Imuran liver disorders

Use sunscreen and wear protective clothing when outdoors. Your doctor may direct you to avoid phototherapy while you use this product. Ask your doctor for details. Azathioprine can make you more likely to get infections or may worsen any current infections. Avoid contact with people who have infections that may spread to others such as chickenpox , measles , flu.

Consult your doctor if you have been exposed to an infection or for more details. Before having surgery, tell your doctor or dentist about all the products you use including prescription drugs , nonprescription drugs, and herbal products. Avoid contact with people who have recently received live vaccines such as flu vaccine inhaled through the nose. To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.

Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using azathioprine. Azathioprine may harm an unborn baby. Ask about reliable forms of birth control while using this medication. If you become pregnant, talk to your doctor right away about the risks and benefits of this medication.

This medication passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast -feeding. What should I know regarding pregnancy, nursing and administering Imuran to children or the elderly? Interactions Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug are: Azathioprine is very similar to mercaptopurine. Of the 26 children, 18 responded to mycophenolate mofetil and 8 6 with ASC did not respond. There are no clear guidelines as to how mycophenolate mofetil should be tapered if a therapeutic response has been achieved. The authors have used doses as low as mg twice per day to maintain patients in a drug-induced remission. Budesonide has been has been used with variable success in patients who had treatment failures.

Incomplete response Incomplete response is defined as an improvement that is insufficient to satisfy remission criteria. The goal of therapy is to control disease activity at the lowest dose of medication possible. Azathioprine may help to serve as a steroid-sparing agent. Patients should be referred for consideration of liver transplantation if they manifest signs of hepatic decompensation eg, new onset of hypoalbuminemia, coagulopathy, variceal bleeding, ascites, hepatic encephalopathy.

Drug toxicity Drug toxicity may occur. Patients must be tapered off from the culprit medication. Some patients successfully achieve treatment goals on alternative medications. Osteoporosis with vertebral compression, diabetes, cataracts, severe emotional lability, and hypertension may develop in patients who are treated with prolonged courses of high-dose prednisone.

Premature treatment withdrawal is justified in patients who develop intolerable obesity, cosmetic changes, or osteoporosis. Azathioprine can function as a steroid-sparing agent. Patients should be co-treated with calcium and vitamin D in order to prevent the development of steroid-induced osteoporosis. Regular exercise should be encouraged. Bone densitometry performed every years should be used to monitor patients. Severe cholestatic acute hepatitis following azathioprine therapy in a patient with ulcerative pancolitis.

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Intravenous azathioprine in severe ulcerative colitis: Safety of disease modifying anti-rheumatic agents in rheumatoid arthritis patients with chronic viral hepatitis.

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The impact of TPMT genotyping in predicting toxicity. Eur J Clin Pharmacol ; Myelotoxicity and hepatotoxicity during azathioprine therapy. Neth J Med ; On the limitation of 6-tioguaninenucleotide monitoring during thioguanine treatment. Aliment Pharmacol Ther ; Incidence, risk factors and clinical course of thiopurine-induced liver injury in patients with inflammatory bowel disease. Thiopurine methyltransferase TPMT heterozygosity and enzyme activity as predictive tests for the development of azathioprine-related adverse events.

J Neurol Sci ; Allopurinol safely and effectively optimizes thioguanine metabolites in inflammatory bowel disease patients not responding to azathioprine and mercaptopurine. Azathioprine induced nodular regenerative hyperplasia in IBD patients. Chronic liver disease related to 6-thoguanine in children with acute lymphoblastic leukaemia. J Hepatol ; Eur J Gastroenterol Hepatol ; Utility of thiopurine methyltransferase genotyping and phenotyping, and measurement of azathioprine metabolites in the management of patients with autoimmune hepatitis.

A systematic survey evaluating 6-thioguanine-related hepatotoxicity in patients with inflammatory bowel disease. Wien Klin Wochenschr ; Liver injury in inflammatory bowel disease: Inflamm Bowel Dis ; Thiopurine-induced liver injury in patients with inflammatory bowel disease: Some evidence for dose or metabolite level dependent effects?

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Initial clinical experience with allopurinol-thiopurine combination therapy in pediatric inflammatory bowel disease. Long-term outcome of using allopurinol co-therapy as a strategy for overcoming thiopurine hepatotoxicity in treating inflammatory bowel disease.

Relationships between thiopurine S-methyltransferase polymorphism and azathioprine-related adverse drug reactions in Chinese renal transplant recipients. Mercaptopurine treatment should be considered in azathioprine intolerant patients with inflammatory bowel disease. Hepatocellular carcinoma occurring in a young Crohn's disease patient. Pathol Int ; Crohn's disease, hepatosplenic T-cell lymphoma and no biological therapy: Hepatosplenic T-cell lymphoma in a patient with Crohn's disease.

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