Leflunomide

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 your treatment?
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 effects:
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 Alcohol:
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 Other medicines:
 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

Source: http://www.aont.org.au/wp-content/uploads/2011/11/Azathioprine.pdf