Azathioprine...heavy arthritis artillery

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Azathioprine, brand name "Imuran," is an immunosuppressive drug that is used in rheumatoid arthritis, systemic lupus erythematosus, polymyositis, and other severe forms of progressive inflammatory arthritis.

It also is used to help lower steroid dose in diseases requiring high dose steroids for control.

Azathioprine works by blocking the synthesis of purines which leads to interference with DNA synthesis and cell division.

Azathioprine is usually started at a dose of 25 mgs a day and slowly increased to a maximum of 3 mgs per kilogram per day.

Prior to initiation of azathioprine, baseline complete blood cell count, liver and kidney function, and urinalysis should be obtained. As the dose is gradually increased complete blood cell counts as well as liver and kidney function should be monitored every two weeks. Once maintenance level is achieved, monitoring should be done every four weeks.

Azathioprine is absorbed well orally. Split dosing (taking half the dose in the morning and the other half in the evening)may help in patients who have gastrointestinal side effects.

Azathioprine has been used in combination with methotrexate and hydroxychloroquine in patients who have severe progressive rheumatoid arthritis. This practice is less common now than it once was with the availability of biologic therapy.

As one might expect, along with potent effects, it also has many potential side effects including hypersensitivity to the drug, fever, chills, nausea, vomiting, diarrhea, lowering of white blood cells and platelets, hepatitis, pancreatitis, pneumonitis (inflammation of the lungs), rash, mouth sores, blood clots in the veins leading to the liver (rare), reduced immunity leading to an increased risk for infection as well as a n increased risk for the development of leukemia and lymphoma.

Significant interaction with other drugs may be a problem. Drugs that should be avoided in patients taking azathioprine include allopurinol and live vaccines.

Azathioprine is absolutely contraindicated (should never be used) in patients who are pregnant, breast-feeding, or who have serious active infections.

Caution should be exercised when used in patients with liver or kidney disease and in elderly patients

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