Azathioprine is a drug used to prevent organ rejection after a transplant. This medication 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 organ that has just been transplanted.

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

Azathioprine trademark: Imuran

What is Azathioprine

group Prescription drug
Category Immunosuppressants
Benefit Prevent organ transplant rejection or relieve symptoms of autoimmune diseases.
Used by Adults and children
Azathioprine for pregnant and lactating women  Category D: There is positive evidence of risk to the human fetus, but the benefits may outweigh the risks, for example in dealing with a life-threatening situation.

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

Drug form Film-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 history of allergies you have.
  • Tell your doctor if you have or are suffering from an infection, bone marrow disorder, blood clotting disorder, cancer , kidney disease, liver disease , Lesch Nyhan syndrome, or TPMT enzyme deficiency.
  • 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 any 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 being active for too long in the sun while undergoing treatment with azathioprine, because this drug can increase the risk of developing skin cancer .
  • Consult your doctor if you are planning to be 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 an allergic drug reaction, overdose, or serious side effect after using azathioprine.

Dosage and Rules for Using 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 injectable form for adults and children:

  • Condition: Kidney transplant
    Dosage 3-5 mg/kgBW per day, given 1-3 days before transplant or on transplant day. Maintenance dose 1–3 mg/kg body weight per day.
  • Conditions: Prevention of organ transplant rejection reactions . The
    dose is 1–5 mg/kgBB. Dosage 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.
  • Conditions: Rheumatoid arthritis
    Initial dose of 1 mg/kg 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 per day.

How to Use Azathioprine Properly

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 recommendations and read the information printed on the drug packaging label before taking azathioprine tablets. Do not reduce or increase your dose without consulting your doctor first.

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

Swallow the tablet whole while drinking water and do not bite the tablet. Be sure to take the drug 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 gap with the next dose is not too close. If it's close, ignore it and don't double the dose.

Be sure to have regular medical check-ups with your doctor when using this medicine. Your doctor will ask you to have 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 interaction effects that can occur if azathioprine is used with certain drugs, including:

  • Decreased anticoagulant effect of warfarin
  • Increased risk of developing a severe or fatal infection when used 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 from vaccines containing live attenuated viruses or bacteria, such as the BCG vaccine or influenza vaccine
  • Increased risk of developing blood disorders when used with ACE inhibitors or co- trimoxazole

Side Effects and Dangers of 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 improve 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 returns or gets worse
  • Easy bruising or pale skin
  • Fast heart rate or difficulty breathing
  • Liver disease characterized by symptoms of dark urine, abdominal pain, persistent vomiting or jaundice
  • Infectious disease characterized by symptoms such as fever, chills , sore throat, or cough that does not improve
  • 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 go to the doctor if you experience these complaints.

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