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IMURAN is indicated for the treatment of active rheumatoid arthritisRAto reduce signs and symptomsAspirinnon-steroidal anti-inflammatory drugs and/or low dose glucocorticoids may be continued during treatment with IMURANThe combined use of IMURAN with disease modifying anti-rheumatic drugsDMARDshas not been studied for either added benefit or unexpected adverse effectsThe use of IMURAN with these agents cannot be recommended.

It is recommended that consideration be given to either genotype or phenotype patients for TPMTPhenotyping and genotyping methods are commercially availableThe most common non-functional alleles associated with reduced levels of TPMT activity are TPMT*2TPMT*3A and TPMT*3CPatients with two nonfunctional alleleshomozygoushave low or absent TPMT activity and those with one non-functional alleleheterozygoushave intermediate activityAccurate phenotypingred blood cell TPMT activityresults are not possible in patients who have received recent blood transfusionsTPMT testing may also be considered in patients with abnormal CBC results that do not respond to dose reductionEarly drug discontinuation in these patients is advisableTPMT TESTING CANNOT SUBSTITUTE FOR COMPLETE BLOOD COUNTCBCMONITORING IN PATIENTS RECEIVING IMURANSee CLINICAL PHARMACOLOGYWARNINGSADVERSE REACTIONS and DOSAGE AND ADMINISTRATION sections.

Imuran tablets are used as an immunosuppressant antimetabolite either alone ormore commonlyin combination with other agentsusually corticosteroidsand procedures which influence the immune responseTherapeutic effect may be evident only after weeks or months and can include a steroid-sparing effectthereby reducing the toxicity associated with high dosage and prolonged usage of corticosteroids.

One of the pathways for inactivation of azathioprine is inhibited by allopurinolPatients receiving IMURAN and allopurinol concomitantly should have a dose reduction of IMURANto approximately 1/3 to 1/4 the usual doseIt is recommended that a further dose reduction or alternative therapies be considered for patients with low or absent TPMT activity receiving IMURAN and allopurinol because both TPMT and XO inactivation pathways are affectedSee CLINICAL PHARMACOLOGYWARNINGSPRECAUTIONSLaboratory Tests and ADVERSE REACTIONS sections.

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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.

Imuran therapy should not be initiated in patients who may be pregnantor who are likely to become pregnant without careful assessment of risk versus benefitsee Special Warnings and Precautions for UsePregnancy and Lactation

The principal and potentially serious toxic effects of IMURAN are hematologic and gastrointestinalThe risks of secondary infection and malignancy are also significantsee WARNINGSThe 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 therapiesThe incidence of hematologic toxicities and neoplasia encountered in groups of renal homograft recipients is significantly higher than that in studies employing IMURAN for rheumatoid arthritisThe relative incidences in clinical studies are summarized below:

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Azathioprine imuran, azasan is a drug prescribed for prevention of organ rejection in kidney transplants.

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Alterations in specific immune responses or immunologic functions in transplant recipients are difficult to relate specifically to immunosuppression by azathioprineThese patients have subnormal responses to vaccineslow numbers of T-cellsand abnormal phagocytosis by peripheral blood cellsbut their mitogenic responsesserum immunoglobulinsand secondary antibody responses are usually normal.

Patients receiving Imuran should be instructed to report immediately any evidence of infectionunexpected bruising or bleeding or other manifestations of bone marrow depression.

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