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Azathioprine – a tablet used for suppressing immune system
Azathioprine is a medicine used for organ transplants and many autoimmune conditions
Generic name: Azathioprine [ ay-za-THYE-oh-preen ]
Brand names: Azasan, Imuran
Uses: Prevent transplant organ rejection and a variety of autoimmune conditions
Tablet form: 50 mg; 75 mg; 100 mg
Drug class: Purine anatagonist
What is azathioprine?
- Azathioprine is an immunosuppressant medication.
- It belongs to a class of drugs called purine antagonist, which work by interfering with the DNA production of certain cells in the immune system.
Uses
Azathioprine is used to treat people with:
- Organ transplants (to prevent the body from rejecting a new kidney, heart, lung or liver)
- Rheumatoid arthritis (usually when other treatments haven’t worked)
- Inflammatory Bowel Disease (IBD), such as Crohn’s disease (CD) or ulcerative colitis (UC)
- Systemic Lupus Erythematosus (SLE)
- Autoimmune hepatitis
Dosage
- Taken once or twice daily, usually with or after food to reduce stomach upset.
- The dose is highly individualised, calculated based on your body weight.
- After a kidney transplant, the maintenance dose is 1–2.5 mg/kg daily.
- It is a slow-acting medicine; it can take weeks or even months to feel the full benefit.
Side-effects
Common side-effects
- Nausea and vomiting (especially when starting treatment)
- Loss of appetite
- Increased sensitivity to sunlight (increased risk of skin cancer)
- Increased risk of minor infections (like colds or flu)
Less common (and more serious) side-effects
- Bone marrow suppression: A significant drop in white blood cells, red blood cells, or platelets (leading to easy bruising or bleeding).
- Liver problems: Jaundice (yellowing of the skin or eyes) or dark urine.
- Pancreatitis: Severe abdominal pain.
- Severe infections: Due to a weakened immune system.
- Allergic reactions: Such as a sudden rash or fever.
Note: If you develop a fever, unexplained bruising, or a sore throat, contact your doctor immediately.
How it works
- It works by reducing the activity of the body’s immune system.
- It does this by blocking the production of T and B lymphocytes (white blood cells) – by disrupting their DNA/RNA synthesis. Its exact mechanism is not entirely understood.
- By limiting the production of lymphocytes, it helps prevent the body from attacking its own healthy tissues (what happens in autoimmune disease) or rejecting a transplanted organ.
- It is a prodrug for 6-mercaptopurine (6-MP).
Monitoring
Because azathioprine affects the blood and liver, regular monitoring is essential:
- Frequent blood tests: Initially every week or two, then moving to every few months once stable. These check your Full Blood Count (FBC) and Liver Function Tests (LFTs).
- TPMT test: Most patients have a blood test before starting to check for an enzyme called TPMT. If this enzyme level is low, you are at a much higher risk of side effects.
- Skin checks: Regular monitoring for new moles or skin changes due to increased photosensitivity.
