Some laboratories offer testing for TPMT deficiency, although these tests have not been shown to identify all patients at risk of severe toxicity. This would indicate that, rather than azathioprine being exclusive cleaved by nucleophilic attack at the 5-position of the nitroimidazole ring to generate 6-mercaptopurine and 1-methyl-4-nitro-5-(S-glutathionyl)imidazole.
These signs are more likely to be manifest following chronic overdosage, rather than after a single acute overdose.
Since impaired renal function may result in slower elimination of azathioprine and its metabolites, consideration should be given to reducing the starting doses in patients with impaired renal function. Adult Dosing . The dose should not be taken with milk or dairy products since they contain xanthine oxidase, an enzyme which metabolises 6–mercaptopurine and might therefore lead to reduced plasma concentrations of 6–mercaptopurine (see sections 4.2 and 5.2).The immunosuppressive activity of azathioprine could result in an atypical and potentially deleterious response to live vaccines. Azathioprine and long-wave ultraviolet light have been shown to have a synergistic clastogenic effect in patients treated with azathioprine for a range of disorders (see section 4.4).There have been reports of premature birth and low birth weight following maternal exposure to azathioprine, particularly in combination with corticosteroids. It also reduces the corticosteroid requirements of renal transplant recipients. The possibility that exacerbation of symptoms might be related to the medicinal product should be borne in mind when treating such patients.Pancreatitis has been reported in a small percentage of patients on azathioprine therapy, particularly in renal transplant patients and those diagnosed as having inflammatory bowel disease.Cholestasis and deterioration of liver function have occasionally been reported in association with azathioprine therapy and are usually reversible on withdrawal of therapy. The immediate toxic effects of this overdose were nausea, vomiting and diarrhoea, followed by mild leukopenia and mild abnormalities in liver function. Experimental data confirm that azathioprine reverses the neuromuscular blockade produced by non-depolarising agents, and show that azathioprine potentiates the neuromuscular blockade produced by depolarising agents (see section 4.4).Inhibition of the anticoagulant effect of warfarin and acenocoumarol has been reported when co-administered with azathioprine; therefore, higher doses of the anticoagulant may be needed. Dosage forms: TAB: 50 mg; INJ: various kidney transplant rejection prophylaxis [1-3 mg/kg/dose PO/IV qd] Start: 3-5 mg/kg/dose PO/IV x1 up to 3 days before transplant; Info: transplant protocols may vary; decr.
Histological findings include sinusoidal dilatation, peliosis hepatis, veno-occlusive disease and nodular regenerative hyperplasia. 1107742-overview
Clinical particulars . 100mg/vial; Juvenile Idiopathic Arthritis. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard, or search for MHRA Yellow Card in the Google Play or Apple App Store.Unexplained infection, ulceration of the throat, bruising and bleeding are the main signs of overdosage with azathioprine and result from bone marrow depression which may be maximal after 9 to 14 days.
Each film-coated tablet contains 50 mg azathioprine. Each scored tablet contains 50 mg azathioprine and the inactive ingredients lactose monohydrate, pregelatinized starch, povidone, corn starch, magnesium stearate, and stearic acid. Objective: To compare the efficacy of combined low-dose azathioprine and oral PUVA therapy versus oral PUVA therapy alone for the treatment of vitiligo. Pharmaceutical form. Megaloblastic bone marrow changes have also been observed but severe megaloblastic anaemia and erythroid hypoplasia are rare.Several different clinical syndromes, which appear to be idiosyncratic manifestations of hypersensitivity, have been described occasionally following administration of azathioprine tablets and injection.
However, the aetiology is not clearly established and high-dose corticosteroids may be implicated. Teratogenicity was evident in rabbits at 10 mg/kg bodyweight/day.The film-coated tablets are packed in either polypropylene-aluminium blister or PVC/PVDC-aluminium blister in a carton box.The pack contains 30, 50, 56 or 100 film-coated tablets.Health professionals who handle uncoated azathioprine tablets should follow guidelines for the handling of cytotoxic medicinal products according to prevailing local recommendations and/or regulations.Provided that the film-coating is intact, there is no risk in handling film-coated azathioprine tablets.
For the treatment of idiopathic pulmonary fibrosis†. Consideration should be given to reducing the starting dosage in these patients and haematological response should be carefully monitored (see sections 4.2 and 5.2).Limited evidence suggests that azathioprine is not beneficial to patients with hypoxanthine- guanine- phosphoribosyltransferase deficiency (Lesch-Nyhan syndrome).