Adult Dosing
Renal Transplantation
- Starting dose: 3-5 mg/kg/day PO qd up to 3 days before transplant
- Maint. dosage: 1-3 mg/kg/day PO qd
Severe, active rheumatoid arthritis
- Start 1 mg/kg/day PO divided qd-bid
- If unsatisfactory response after 6-8 wks, increase dose by 0.5 mg/kg/day q4 wks
- Max: 2.5 mg/kg/day
- If no response after 12 wks, discontinue
Goodpastures syndrome [Non-FDA Approved]
- Initial loading dose: 3-5 mg/kg PO given x 1 dose then start maintenance dose in 24 hours
- Maintenance: 1-3 mg/kg/day PO given qd
Crohn's Disease [Non-FDA approved]
- 1 to 2.5 mg/kg/dose PO qd
Pediatric Dosing
- Note: Safety and effectiveness in pediatric patients have not been established
Renal Transplantation (Not FDA approved)
- Starting dose: 3-5 mg/kg/day PO qd up to 3 days before transplant
- MAINT dosage: 1-3 mg/kg/day PO qd
Goodpastures syndrome [Non-FDA Approved]
- Initial loading dose: 3-5 mg/kg PO given x 1 dose then start maintenance dose in 24 hours
- Maintenance: 1-3 mg/kg/day PO given qd
Crohn's Disease [Non-FDA approved]
- Maintenance 1 to 3 mg/kg/24 hrs PO qd
[Outline]
Renal Dose Adjustment (Based on CrCl)
- 10-50 mL/min: Decrease dose by 25%
- <10 mL/min: Decrease dose by 50%
Hepatic Dose Adjustment
- Hepatic impairment: Use with caution; dose adjustments not defined
- Azathioprine is a purine antimetabolite with carcinogenic and mutagenic potential
- Risk of severe bone marrow suppression; severe leukopenia, thrombocytopenia, macrocytic anemia, and/or pancytopenia have been reported
- Monitor CBC with platelet counts qwk x 1 month, then q2 wk for second and third month, then monthly
- Chronic immunosuppression with azathioprine increases risk of neoplasia. Patients with rheumatoid arthritis previously treated with alkylating agents (eg cyclophosphamide, chlorambucil, melphalan) may have prohibitive risk of neoplasia
- Reversible GI hypersensitivity reaction with severe nausea and vomiting may occur; most common during first few weeks of therapy
- Delayed hematologic suppression may occur. Reduce dosage or temporarily withdraw therapy if rapid fall in WBC or persistent leukopenia, or evidence of bone marrow depression
- Azathioprine may cause fetal harm when administered to a pregnant woman
- Serious fungal, viral, bacterial and protozoal infections may develop in patients on long-term immunosuppression
Cautions: Use cautiously in
- Severe renal impairment
- Oliguria
- Malignancies
- Reduced bone marrow reserve
- Concurrent use of other immunosuppressants
- Patients with TPMT enzyme deficiency
- Previous or concurrent radiation therapy
- Chronic debilitating illnesses
- Concurrent use of ACE inhibitors
- Concurrent use of Warfarin
Pregnancy Category:D
Breastfeeding: Possibly unsafe. Azathioprine and its active metabolite are excreted in breast milk in low levels. Avoiding breastfeeding for 4-6 hrs after a dose markedly decreases the dose received by the infant in breastmilk. Possible risk of immunosuppression, growth retardation, and carcinogenesis in breastfed infants; monitor exclusively breastfed infants with a complete blood count with differential, and liver function tests. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 10 July 2010). According to manufacturer's data, use during breastfeeding is not recommended.
Note: Chronic immunosuppression with this agent may increase risk of neoplasia
- HEMA: Leukopenia, thrombocytopenia, macrocytic anemia, bleeding
- GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, hepatotoxicity (increased serum alkaline phosphatase, bilirubin, and/or serum transaminases), pancreatitis, hepatic veno-occlusive disease
- DERM: Rash, alopecia
- MUSC: Myalgia, arthralgia
- RESP: Reversible interstitial pneumonitis
- MISC: Super infection, fever, malaise, neoplasia, immunosuppression
US Trade Name(s)
US Availability
azathioprine (generic)
Azasan
Imuran
Canadian Trade Name(s)
Canadian Availability
azathioprine (generic)
Imuran
UK Trade Name(s)
UK Availability
azathioprine (generic)
Imuran
Australian Trade Name(s)
- Azahexal
- Azamun
- Azapin
- Imuran
- Thioprine
Australian Availability
azathioprine (generic)
Azahexal, Imuran
Azamun, Azapin, Thioprine
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Imuran 50 MG TABS [Bottle] (PROMETHEUS)
30 mg = $180
60 mg = $349.98 - AzaTHIOprine 50 MG TABS [Bottle] (ROXANE)
30 mg = $27.99
90 mg = $70.97 - Azasan 75 MG TABS [Bottle] (SALIX PHARMACEUTICALS)
INC. mg = $30
mg = $90 - Azasan 100 MG TABS [Bottle] (SALIX PHARMACEUTICALS)
INC. mg = $30
mg = $90
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
