- March 15, 2022
- Newsletter
- 617-430-5616
Menu
Menu
Menu
Menu
Menu
Menu
Brand Name :
APO-Azathioprine, Azasan, Imuran, TEVA-Azthioprine
Synonyms :
Class :
Anticancer & antimetabolites
Dosage forms & Strengths
Solution reconstituted, Injection
100 mg
Tablet, Oral
75 mg
100 mg
50 mg
Note: Patients with thiopurine S- methyltransferase (TPMT) and Nudix hydrolase 15 deficiency are prone to severe hemolytic toxicity.
Consider testing for TPMT and NUDT15 deficiency before starting the treatment.
Behcet syndrome:
50 mg orally once daily for the initial week increase 50mg/4 weeks to reach a maximum dose of 2.5 mg/ kg if tolerated (may be given in combination with glucocorticoid)
Organ transplantation: used as an alternative to mycophenolate in conditions where patients cannot tolerate mycophenolate
Kidney transplantation:
1 to 2 mg/kg oral/IV once a day (do not exceed 150mg/day)
Heart transplantation:
1 to 3 mg/kg oral/IV once a day (do not exceed 200mg/day)
Liver and Lung transplantation:
1 to 2 mg/kg oral/IV once a day (do not exceed 200mg/day)
Lupus nephritis:
Used as an alternative therapy to cyclophosphamide or mycophenolate
50 mg orally once a day for the initial week increase 50mg/4 weeks to reach a maintenance dose of 2 mg/ kg if tolerated, generally given in combination with glucocorticoid
Rheumatoid arthritis:
Used as an alternative to methotrexate therapy
25 to 50 mg once a day for initial 2 weeks and increased for 50mg/4 weeks if tolerated to reach a maintenance dose of 1.5 mg/kg once a day (do not exceed 200 mg/day)
Crohn’s disease:
Induction of remission: 50 mg orally once a day and increased up to 2.5 mg/kg once daily over >12 weeks if tolerated
Management dose: 50 mg orally once a day and increased up to 2.5 mg/kg once daily over >12 weeks if tolerated
Ulcerative colitis:
50 mg orally once a day and increased up to 2.5 mg/kg once daily over >12 weeks if tolerated
The response of azathioprine may take 3 to 6 months
Eosinophilic granulomatosis with polyangiitis:
Maintenance therapy: 25 to 50 mg once a day and increased up to 2 mg/kg once daily over >12 weeks if tolerated (do not exceed 200 mg/day)
Dose adjustments:
Dose adjustment for kidney impairment:
CrCl > 30 ml/minute: No dose adjustment necessary
CrCl 10 to <30 ml/minute: administer 75% of the usual indicated dose
CrCl <10 ml/minute: administer 50% of the usual indicated dose
Intermittent Hemodialysis: administer 50% of the indicated dose
No dose adjustments were provided for any hepatic impairment conditions
Dosage forms & Strengths
Solution reconstituted, Injection
100 mg
Tablet, Oral
75 mg
100 mg
50 mg
Note: Patients with thiopurine S- methyltransferase (TPMT) and Nudix hydrolase 15 deficiency are prone to severe hemolytic toxicity.
Consider testing for TPMT and NUDT15 deficiency before starting the treatment.
uvenile idiopathic arthritis:
1 mg/kg oral/IV initially single dose per day or two doses divided for 12hr
Increase dose by 0.5 mg/kg/day after 6-8 weeks
Do not exceed 2.5 mg/kg/day
Transplantation:
3-5 mg/kg/day oral/IV initially on day of transplant or in rare cases 3 days before transplant
Maintenance dose: 1 to 3 mg/kg/day oral/IV
Lupus Nephritis:
Children and adolescents: 2 to 2.5 mg/kg/dose oral once a day
Dose adjustment for kidney impairment:
GFR >50 ml/minute/1.73m2: No dose adjustment is necessary
GFR 10 to 50 ml/minute/1.73m2: administer 75% of the usual indicated dose
GFR <10 ml/minute/1.73m2: administer 50% of the usual indicated dose
Intermittent Hemodialysis: administer 50% of the indicated dose
No dose adjustments were provided for any hepatic impairment conditions
Refer to adult dosing
it may reduce the therapeutic effect of covid-19 vaccines
may decrease the therapeutic effect of COVID-19 vaccine
may diminish the excretion rate of amantadine
interaction raises immunosuppressive effects and risk of infection
adenovirus types and live oral
may decrease therapeutic effects of the vaccine and increase the risk of adverse effects, vaccines should be avoided until 3 months after immunosuppressive therapy completion
interaction raises immunosuppressive effects and risk of infection
increases the risk of myelosuppression by decreasing the metabolism of azathioprine
interaction raises immunosuppressive effects and risk of infection
may decrease therapeutic effects of the vaccine and increase the risk of adverse effects, vaccines should be avoided until 3 months after immunosuppressive therapy completion
interaction raises immunosuppressive effects and risk of infection
combination should be avoided, may enhance the toxicity of the other by immunosuppressive effects
interaction raises immunosuppressive effects and risk of infection
may diminish therapeutic effects of the vaccine
interaction raises immunosuppressive effects and risk of infection
interaction raises immunosuppressive effects and risk of infection
interaction raises immunosuppressive effects and risk of infection
interaction raises immunosuppressive effects and risk of infection
interaction raises immunosuppressive effects and risk of infection
interaction raises immunosuppressive effects and risk of infection
interaction raises immunosuppressive effects and risk of infection
interaction raises immunosuppressive effects and risk of infection
interaction raises immunosuppressive effects and risk of infection
interaction raises immunosuppressive effects and risk of infection
interaction raises immunosuppressive effects and risk of infection
interaction raises immunosuppressive effects and risk of infection
interaction raises immunosuppressive effects and risk of infection
interaction raises immunosuppressive effects and risk of infection
may enhance hepatotoxic effects of pexidartinib
pretomanid may enhance hepatotoxic effect, use alternate drug
interaction raises immunosuppressive effects and risk of infection
may diminish therapeutic effects of the vaccine
interaction raises immunosuppressive effects and risk of infection
smallpox (vaccinia) vaccine live
avoid vaccine during azathioprine therapy, may decrease effects of smallpox vaccine
interaction raises immunosuppressive effects and risk of infection
interaction raises immunosuppressive effects and risk of infection
interaction raises immunosuppressive effects and risk of infection
interaction raises immunosuppressive effects and risk of infection
interaction raises immunosuppressive effects and risk of infection
interaction raises immunosuppressive effects and risk of infection
azathioprine exerts an antagonistic pharmacodynamic effect on the live rotavirus oral vaccine, leading to a reduction in its efficacy
may diminish effects of antithrombin alfa by an unknown mechanism
may diminish effects of antithrombin III by an unknown mechanism
may diminish therapeutic effects of argatroban
may increase excessive immunosuppressive effects and raise the risk of infection
reduce therapeutic effects of bemiparin
may enhance the risk of neutropenia
reduce therapeutic effects of bivalirudin
may enhance the risk of neutropenia
reduce therapeutic effects of dalteparin
may reduce the immune response to dengue vaccine due to immunosuppressive effects
risk of severe infection due to immunosuppressive effects
combination may enhance the risk of neutropenia
reduce therapeutic effects of enoxaparin
risk of severe infection due to immunosuppressive effects
reduce therapeutic effects of fondaparinux
may enhance the risk of neutropenia
reduce therapeutic effects of heparin
may increase bone marrow suppression
may enhance the risk of immunosuppression and bone marrow suppression
may increase the risk of neutropenia
may increase the risk of neutropenia
risk of severe infection due to immunosuppressive effects
risk of severe infection due to immunosuppressive effects
risk of severe infection due to immunosuppressive effects
may increase the risk of blood disorders
may increase hepatotoxicity
may enhance the risk of neutropenia
risk of severe infection due to immunosuppressive effects
may enhance the risk of immunosuppression and bone marrow suppression
risk of severe infection due to immunosuppressive effects
risk of severe infection due to immunosuppressive effects
may enhance the risk of neutropenia poliovirus vaccine inactivated
decreases effects of sipuleucel-T
risk of severe infection due to immunosuppressive effects
decreases effects of warfarin
may have an increased myelosuppressive effect when combined with azathioprine
may have an increased myelosuppressive effect when combined with azathioprine
may have an increased myelosuppressive effect when combined with azathioprine
may have an increased myelosuppressive effect when combined with azathioprine
may have an increased myelosuppressive effect when combined with azathioprine
It may enhance the toxicity when combined with mipomersen
azathioprine has the potential to reduce the rate of excretion of idebenone, leading to an elevation in levels of serum
Combining tegafur with azathioprine can reduce tegafur’s metabolism
when both drugs combine the risk of both drug increases the toxicity of other by synergism.
when both drugs are combined, there may be an increased risk or severity of adverse effects
when both the drugs are combined, the risk or severity of adverse effects increases
when both drugs are combined, there may be an increased risk or severity of adverse effects
both the drugs increase the effect of immunosuppression risk of infection increases on administering both the drugs simultaneously
when both drugs are combined, there may be an increased risk or severity of adverse effects
trimethoprim: they may increase the myelosuppressive effect of azathioprine
Frequency defined:
>10%:
Nausea (30%)
Vomiting (30%)
Weight loss
Increased liver enzymes (14%)
Myelosuppression (11%)
Leukopenia
infection
decreased CrCl (16%)
<1%
Lymphoma
Frequency not defined:
Alopecia
Arthralgia
Diarrhea
Hepatotoxicity
Sweat syndrome
Thrombocytopenia
Rash
Myelosuppression
Pregnancy consideration: azathioprine is assigned under pregnancy category D. Avoid during pregnancy.
Lactation: excreted in breast milk at very low levels, avoid use during lactation
Pregnancy category:
Azathioprine is a drug from the immunosuppressants class given to patients who underwent kidney transplantation.
This drug suppresses the immune system so that the recipient body accepts the donated organs.
The condition in which the body’s immune system affects the joints is rheumatoid arthritis. Azathioprine helps to treat this dysfunction.
This drug also carries a high risk of developing cancers like lymphoma or skin cancer.
This risk is more prone in patients who are undergoing organ transplantation.
The medication is taken orally once or twice a day or as directed by the physician.
You should take the medication with meals to reduce gastric upset.
The treatment may take two months for arthritis to get better.
Side effects may include vomiting, nausea, and temporary hair loss.
As a precautionary measure, you must tell your doctor about the previous allergy or any allergy to mercaptopurine if you have it, as it may cause severe allergic reactions or other severe problems.
This medication can cause skin cancer, so you should limit the exposure to the sun during the treatment with azathioprine.
Consultation is very much required for pregnant and lactating females to continue the medication during the tenure of treatment.
To check on a missed dose, you must take the amount as soon as you remember and should not double the dose if the skipped dose is near to the next dose.
Store the medication at room temperature and away from sunlight/moisture. It is also advised to keep the product away from pets and children.
ADVERTISEMENT
