PATIENT INFORMATION ON AZATHIOPRINE (Brand names: Azahexal, Azapin, Imuran, Thioprine)
This information sheet has been produced by the
What benefit can you expect from
Australian Rheumatology Association to help
you understand the medicine that has been prescribed for you. It includes important
Azathioprine is usually used to treat severe
rheumatoid arthritis that has not responded to
How you should take your medicine;
The possible side effects;
The medicine does not work straight away. It
What tests you must have to monitor your
usually takes 6 to 8 weeks for symptoms such as
condition and to detect unwanted effects;
swelling and stiffness to start to improve. The
full effect on these symptoms may take up to 26
weeks. The effects to delay or prevent joint
Other precautions you should take.
damage will take several months to be noticed.
Please read it carefully and discuss with your doctor.
Other medicines may be given to improve your symptoms while waiting for azathioprine to
What is azathioprine?
If azathioprine treatment is stopped for more
Azathioprine (brand names Azahexal, Azapin,
than a few weeks there is a risk that your
Imuran, Thioprine) is a medicine used to treat
condition may worsen. Continue with your
rheumatoid arthritis and other rheumatic
treatment unless advised by your doctor or
conditions such as systemic lupus erythematosus
How is azathioprine taken?
Azathioprine is also used to prevent the rejection of transplanted organs.
Azathioprine is taken by mouth in 25mg or 50mg tablets. The dose used to treat rheumatoid
arthritis depends on the person's body weight.
It is usually 50mg to 100mg per day. The dose
reducing the activity of the immune system. In
can be increased every 1 to 2 months. The
rheumatoid arthritis, this action helps to reduce
maximum dose is usually 75mg to 150mg per
swelling. It also limits damage to the joints and helps to prevent disability in the long term.
It can be taken as a single dose or twice a day.
Because azathioprine acts to reduce the damage
The treatment can be continued indefinitely as
to the joints, rather than just relieve the pain, it
long as it is effective and no serious side effects
belongs to the group of medicines called disease modifying antirheumatic drugs(DMARDs).
It may be used with other arthritis medicines
For more information about RHEUMATOID ARTHRITIS see the Arthritis Australia website
steroid medicines such as prednisolone or
anti-inflammatory medicines (NSAIDs) such
simple pain medicines such as paracetamol.
mouth ulcers, easy bruising, nosebleeds, bleeding gums, breathlessness, infection or
Are there any side effects?
Hypersensitivity: A small number of people
Below are possible side effects that you might
have a hypersensitivity reaction one to two
experience with your treatment. Tell your
doctor if you experience any side effects.
causes sudden onset muscle aches and pains and fever. If you develop any of these
If you do experience side effects, a reduction in
symptoms tell your doctor straight away.
dose may minimise these so that you can continue to take the medicine. Your doctor will
Infections: There is an increased risk of
advise on any dose changes that are necessary.
developing some infections, especially herpes zoster (chicken pox and shingles).
Most common possible side effects:
You should try to avoid contact with people
who have these infections. If you have an
10-15% of people taking azathioprine experience stomach or bowel side effects,
infection or persistent fever, tell your doctor
which might include nausea (feeling sick), vomiting, abdominal pain or diarrhoea.
Cancer: Studies of transplant patients taking
Taking azathioprine twice daily instead of all
azathioprine have found it may increase risk
at once, or taking it after eating, may help
of skin cancers. There may be a similar risk
avoid these problems. Antinausea tablets
take azathioprine for long periods of time.
About 5% of people have side effects such as skin rashes and increased sensitivity to the
rheumatologist before starting the medicine
sun. It is a good idea to use sunscreen and to
(see Precautions on page 3) What precautions are necessary? Tell your doctor if you experience any Blood tests: possible side effects.
Before starting azathioprine, you may be
Less common or rare possible side
asked to have a blood test to look at an enzyme (TPMT). This will check whether
your bone marrow cells are more sensitive to
Effects on the liver and pancreas:
the medicine. The result will decide whether
azathioprine can cause liver test
abnormalities or hepatitis (inflammation of
the liver). This occurs in less than 1% of
Since the liver and blood cells may be
people taking the medicine. This does not
affected by azathioprine, you must have
regular blood tests during your treatment.
This is very important, as you may not get
discolouration of the whites of your eyes or
Blood tests are particularly important during
yellow skin tell your doctor straight away.
Azathioprine can also cause pancreatitis
(inflammation of the pancreas), which can
As well as monitoring for side effects, blood
tests help to monitor your condition to determine if the treatment is effective.
Blood counts: azathioprine can cause a drop
in the number of white blood cells, which are
You will need to have full blood counts and
needed to fight infection. It can also cause a
liver function tests every 2 to 4 weeks for the
drop in the number of platelets, which help
first few months of treatment and then every
Azathioprine can also be used safely with
If there are no abnormalities seen after three
anti-inflammatory drugs (NSAIDs) as long
months of treatment at a specific dose of
azathioprine, the blood tests may be done less frequently.
Most vaccines can be given safely with
Your general practitioner will be informed
azathioprine. Talk with your rheumatologist
important to see your general practitioner if you have been asked to do so as they have an
important role to play in monitoring your
Because azathioprine can affect your liver,
you should avoid heavy alcohol use while taking it. It is not known precisely what
Azathioprine can interact with other
agreement that 1 to 2 standard drinks taken
once or twice a week is unlikely to cause a
medicines you are taking or plan to take.
drinks on one occasion, even if infrequently,
Pregnancy and breastfeeding:
Allopurinol (Allohexal, Allosig, Progout,
Zyloprim), used in the treatment of gout,
Azathioprine has been used safely in
will increase the level of azathioprine in the
blood causing serious toxicity. This can be
wish to become pregnant or you intend to
very dangerous. You must tell your doctor
breastfeed, you should discuss this with
if you are taking or advised to take allopurinol. Skin cancer prevention:
Combined pain medicines such as Panadeine
and Panadeine Forte, can be used safely with
When taking azathioprine, it is important to
exposure. A yearly skin check is recommended.
All patients taking azathioprine should be seen Your doctor's contact details: regularly by a rheumatologist to optimise treatment and to minimise any potential side effects. If you have any questions or concerns write them down and discuss them with your doctor. REMEMBER - Keep all medicines out of reach of children
The information in this sheet has been obtained from various sources and has been reviewed by the Australian Rheumatology Association. It is
intended as an educational aid and does not cover all possible uses, actions, precautions, side effects, or interactions of the medicines
mentioned. This information is not intended as medical advice for individual problems nor for making an individual assessment of the risks and
benefits of taking a particular medicine. It can be reproduced in its entirety but cannot be altered without permission from the ARA.
The NHMRC publication: How to present the evidence for consumers: preparation of consumer publications (2000) was used as a guide in
Australian Rheumatology Association Revised May 2009 - next review May 2010
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