Imuran

Last updated on RxList: 10/15/2020
Imuran Side Effects Center

What Is Imuran?

Imuran (azathioprine) is an immunosuppressive antimetabolite used to prevent the body from rejecting a transplanted kidney. Imuran is also used to treat symptoms of rheumatoid arthritis. Imuran is available in generic form.

What Are Side Effects of Imuran?

Common side effects of Imuran include:

Tell your doctor if you experience unlikely but serious side effects of Imuran including:

  • muscle loss,
  • hair loss,
  • cold/numbness in the fingers,
  • mouth sores,
  • difficult/painful swallowing, or
  • greasy stools.

Dosage for Imuran

The dose of Imuran to prevent transplant rejection and minimize toxicity varies. The initial dose is usually 3 to 5 mg/kg daily, beginning at the time of transplant. It is usually given as a single daily dose on the day of, and in some cases 1 to 3 days before, transplantation. Maintenance levels of 1 to 3 mg/kg daily are usually possible. For rheumatoid arthritis, the initial dose is approx. 1.0 mg/kg (50 to 100 mg) given as a single dose or twice-daily. Maximum dose is 2.5 mg/kg per day.

What Drugs, Substances, or Supplements Interact with Imuran?

Imuran may interact with allopurinol, mercaptopurine, methotrexate, blood thinners, cyclosporine, olsalazine, sulfasalazine, sulfamethoxasole, trimethoprim, or ACE inhibitors. Tell your doctor all medications you use.

Imuran During Pregnancy and Breastfeeding

Imuran is not recommended for use during pregnancy. It may harm a fetus. Men and women should use two forms of birth control (e.g., condoms, birth control pill) while taking this medication. This medication can decrease the effectiveness of intrauterine devices (IUDs). Talk to your doctor about birth control. This medication passes into breast milk and may have undesirable effects on a nursing infant. Breastfeeding while using this drug is not recommended.

Additional Information

Our Imuran (azathioprine) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

SLIDESHOW

Kidney Stones: Symptoms, Causes, and Treatment See Slideshow
Imuran Consumer Information

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Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Azathioprine may cause a serious brain infection that can lead to disability or death. Call your doctor right away if you have problems with speech, thought, vision, or muscle movement. These symptoms may start gradually and get worse quickly.

Stop using azathioprine and call your doctor right away if you have any of these symptoms of lymphoma:

  • fever, swollen glands, body aches, night sweats, not feeling well;
  • pale skin, rash, easy bruising or bleeding;
  • cold hands and feet, feeling light-headed or short of breath;
  • pain in your upper stomach that may spread to your shoulder; or
  • feeling full after eating only a small amount, weight loss.

Also call your doctor at once if you have:

  • signs of infection (fever, chills, weakness, flu symptoms, sore throat, cough, pain or burning when you urinate);
  • severe nausea, vomiting, or diarrhea;
  • easy bruising, unusual bleeding;
  • rapid heartbeats, shortness of breath;
  • pale skin, cold hands and feet; or
  • dark urine, jaundice (yellowing of the skin or eyes).

Common side effects may include:

  • nausea, diarrhea, stomach pain;
  • hair loss; or
  • skin rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Read the entire detailed patient monograph for Imuran (Azathioprine)

QUESTION

The only purpose of the kidneys is to filter blood. See Answer
Imuran Professional Information

SIDE EFFECTS

The principal and potentially serious toxic effects of IMURAN are hematologic and gastrointestinal. The risks of secondary infection and malignancy are also significant (see WARNINGS). The frequency and severity of adverse reactions depend on the dose and duration of IMURAN as well as on the patient's underlying disease or concomitant therapies. The incidence of hematologic toxicities and neoplasia encountered in groups of renal homograft recipients is significantly higher than that in studies employing IMURAN for rheumatoid arthritis. The relative incidences in clinical studies are summarized below:

Toxicity Renal Homograft Rheumatoid Arthritis
Leukopenia (any degree) > 50% 28%
   < 2500 cells/mm³ 16% 5.30%
  Infections 20% < 1%
Neoplasia *
  Lymphoma 0.50%  
  Others 2.80%  
* Data on the rate and risk of neoplasia among persons with rheumatoid arthritis treated with azathioprine are limited. The incidence of lymphoproliferative disease in patients with RA appears to be significantly higher than that in the general population. In one completed study, the rate of lymphoproliferative disease in RA patients receiving higher than recommended doses of azathioprine (5 mg/kg per day) was 1.8 cases per 1000 patient-years of follow-up, compared with 0.8 cases per 1000 patient-years of follow-up in those not receiving azathioprine. However, the proportion of the increased risk attributable to the azathioprine dosage or to other therapies (i.e., alkylating agents) received by patients treated with azathioprine cannot be determined.

Hematologic

Leukopenia and/or thrombocytopenia are dose-dependent and may occur late in the course of therapy with IMURAN. Dose reduction or temporary withdrawal may result in reversal of these toxicities. Infection may occur as a secondary manifestation of bone marrow suppression or leukopenia, but the incidence of infection in renal homotransplantation is 30 to 60 times that in rheumatoid arthritis. Anemias, including macrocytic anemia, and/or bleeding have been reported.

TPMT genotyping or phenotyping can help identify patients with low or absent TPMT activity (homozygous for non-functional alleles) who are at increased risk for severe, life-threatening myelosuppression from IMURAN. See CLINICAL PHARMACOLOGY, WARNINGS and PRECAUTIONS: Laboratory Tests. Death associated with pancytopenia has been reported in patients with absent TPMT activity receiving azathioprine.6,20

Gastrointestinal

Nausea and vomiting may occur within the first few months of therapy with IMURAN, and occurred in approximately 12% of 676 rheumatoid arthritis patients. The frequency of gastric disturbance often can be reduced by administration of the drug in divided doses and/or after meals. However, in some patients, nausea and vomiting may be severe and may be accompanied by symptoms such as diarrhea, fever, malaise, and myalgias (see PRECAUTIONS). Vomiting with abdominal pain may occur rarely with a hypersensitivity pancreatitis. Hepatotoxicity manifest by elevation of serum alkaline phosphatase, bilirubin, and/or serum transaminases is known to occur following azathioprine use, primarily in allograft recipients. Hepatotoxicity has been uncommon (less than 1%) in rheumatoid arthritis patients. Hepatotoxicity following transplantation most often occurs within 6 months of transplantation and is generally reversible after interruption of IMURAN. A rare, but life-threatening hepatic veno-occlusive disease associated with chronic administration of azathioprine has been described in transplant patients and in one patient receiving IMURAN for panuveitis.21,22,23 Periodic measurement of serum transaminases, alkaline phosphatase, and bilirubin is indicated for early detection of hepatotoxicity. If hepatic veno-occlusive disease is clinically suspected, IMURAN should be permanently withdrawn.

Others

Additional side effects of low frequency have been reported. These include skin rashes, alopecia, fever, arthralgias, diarrhea, steatorrhea, negative nitrogen balance, reversible interstitial pneumonitis, hepatosplenic T-cell lymphoma (see WARNINGSMalignancy), and Sweet's Syndrome (acute febrile neutrophilic dermatosis).

Read the entire FDA prescribing information for Imuran (Azathioprine)

© Imuran Patient Information is supplied by Cerner Multum, Inc. and Imuran Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.

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