Azathioprine

Azathioprine Brand Names- Azasan | Imuran

What is Azathioprine

Azathioprine is an oral and parenteral immunosuppressive agent. It is a chemical analog of the endogenous purines adenine, guanine, and hypoxanthine.

Azathioprine is metabolized to 6-mercaptopurine.

As an immunosuppressant, azathioprine is commonly used in transplant patients but also is useful in the treatment of rheumatoid arthritis, lupus nephritis, and psoriatic arthritis.

It is being investigated as an agent to prevent the development of diabetes mellitus.

Azathioprine was originally approved by the FDA in 1968.

Indications

  1. atopic dermatitis
  2. autoimmune hepatitis
  3. Behcet’s syndrome
  4. Crohn’s disease
  5. dermatomyositis
  6. immune thrombocytopenic purpura (ITP)
  7. kidney transplant rejection prophylaxis
  8. lupus nephritis
  9. myasthenia gravis
  10. polymyositis
  11. psoriasis
  12. pulmonary fibrosis
  13. rheumatoid arthritis
  14. systemic lupus erythematosus (SLE)
  15. ulcerative colitis
  16. Wegener’s granulomatosis

Side Effects

  1. abdominal pain
  2. alopecia
  3. anemia
  4. arthralgia
  5. ascites
  6. bleeding
  7. diarrhea
  8. elevated hepatic enzymes
  9. fever
  10. hepatic failure
  11. hypotension
  12. infection
  13. jaundice
  14. leukoencephalopathy
  15. leukopenia
  16. leukopenia
  17. lymphoma
  18. malaise
  19. myalgia
  20. nausea
  21. new primary malignancy
  22. pancreatitis
  23. pancytopenia
  24. pneumonitis
  25. rash
  26. serum sickness
  27. steatorrhea
  28. thrombocytopenia
  29. veno-occlusive disease (VOD)
  30. vomiting

Monitoring Parameters

  • CBC
  • serum amylase

Contraindications

  • anemia
  • Asian patients
  • Black patients
  • bone marrow suppression
  • breast-feeding
  • Caucasian patients
  • children
  • hepatic disease
  • immunosuppression
  • infection
  • infertility
  • inflammatory bowel disease
  • intramuscular injections
  • leukopenia
  • lymphoma
  • new primary malignancy
  • nucleotide diphosphatase deficiency
  • pregnancy
  • progressive multifocal leukoencephalopathy
  • renal disease
  • renal impairment
  • requires an experienced clinician
  • rheumatoid arthritis
  • sunlight (UV) exposure
  • thiopurine methyltransferase deficiency
  • thrombocytopenia
  • vaccination

Interactions

  • Abacavir; Lamivudine, 3TC; Zidovudine, ZDV
  • Abatacept
  • Adalimumab
  • Alefacept
  • Allopurinol
  • Alpha interferons
  • Amlodipine; Benazepril
  • Amlodipine; Celecoxib
  • Angiotensin-converting enzyme inhibitors
  • Azelastine; Fluticasone
  • Bacillus Calmette-Guerin Vaccine, BCG
  • Balsalazide
  • Baricitinib
  • Basiliximab
  • Beclomethasone
  • Benazepril
  • Benazepril; Hydrochlorothiazide, HCTZ
  • Betamethasone
  • Budesonide
  • Budesonide; Formoterol
  • Captopril
  • Captopril; Hydrochlorothiazide, HCTZ
  • Carbamazepine
  • Celecoxib
  • Certolizumab pegol
  • Ciclesonide
  • Corticosteroids
  • Corticotropin, ACTH
  • Cortisone
  • Cyclophosphamide
  • Daclizumab
  • Deflazacort
  • Dexamethasone
  • Diclofenac
  • Diclofenac; Misoprostol
  • Diflunisal
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Echinacea
  • Efalizumab
  • Enalapril, Enalaprilat
  • Enalapril; Felodipine
  • Enalapril; Hydrochlorothiazide, HCTZ
  • Esomeprazole; Naproxen
  • Etodolac
  • Famotidine; Ibuprofen
  • Febuxostat
  • Fenoprofen
  • Fludrocortisone
  • Flunisolide
  • Flurbiprofen
  • Fluticasone
  • Fluticasone; Salmeterol
  • Fluticasone; Umeclidinium; Vilanterol
  • Fluticasone; Vilanterol
  • Formoterol; Mometasone
  • Fosinopril
  • Fosinopril; Hydrochlorothiazide, HCTZ
  • Golimumab
  • Hydrochlorothiazide, HCTZ; Lisinopril
  • Hydrochlorothiazide, HCTZ; Moexipril
  • Hydrochlorothiazide, HCTZ; Quinapril
  • Hydrocodone; Ibuprofen
  • Hydrocortisone
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Indomethacin
  • Infliximab
  • Influenza Virus Vaccine
  • Interferon Alfa-2a
  • Interferon Alfa-2b
  • Interferon Alfa-2b; Ribavirin
  • Interferon Alfa-n3
  • Interferon Alfacon-1
  • Intranasal Influenza Vaccine
  • Ketoprofen
  • Ketorolac
  • Lamivudine, 3TC; Zidovudine, ZDV
  • Lansoprazole; Naproxen
  • Leflunomide
  • Lesinurad; Allopurinol
  • Lisinopril
  • Live Vaccines
  • Measles Virus; Mumps Virus; Rubella Virus; Varicella Virus Vaccine, Live
  • Measles/Mumps/Rubella Vaccines, MMR
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Meloxicam
  • Mercaptopurine, 6-MP
  • Mesalamine, 5-ASA
  • Methylprednisolone
  • Moexipril
  • Mometasone
  • Muromonab-CD3
  • Mycophenolate
  • Nabumetone
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Natalizumab
  • Nonsteroidal antiinflammatory drugs
  • Olsalazine
  • Oxaprozin
  • Peginterferon Alfa-2a
  • Peginterferon Alfa-2b
  • Perindopril
  • Perindopril; Amlodipine
  • Pexidartinib
  • Piroxicam
  • Prednisolone
  • Prednisone
  • Quinapril
  • Ramipril
  • Ribavirin
  • Rilonacept
  • Riluzole
  • Rituximab
  • Rituximab; Hyaluronidase
  • Rofecoxib
  • Rotavirus Vaccine
  • Rubella Virus Vaccine Live
  • Sipuleucel-T
  • Sirolimus
  • Smallpox and Monkeypox Vaccine, Live, Nonreplicating
  • Smallpox Vaccine, Vaccinia Vaccine
  • Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
  • Sulfasalazine
  • Sulindac
  • Tacrolimus
  • Tocilizumab
  • Tofacitinib
  • Tolmetin
  • Trandolapril
  • Trandolapril; Verapamil
  • Triamcinolone
  • Trimethoprim
  • Typhoid Vaccine
  • Upadacitinib
  • Valdecoxib
  • Varicella-Zoster Virus Vaccine, Live
  • Vigabatrin
  • Warfarin
  • Yellow Fever Vaccine, Live
  • Zidovudine, ZDV