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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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29Jones RBFrank RMass TSafe handling of chemotherapeutic agentsa report from The Mount Sinai Medical CenterCA Cancer J for Clinicians198333:258-263.

12Tagatz GESimmons RLPregnancy after renal transplantationAnn Intern Med197582:113-114Editorial Notes.

Chromosomal abnormalitieswhich disappear with timehave been demonstrated in lymphocytes from the offspring of patients treated with ImuranExcept in extremely rare casesno overt physical evidence of abnormality has been observed in the offspring of patients treated with ImuranAzathioprine and long-wave ultraviolet light have been shown to have a synergistic clastogenic effect in patients treated with azathioprine for a range of disorders.

Using Imuran for a long time may increase your risk of skin cancer and lymphomaLymphoma is a cancer that affects your immune cells.

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