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The use of ribavirin for hepatitis C in patients receiving azathioprine has been reported to induce severe pancytopenia and may increase the risk of azathioprine-related myelotoxicityInosine monophosphate dehydrogenaseIMDHis required for one of the metabolic pathways of azathioprineRibavirin is known to inhibit IMDHthereby leading to accumulation of an azathioprine metabolite6-methylthioionosine monophosphate6MTITPwhich is associated with myelotoxicityneutropeniathrombocytopeniaand anemiaPatients receiving azathioprine with ribavirin should have complete blood countsincluding platelet countsmonitored weekly for the first monthtwice monthly for the second and third months of treatmentthen monthly or more frequently if dosage or other therapy changes are necessary.
It is important that you take this medication regularly as prescribeddo not stop taking it and do not take more or less of the drug than is prescribed.
Chromosomal abnormalities have been demonstrated in both male and female patients treated with ImuranIt is difficult to assess the role of Imuran in the development of these abnormalities.
30American Society of Hospital PharmacistsASHP technical assistance bulletin on handling cytotoxic and hazardous drugsAm J Hosp Pharm199047:1033-1049.
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