Azathioprine

Summary

Azathioprine is an immunosuppressant drug used to treat autoimmune diseases like lupus and irritable bowel syndrome, among others. Azathioprine is also used to prevent organ transplant rejection. A major side effect to know is bone marrow suppression, which can manifest as a reduction of red blood cells, white blood cells, and platelets.

Key Points

• Azathioprine (Imuran)
  • Also known as AZA
  • Mechanism
    • Immunosuppressant
      • Purine antimetabolite
        • Blocks purine metabolism and DNA synthesis, suppressing T- and B-lymphocyte proliferation
    • A precursor to the drug 6-MP (6-mercaptopurine)
  • Clinical Uses
    • Autoimmune conditions
      • Systemic Lupus Erythematosus (SLE)
      • Irritable bowel syndrome (IBS)
      • Ulcerative colitis
      • Myasthenia Gravis
    • Prevention of organ transplant rejection
      • Most commonly used post-kidney transplant
  • Side Effects and Adverse Reactions
    • Bone Marrow Suppression
      • Also known as myelosuppression
      • Can lead to anemia (low red blood cells)
      • Can lead to thrombocytopenia (low platelets)
      • Can lead to leukopenia (low white blood cells)
        • Severe, adverse reaction that should be reported to provider
        • Increased when taken with antihypertensives
        • Increased risk of infection
          • Should not receive live vaccines
      • A CBC, including platelet count, should be monitored
    • Nausea and fatigue
    • Hepatotoxicity
      • Liver enzymes should be monitored during treatment