Azathioprine and hepatic veno-occlusive disease in renal transplant patients.  The FDA-approved drug label for azathioprine recommends testing for TPMT activity to identify patients at risk for myelotoxicity. Azathioprine inhibits purine synthesis. These include skin rashes, alopecia, fever, arthralgias, diarrhea, steatorrhea, negative nitrogen balance, reversible interstitial pneumonitis and hepatosplenic T-cell lymphoma (see Warnings Malignancy), and Sweet’s Syndrome (acute febrile neutrophilic dermatosis). The cytotoxicity of Azathioprine is due, in part, to the incorporation of 6-TGN into DNA. Keep the bottle tightly closed when not in use.
Therapeutic response occurs after several weeks of treatment, usually 6 to 8; an adequate trial should be a minimum of 12 weeks. Either of the drugs for sure, so take it easy. Mayo Clinic College of Medicine and Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, FREE book offer – Mayo Clinic Health Letter, sores, ulcers, or white spots on the lips or in the mouth, greatly decreased frequency of urination or amount of urine, pains in the stomach, side, or abdomen, possibly radiating to the back, unusual feeling of discomfort or illness (sudden). Purines are needed to produce DNA and RNA. My urine is always bright the first few times I go after my morning vitamin.
This has occurred mainly in teenagers and young men with Crohn's disease or ulcerative colitis. You should not take azathioprine if you are allergic to azathioprine.
Patients with low or absent TPMT or NUDT15 activity are at increased risk for severe, life-threatening myelosuppression from Azathioprine (see CLINICAL PHARMACOLOGY, WARNINGS: Cytopenias and PRECAUTIONS: Laboratory Tests, DOSAGE AND ADMINISTRATION). Imuran (azathioprine) is an immunosuppressive antimetabolite drug that may be prescribed to treat conditions such as inflammatory bowel disease (IBD) or rheumatoid arthritis. A known carcinogen. These side effects may go away during treatment as your body adjusts to the medicine. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: Other side effects not listed may also occur in some patients. , Azathioprine is absorbed from the gut to about 88%. Inhibition of XO may cause increased plasma concentrations of Azathioprine or its metabolite, 6-MP, leading to toxicity. People who have previously been treated with an alkylating agent may have an excessive risk of cancers if treated with azathioprine. Keep using azathioprine as directed and tell your doctor if your symptoms have not improved after 12 weeks of use. Azathioprine Tablets USP, 25 mg are yellow, round, flat, radial edge tablets with bisect on one side and other side is plain; one side of the bisect is debossed with logo of "ZD" and other side is debossed with "11" and are supplied as follows: NDC 68382-118-01 in bottles of 100 tablets, NDC 68382-118-05 in bottles of 500 tablets. Discontinuation may be necessary for severe hematologic or other toxicity, even if rejection of the homograft may be a consequence of drug withdrawal. Guidelines for handling parenteral antineoplastics. Activation of 6-mercaptopurine occurs via hypoxanthine-guanine phosphoribosyltransferase (HGPRT) and a series of multi-enzymatic processes involving kinases to form 6-thioguanine nucleotides (6-TGNs) as major metabolites.
 When Calne asked Elion for related compounds to investigate, she suggested azathioprine, which was subsequently found out to be superior (as effective and less toxic to the bone marrow) by Calne.. Concomitant use of these agents with Azathioprine tablets should be done with caution. A gastrointestinal hypersensitivity reaction characterized by severe nausea and vomiting has been reported.  Use during pregnancy may result in harm to the baby. Conversion to mercaptopurine also occurs in the presence of sulfhydryl compounds such as cysteine, glutathione, and hydrogen sulfide.  It is on the World Health Organization's List of Essential Medicines. However, on several forums patients discussed the occurrence of bright yellow urine while using azathioprine [9-12]. , It was widely used for the treatment of multiple sclerosis until the first half of the 1990s.
Both the immunosuppressive and therapeutic effects in animal models are dose-related. Breast-feeding after renal transplantation.
Use with xanthine oxidase (XO) inhibitors: One of the pathways for inactivation of Azathioprine is inhibited by XO inhibitors (allopurinol or febuxostat). However, anyone with an inflammatory autoimmune disorder may have a higher risk of lymphoma. U.S. Food and Drug Administration.
Physicians using this drug should be very familiar with this risk as well as with the mutagenic potential to both men and women and with possible hematologic toxicities.
Azathioprine is metabolized to 6-mercaptopurine (6-MP). The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. The optimum duration of maintenance Azathioprine tablets has not been determined. Azathioprine oral tablet is a prescription medication used to treat rheumatoid arthritis. Physicians should inform patients of the risk of malignancy with Azathioprine. You should definitely relax, take a deep breadth and enjoy your remission.