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Imuran (Azathioprine) Information

Imuran, which contains the active ingredient azathioprine, is a prescription immunosuppressive medication used to treat several inflammatory and autoimmune conditions. It is primarily indicated as an adjunct to prevent organ rejection in patients receiving kidney transplants and to reduce the signs and symptoms of severe rheumatoid arthritis in adults. Off-label, it is frequently used to manage Crohn's disease, ulcerative colitis, and systemic lupus erythematosus. The mechanism of action involves interfering with the synthesis of DNA and RNA, preventing the rapid multiplication of lymphocytes (white blood cells). By suppressing the specific cells that drive inflammation and organ rejection, Imuran effectively lowers the body's immune response.

Imuran Side Effects

Imuran is generally well-tolerated, but common side effects may occur as your body adjusts to the medication. Commonly reported effects include nausea and vomiting, which can often be managed by taking the medication with or after a meal. Other common side effects include a loss of appetite, diarrhea, stomach pain, and unusual fatigue. Some patients may also notice temporary hair thinning or mild skin rashes.

More serious side effects can occur and require immediate medical attention. Stop taking the medication and seek help if you experience:
• Bone Marrow Suppression: Signs include unusual bruising or bleeding, pale skin, or extreme weakness, indicating low counts of white blood cells, red blood cells, or platelets.
• Increased Cancer Risk: Long-term use is associated with a higher risk of lymphoma and skin cancer; report any new lumps or changes in moles.
• Liver Damage: Symptoms such as yellowing of the skin or eyes (jaundice), dark urine, or clay-colored stools.
• Pancreatitis: Sudden, severe abdominal pain that may radiate to the back, accompanied by nausea.
• Severe Infections: Because the drug weakens the immune system, monitor for fever, chills, sore throat, or a persistent cough.

Imuran Precautions

Do not use Imuran if you have a known allergy to azathioprine or any inactive ingredient in the medication. Before starting treatment, inform your doctor of your complete medical history, especially if you have a history of liver or kidney disease, hepatitis, or bone marrow problems. It is particularly important to disclose if you have a known deficiency in the TPMT or NUDT15 enzymes, as these genetic variations can lead to dangerously high levels of the drug in the body and severe toxicity. You should also mention any recent or planned vaccinations, as you should avoid live vaccines (such as MMR or chickenpox) while taking this medication. Live vaccines should be avoided not just during treatment, but also for a period before and after, as the immune system is significantly compromised.

Tell your doctor about all medications you are taking, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements. Imuran may interact with allopurinol (this interaction is particularly dangerous because allopurinol can cause azathioprine levels to skyrocket, requiring a major dose reduction), ACE inhibitors such as lisinopril, warfarin, and aminosalicylates such as mesalamine.

Inform your doctor if you are pregnant, planning to become pregnant, or breastfeeding. Imuran should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. While it may cause low blood counts in the newborn, it is often essential for maintaining the health of transplant or autoimmune patients. Azathioprine passes into breast milk in very small amounts. Exercise caution and consult your doctor before breastfeeding while using this medication.

Use Imuran exactly as your doctor tells you. To reduce stomach upset, take Imuran with a meal or a glass of milk. Tablets must be swallowed whole. Do not break, chew, or crush them. Because it increases the risk of skin cancer, you should practice strict sun protection, including wearing hats, protective clothing, and using SPF 30+ sunscreen daily. You will need regular blood tests, weekly for the first month and monthly thereafter, to monitor your liver function and blood cell counts. Never stop taking Imuran abruptly without medical guidance, as this could lead to a flare of your condition. Because azathioprine is a cytotoxic (chemotherapy-like) agent, caregivers should wear gloves when handling the tablets, especially if the tablets are damaged. Store the tablets at room temperature (20°C to 25°C) in a cool, dry place away from direct light and moisture. Keep them in their original packaging and keep them strictly out of reach of children and pets.

Do I need a prescription to order Imuran?

Yes, a prescription is required from your physician to order Imuran.