicine can be harmful if it comes into direct contact with your skin or is accidentally inhaled.
- Take this medicine with or immediately after a meal to help reduce stomach upset, nausea, or vomiting.
- Try to take your dose at the same time every day to keep a steady amount of the medicine in your body.
Always follow your doctor's exact instructions regarding how and when to take your medicine. Do not change your dose or stop taking it without consulting your healthcare provider first.
Storage
Side Effects of Azathioprine
Common Side Effects (Usually mild):
- Nausea
- Vomiting
- Loss of appetite
- Hair thinning
- Upset stomach
- Mild diarrhea
Serious Side Effects (Call a doctor right away):
- Signs of an infection, such as fever, chills, sore throat, or a cough that will not go away
- Unusual bleeding, easy bruising, or purple spots on the skin
- Yellowing of the eyes or skin (signs of liver damage) accompanied by dark urine
- Extreme tiredness, pale skin, or shortness of breath (signs of low red blood cells)
- A new skin growth, changes in an existing mole, or a lump that does not go away
Medicines Containing this Salt
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Drug Warnings
- Inspect your tablets: Always check them before taking; do not take them if they are discoloured, chipped, or broken.
- Avoid handling broken tablets: Never handle broken or crushed tablets if you are pregnant or planning to become pregnant, as the active substance can be absorbed through the skin.
- Keep up with regular lab tests: Ensure you complete all scheduled blood tests, as your doctor needs to monitor your white blood cell count and liver enzymes to keep you safe.
- Alert other healthcare providers: Inform all healthcare professionals you visit, including dentists and surgeons, that you are taking an immunosuppressant before any procedure is scheduled.
- Check your vaccine status: Avoid getting any live vaccines while taking this medicine, as they can cause severe infections. Always consult your doctor before receiving any immunisations.
Drug Interactions
Drug-Drug Interactions
- Gout medications (e.g., Allopurinol and Febuxostat): These can dangerously increase the levels of Azathioprine in your body, significantly raising the risk of severe blood disorders and infections.
- Blood thinners (e.g., Warfarin): This medicine can reduce the effectiveness of blood thinners, meaning your doctor may need to adjust your dose and monitor your clotting times more frequently.
- Other immunosuppressants or bone marrow-affecting drugs (e.g., Sulfasalazine or ACE inhibitors): Combining these can severely increase your risk of low blood counts and serious infections.
Drug-Food Interactions
- Alcohol: Drinking alcohol while taking this medicine can increase the risk of liver damage and should be avoided.
Drug-Disease Interactions
- Liver or kidney disease: These conditions make it harder for your body to clear the medicine, which can cause it to build up and increase the risk of severe side effects.
- TPMT deficiency: A genetic lack of the thiopurine methyltransferase (TPMT) enzyme stops your body from safely breaking down this drug, leading to potentially life-threatening bone marrow suppression.
- Active infections: Taking this medicine while you have an active infection (such as tuberculosis) can make it much harder for your body to fight the infection.
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
- Practice strict food safety: Since this medicine lowers your immune system's ability to fight infections, avoid eating raw or undercooked meat, seafood, and eggs, and wash all raw fruits and vegetables thoroughly before eating.
- Protect your skin from the sun: This medication can make your skin more sensitive to sunlight and increase your risk of skin cancer. Apply a broad-spectrum sunscreen with an SPF of 30 or higher daily, wear protective clothing, and avoid tanning beds.
- Maintain strict hygiene: Wash your hands frequently with soap and water, especially before eating and after being in public spaces, to reduce your risk of catching common viruses or bacteria.
- Avoid contagious illnesses: Stay away from anyone who has an active contagious illness, such as chickenpox, shingles, flu, or measles, as your body will find it harder to fight off these infections.
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.
Inflammatory bowel disease (IBD): IBD is a group of long-term conditions that cause ongoing inflammation in the digestive tract. This inflammation can lead to symptoms such as abdominal pain, diarrhoea, fatigue, weight loss, and digestive discomfort. The two main types of IBD are Crohn's disease and ulcerative colitis.
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.
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.
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.
It is best to avoid or limit alcohol while taking this medicine. Both alcohol and Azathioprine can strain your liver, and combining them increases your risk of liver damage. Talk to your doctor or pharmacist.
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.
Azathioprine does not work immediately. For autoimmune conditions like rheumatoid arthritis or inflammatory bowel disease, it can take anywhere from a few weeks to several months before you notice a full improvement in your symptoms. Talk to your doctor.
You can receive inactive (killed) vaccines, such as the yearly flu shot, though they may be less effective. However, you must avoid live vaccines, such as those for shingles, yellow fever, or measles, because your weakened immune system may not be able to handle the vaccine virus safely. Talk to your doctor.
Azathioprine can lower the number of blood cells your bone marrow makes, which increases your risk of infections, anaemia, and bleeding. Regular blood tests allow your doctor to monitor your white and red blood cell counts, platelets, and liver health, ensuring your dose remains safe. Talk to your doctor.
Azathioprine can cause harm to an unborn baby and is generally not recommended during pregnancy. Both men and women taking this medication should use reliable birth control during treatment and for a period after stopping. Talk to your doctor.
Small amounts of Azathioprine can pass into breast milk and could potentially harm a nursing infant. It is generally advised to discuss alternative options with your healthcare provider. Talk to your doctor or pharmacist.
Mild hair thinning is a known, usually temporary, side effect of this medicine. It often improves over time or after the treatment is stopped. If your hair loss is severe or bothersome, do not stop taking your medicine without medical advice. Talk to your doctor.
