Azathioprine

Also known by its brand names Imuran or Azasan

This is another common medication that is very commonly prescribed to patients when they are first diagnosed. Its a medication that works by decreasing the effects of certain cells in the immune system. Its function is to try and stop the immune system from attacking your colon which is the root cause of the problem in UC.

Most Common Side Effects

  • Nausea (eating before taking the meds helps with this)
  • Rash
  • Muscle Pain
  • Some people report some hair thinning or loss
  • infections caused by a virus, fungus or bacteria
  • reduction in your bone marrow function, which may make you feel unwell or show up in your blood tests
  • low white blood cell level in your blood tests, which may cause an infection.

Initial Blood Testing

There are a few side effects that you have to keep an eye out for when you start taking this medication! Usually your GI will also write you a requisition to have blood tests done fairly regularly to make sure the medication is not having any ill effects on your liver. I had  a test every 2 weeks at first but have heard about people getting them even weekly and also monthly. It just keeps an eye on your liver enzyme numbers to ensure that it is not  causing any damage. It sounds dangerous but that is why the initial blood tests are done to know right out of the gate if your body is going to tolerate the medication!

Developing Antibodies

Another thing you will hear about from people is that they developed anti bodies to this medication and had to stop taking. This means that your body has identified the medication and instead of letting it help by decreasing the effects of your immune system, which is what we need it for, it actually sees the medication as a threat and your body builds up anti bodies to the medication leaving it ineffective and leaving you feeling nauseous after taking it.  It seems that for most people this eventually happens in the end, but with varying timelines. You could find it effective for 3 to 6 months like I did, and some people actually last for years on Azathioprine with no problems! Lets hope you are in the latter!
One thing you can do to combat building anti bodies is by not missing doses! Missing doses of medications like Azathioprine only contributes to the chances your body will develop antibodies!

 Other side effects

  • Black, tarry stools
  • bleeding gums
  • blood in the urine or stools
  • chest pain
  • cough or hoarseness
  • fever or chills
  • lower back or side pain
  • painful or difficult urination
  • pinpoint red spots on the skin
  • shortness of breath
  • sore throat
  • sores, ulcers, or white spots on the lips or in the mouth
  • swollen glands
  • unusual bleeding or bruising
  • unusual tiredness or weakness

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking azathioprine it is important that your doctor or pharmacist knows:

  • If you are pregnant, trying for a baby or breast-feeding.
  • If you have liver or kidney problems.
  • If you have an infection.
  • If you have had chickenpox or shingles.
  • If you are taking or using any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
  • If you have ever had an allergic reaction to a medicine. It is particularly important that you tell your doctor if you are allergic to a medicine called mercaptopurine (aka 6mp).
  • Before you start this treatment, read the manufacturer’s printed information leaflet from inside your pack. The leaflet will give you more information about azathioprine, how to take it, and a full list of side-effects which you may experience from taking it.
  • Your doctor will prescribe a dose for you which is tailored to your weight and the reason why you are taking it. Make sure you take the tablets exactly as your doctor has told you – your dose will be on the label of the pack to remind you.
  • Take the tablets after eating a meal or with a snack. This will help to stop any feelings of queasiness or nausea. Drink plenty of water as you take the tablets.
  • Try to take your doses at the same time of day each day, as this will help you to remember to take them. If you forget to take a dose at the usual time, take one as soon as you remember, but do not take two doses together to make up for a missed dose.
  • Your doctor will tell you how long your treatment is expected to continue. Keep taking azathioprine until your doctor tells you otherwise.
  • Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress. Your doctor will want you to have regular blood tests during this treatment to monitor for unwanted side-effects.
  • It is important to try to avoid anyone who is suffering from chickenpox or shingles. Tell your doctor if you come into contact with anyone with these infections.
  • While you are taking azathioprine, and for a while after you stop treatment, do not have any immunisations (vaccinations) without talking to your doctor first. Azathioprine lowers your body’s resistance and there is a chance that you may get an infection from the vaccine. Also, some vaccines may be less effective.
  • Your doctor will have discussed with you the possibility of a slightly increased risk of cancer (particularly skin cancer) associated with immunosuppressants like azathioprine. Do not use sunbeds, and avoid strong sunlight or use a sun cream with a high sun protection factor (SPF of at least 15).
  • You should avoid becoming pregnant while you are taking azathioprine. Make sure you have discussed with your doctor which types of contraception are suitable for you and your partner.
  • If you are having an operation or any dental treatment, tell the person carrying out the treatment that you are taking azathioprine.
  • If you buy any medicines, check with your doctor or a pharmacist that they are suitable for you to take with your other medicines.

Taking other medicines

Please tell your doctor, nurse or pharmacist if you are taking or have recently taken any other medicines.This includes medicines obtained without a prescription, including herbal medicines. This is because Azathioprine can affect the way some medicines work.

Also some other medicines can affect the way Azathioprine works.

In particular, tell your doctor, nurse or pharmacist if you are taking any of the following medicines:

  • allopurinol – used for gout
  • tubocurarine or succinylcholine – used during operations
  • warfarin – used for blood clots
  • penicillamine – used for rheumatoid arthritis
  • co-trimoxazole – used for infections
  • captopril – used for high blood pressure or heart problems
  • cimetidine – used for stomach ulcers and indigestion
  • indomethacin – used for pain and inflammation
  • furosemide – used for high blood pressure and heart problems
  • olsalazine or mesalazine – used for a bowel problem called ulcerative colitis
  • sulfasalzine or balsalazide – used for rheumatoid arthritis or ulcerative colitis.

If you are not sure if any of the above apply to you, talk to your doctor, nurse or pharmacist before taking Azathioprine.

Having vaccines while you are taking Azathioprine

If you are going to have a vaccination speak to your doctor or nurse before you have it. This is because vaccines may not work properly while you are taking Azathioprine.

Azathioprine and the sun

While taking Imuran you may be more likely to develop some types of cancers such as skin cancer.

Some people also become sensitive to sunlight which can cause skin discolouration or a rash. Take care to avoid too much sun, cover up and use sunscreen.

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