Azathioprine - Benefits, dosage and side effects

Azathioprine is a drug to prevent organ rejection reactions after transplantation. This drug is also used in the treatment of autoimmune diseases, such as rheumatoid arthritis.

Azathioprine belongs to the class of immunosuppressant drugs. This drug works by suppressing the work of the immune system so that it helps the body to accept the newly transplanted organ.

In the treatment of autoimmune diseases, azathioprine will suppress the work of the immune system so that it does not attack healthy cells or tissues.

Azathioprine trademarks: Imuran

What's that Azathioprine

groupPrescription drugs
BenefitPrevent organ transplant rejection or relieve symptoms of autoimmune diseases.
Used byAdults and children
Azathioprine for pregnant and lactating womenCategory D: There is positive evidence of risks to the human fetus, but the benefits may outweigh the risks, for example in dealing with life-threatening situations.

Azathioprine can be absorbed into breast milk. If you are breastfeeding, do not use this medicine without consulting your doctor first.

Drug formFilm-coated tablets and injections

Precautions Before Using Azathioprine

Azathioprine should only be used as prescribed by a doctor. The following are some things you need to pay attention to before using azathioprine:

  • Do not use azathioprine if you are allergic to this medicine or to mercaptopurine. Tell your doctor about any allergies you have.
  • Tell your doctor if you have or have had an infectious disease, bone marrow disorder, blood clotting disorder, cancer, kidney disease, liver disease, Lesch Nyhan syndrome, or a deficiency of the TPMT enzyme.
  • Tell your doctor if you are taking certain medications, supplements, or herbal products.
  • Tell your doctor that you are taking azathioprine if you are having surgery, including dental surgery.
  • Tell your doctor if you are pregnant, planning a pregnancy, or are breastfeeding. Use effective contraception while on treatment with azathioprine.
  • Avoid spending too much time in the sun while taking azathioprine, as this drug can increase the risk of developing skin cancer.
  • Talk to your doctor if you plan to get vaccinated with live vaccines, while on treatment with azathioprine.
  • Avoid close contact with people with infectious diseases that are easily transmitted, such as the flu, measles, or chickenpox, during treatment with azathioprine, as this can increase your risk of contracting it.
  • See your doctor right away if you experience a drug allergic reaction, overdose, or serious side effect after using azathioprine.

Dosage and Instructions for Use of Azathioprine

The dose of azathioprine will be adjusted according to the patient's condition, weight, and body response to the drug. The following is a breakdown of the general dosages of azathioprine in tablet or injection form for adults and children:

  • Condition: Kidney transplant

    The dose is 3-5 mg/kgBW per day, given 1-3 days before transplantation or on the day of transplantation. Maintenance dose 1–3 mg/kg body weight per day.

  • Condition: Prevention of organ transplant rejection reactions

    The dose is 1–5 mg/kgBW. The dose will be adjusted according to the patient's response to the drug.

  • Condition: Autoimmune disease

    The dose is 1-3 mg/kgBW. The use of the drug needs to be discontinued if there is no improvement in the condition after 3-6 months.

  • Condition:Rheumatoid arthritis

    The initial dose is 1 mg/kg body weight per day in 1–2 divided doses, for 6–8 weeks. The dose can be increased by 0.5 mg/kg, once every 4 weeks. The maximum dose is 2.5 mg/kg body weight per day.

MethodUsing Azathioprine Correctly

Azathioprine in the form of an injection will be injected into the patient's vein by a doctor or medical officer on the doctor's instructions. Usually, when the patient's condition has improved, the doctor will replace the injectable azathioprine into tablet form.

Follow the doctor's advice and read the information listed on the drug packaging label before taking azathioprine tablets. Do not reduce or increase the dose without consulting your doctor first.

Azathioprine in tablet form can be taken before or after meals. However, to prevent stomach pain, you should take this drug at mealtime or after eating.

Swallow the tablet whole while drinking water and do not bite the tablet. Make sure to take the medicine regularly for the treatment to be effective. Do not stop taking the drug, unless directed by your doctor.

If you forget to take azathioprine, take this drug immediately if the interval with the next dose is not too close. If it is close, ignore it and do not double the dose.

Be sure to have regular medical check-ups with your doctor when using this medicine. The doctor will ask you to undergo liver function tests, kidney tests, and blood tests, on a regular basis, to monitor your condition.

Store azathioprine in a closed container in a cool, dry place. Avoid exposure to sunlight and keep this medicine out of reach of children.

Azathioprine Interactions with Other Drugs

There are several drug interactions that can occur if azathioprine is used with certain drugs, including:

  • Decreased anticoagulant effect of warfarin
  • Increased risk of severe and fatal infection with fingolimod, golimumab, or adalimumab
  • Increased levels and effects of azathioprine when used with allopurinol
  • Increased effect of decreasing bone marrow activity in producing blood cells (myelosuppressive) when used with cimetidine or indomethacin
  • Increased risk of azathioprine poisoning when used with ribavirin
  • Increased risk of infection due to vaccines containing live attenuated viruses or bacteria, such as BCG vaccine or influenza vaccine
  • Increased risk of developing blood disorders when used with ACE inhibitors or cotrimoxazole

Side Effects and Dangers Azathioprine

Side effects that can occur after using azathioprine are:

  • Nausea or vomiting
  • Headache
  • Hair loss
  • skin rash

Check with your doctor if the side effects above don't get better or get worse. Immediately see a doctor if you experience an allergic drug reaction or serious side effects, such as:

  • Diarrhea or severe nausea and vomiting
  • Joint pain that comes back or gets worse
  • Easy bruising or pale skin
  • Fast heart rate or difficulty breathing
  • Liver disease characterized by symptoms such as dark urine, abdominal pain, persistent vomiting, or jaundice
  • Infectious disease characterized by symptoms such as fever, chills, sore throat, or cough that doesn't get better
  • Lymphoma which can be characterized by the appearance of symptoms such as fever, or swollen lymph nodes

In addition, the use of azathioprine can increase the risk of developing progressive multifocal leukoencephalopathy (PML). Some of the symptoms are loss of balance, difficulty concentrating, and seizures. Immediately see a doctor if you experience these complaints.