Azathioprine

Azathioprine

Azathioprine is one of the most accessible immunosuppressive medications. The powerful drug plays a significant role in preventing organ rejection for kidney transplant patients. The medication helps doctors treat health conditions beyond transplant care. It effectively manages rheumatoid arthritis, Crohn's disease, ulcerative colitis, and systemic lupus erythematosus. 

This article explains how azathioprine works, its uses, side effects, and what it all means.

What is Azathioprine?

Azathioprine tablets are small, round white pills that contain 50 mg of the active ingredient along with inactive components like lactose and potato starch. 
Azathioprine is an immunosuppressive antimetabolite that doctors classify as an imidazolyl derivative of 6-mercaptopurine. Your body absorbs the drug quickly after you take it and blood levels peak within 1-2 hours.

Azathioprine Uses

Doctors prescribe azathioprine to prevent kidney transplant rejection and manage active rheumatoid arthritis. It also helps treat several autoimmune conditions like systemic lupus erythematosus, inflammatory bowel disease and other inflammatory disorders.

How and When to Use Azathioprine Tablet

• You should take the medication once or twice daily after meals to avoid stomach upset. 
• Take the medicine at the same time each day to maintain its concentration.
• Swallow the tablet whole with water; do not crush or chew the tablet.
• The medication works best if you take it at least 1 hour before or 2 hours after having milk or dairy products.
• Do not stop the medicine without consulting your doctor.

Azathioprine Side Effects 

Common side effects include:

• Nausea and vomiting
• Loss of appetite
• Diarrhoea
• Fatigue
• Reduced blood cell counts
• Hair loss
• Increased risk of infections

Serious side effects:

• Allergic reaction
• Long term use of azathioprine might increase the risk of certain cancers

Precautions

• You will need regular blood tests while taking azathioprine, especially during your first 8 weeks of treatment. 
• Take medicine exactly as prescribed by your doctor do not change the timing and dosage of the drug on your own.
• You should avoid vaccinations unless your doctor approves them.
• Take extra care to protect yourself from infections.
• Azathioprine works differently from other medications - patients might need to wait up to 12 weeks before seeing improvements.

How Azathioprine Tablet Works

Your body converts azathioprine into active substances called 6-MP and 6-TGN. These compounds block DNA and RNA production and prevent white blood cells from multiplying. The medication reduces immune response by targeting cells that grow rapidly. This helps arthritis patients by lowering joint inflammation and protects transplanted organs from rejection.

Can I Take Azathioprine with Other Medicines

Azathioprine interacts with many drugs, so careful consideration is essential. The most significant interactions include:

• Allopurinol 
• ACE inhibitors (like lisinopril) 
• Aminosalicylates
• Febuxostat 
• Tacrolimus
• Warfarin

Make sure to inform your doctors about all your medications.

Dosage Information

Your condition and body weight determine the dose:

• Kidney transplants: The original dose is 3-5 mg/kg daily, followed by maintenance at 1-3 mg/kg
• Rheumatoid arthritis: Treatment begins at 1 mg/kg daily, with gradual increases every 4-8 weeks as needed

Conclusion

Azathioprine is a powerful tool to fight several challenging health conditions. Doctors used it first for kidney transplants, and now they prescribe it to help people manage rheumatoid arthritis, Crohn's disease, and lupus. The medication takes time to work, and patients might wait up to 12 weeks to see results. This drug requires careful monitoring. Blood tests become essential during treatment to detect any issues early, especially in the first two months. 

Taking this medicine after meals helps reduce stomach issues. Your body absorbs the medication better if you avoid dairy products at the time you take your pill. The right balance between controlling your condition & reducing side effects depends on following your doctor's prescribed dosage.

FAQs

1. Is azathioprine high risk?

This medicine carries the most important risks. The chances of developing skin cancer and lymphoma might increase over time. Your genetic factors could increase these risks, so regular monitoring becomes vital.

2. How long does azathioprine take to work?

The medicine usually needs 6-8 weeks to work. Most patients see improvements only after 3 months of regular use. Your doctor might think over different treatments if the benefits don't show up within 3 months.

3. What happens if I miss a dose?

Take it when you remember. However, if your next dose is coming up soon, skip the missed one and stick to your regular schedule. Never double your dose to make up for it.

4. What happens if I overdose?

Call emergency services right away. Watch for throat ulceration, fever, infections, bruising, bleeding and fatigue. No specific antidote exists, but dialysis helps in severe cases.

5. What not to take with azathioprine?

Stay away from:

• Allopurinol and febuxostat (gout medications)
• Mercaptopurine
• Warfarin
• Ribavirin
• co-trimoxazole
• ACE inhibitors

6. Who cannot take azathioprine?

The medication isn't safe for people with hypersensitivity. Patients with active infections, previous cancer, and unknown TPMT status should also avoid it. The drug remains unsafe for pregnant women who need arthritis treatment.

7. When should I take azathioprine?

Taking it with food helps reduce stomach problems. This simple step minimises digestive discomfort effectively.

8. How many days to take azathioprine?

Treatment typically spans several months or years. Whatever your condition, you will need to stick with this medication long-term.

9. When to stop azathioprine?

You might stop after 1-2 years of steady remission. Patients with cirrhosis or previous relapses may need ongoing treatment indefinitely.

10. Is it safe to take azathioprine daily?

Yes if doctors monitor you properly. Regular blood tests play a vital role throughout your treatment.

11. What is the best time to take azathioprine?

The medication works best after meals, once or twice daily. Avoid dairy products an hour before and two hours after your dose.

12. What to avoid when taking azathioprine?

The drug doesn't mix well with allopurinol, febuxostat, mercaptopurine, and too much sun exposure. You should definitely limit your alcohol intake too.