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Imuran (azathioprine) Disease Interactions

There are 4 disease interactions with Imuran (azathioprine):

Major

Azathioprine (Includes Imuran) ↔ Bone Marrow Depression

Severe Potential Hazard, High plausibility

Applies to: Bone Marrow Depression/Low Blood Counts

Azathioprine may cause severe leukopenia, thrombocytopenia, macrocytic anemia, severe bone marrow depression and, rarely, pure red cell aplasia. Therapy with azathioprine should be administered cautiously in patients with bone marrow depression. Hematological toxicities are dose related. Caution and routine monitoring of blood counts and platelets is recommended. Patients should report any unusual bleeding or bruising.

References

  1. Snow JL, Gibson LE "A pharmacogenetic basis for the safe and effective use of azathioprine and other thiopurine drugs in dermatologic patients." J Am Acad Dermatol 32 (1995): 114-6
  2. Anstey A, Lennard L, Mayou SC, Kirby JD "Pancytopenia related to azathioprine-an enzyme deficiency caused by a common genetic polymorphism: a review." J R Soc Med 85 (1992): 752-6
  3. Singh G, Fries JF, Spitz P, Williams CA "Toxic effects of azathioprine in rheumatoid arthritis: a national post-marketing perspective." Arthritis Rheum 32 (1989): 837-43
  4. Agarwal SK, Mittal D, Tiwari SC, Dash SC, Saxena S, Saxena R, Mehta SN "Azathioprine-induced pure red blood cell aplasia in a renal transplant recipient." Nephron 63 (1993): 471
  5. Hogge DE, Wilson DR, Shumak KH, Cattran DC "Reversible azathioprine-induced erythrocyte aplasia in a renal transplant recipient." Can Med Assoc J 126 (1982): 512-3
  6. Creemers GJ, van Boven WP, Lowenberg B, van der Heul C "Azathioprine-associated pure red cell aplasia." J Intern Med 233 (1993): 85-7
  7. Jeurissen ME, Boerbooms AM, Van de Putte LB "Pancytopenia related to azathioprine in rheumatoid arthritis." Ann Rheum Dis 47 (1988): 503-5
  8. Whisnant JK, Pelkey J "Rheumatoid arthritis: treatment with azathioprine (IMURAN (R)): clinical side-effects and laboratory abnormalities." Ann Rheum Dis 41 (1982): 44-7
  9. Hohlfeld R, Michels M, Heininger K, Besinger U, Toyka KV "Azathioprine toxicity during long-term immunosuppression of generalized myasthenia gravis." Neurology 38 (1988): 258-61
  10. Speerstra F, Boerbooms AM, van de Putte LB, et al "Side-effects of azathioprine treatment in rheumatoid arthritis: analysis of 10 years of experience." Ann Rheum Dis 41 (1982): 37-9
  11. Kerstens PJ, Stolk JN, Hilbrands LB, Vandeputte LB, Deabreu RA, Boerbooms AM "5-nucleotidase and azathioprine-related bone-marrow toxicity." Lancet 342 (1993): 1245-6
  12. DeClerck YA, Ettenger RB, Ortega JA, Pennisi AJ "Macrocytosis and pure RBC anemia caused by azathioprine." Am J Dis Child 134 (1980): 377-9
  13. Kerstens PJSM, Stolk JN, Deabreu RA, Lambooy LHJ, Vandeputte LBA, Boerbooms AAMT "Azathioprine-related bone marrow toxicity and low activities of purine enzymes in patients with rheumatoid arthritis." Arthritis Rheum 38 (1995): 142-5
  14. Thompson DF, Gales MA "Drug-induced pure red cell aplasia." Pharmacotherapy 16 (1996): 1002-8
  15. Lennard L, Van Loon JA, Weinshilboum RM "Pharmacogenetics of acute azathioprine toxicity: relationship to thiopurine methyltransferase genetic polymorphism." Clin Pharmacol Ther 46 (1989): 149-54
  16. Nossent JC, Swaak AJ "Pancytopenia in systemic lupus erythematosus related to azathioprine." J Intern Med 227 (1990): 69-72
View all 16 references
Major

Azathioprine (Includes Imuran) ↔ Infections

Severe Potential Hazard, Moderate plausibility

Applies to: Infection - Bacterial/Fungal/Protozoal/Viral

Serious infections, including reactivation of latent infections have been reported with the use of azathioprine. Cases of JC virus-associated infection resulting in progressive multifocal leukoencephalopathy (PML), sometimes fatal, have been reported in patients treated with immunosuppressants, including azathioprine. A diagnosis of PML should be considered in any patient presenting with new-onset neurological manifestations and a consultation with a neurologist is recommended. Consider reducing the amount of immunosuppression in patients who develop PML, and in transplant patients, consider the risk that the reduced immunosuppression represents to the graft.

Major

Azathioprine (Includes Imuran) ↔ Renal Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Azathioprine may accumulate in patients with impaired renal function. Therapy with azathioprine should be administered cautiously and may need dosage reduction in patients with impaired renal function.

References

  1. Odlind B, Hartvig P, Lindstrom B, Lonnerholm G, Grefberg N "Serum azathioprine and 6-mercaptopurine levels and immunosuppressive activity after azathioprine in uremic patients." Int J Immunopharmacol 8 (1986): 1-11
  2. Keystone EC, Schabas R "Hypotension with oliguria: a side-effect of azathioprine." Arthritis Rheum 24 (1981): 1453-4
  3. Schusziarra V, Ziekursch V, Schlamp R, Siemensen HC "Pharmacokinetics of azathioprine under haemodialysis." Int J Clin Pharmacol 14 (1976): 298-302
  4. Chan GL, Erdmann GR, Gruber SA, Matas AJ, Canafax DM "Azathioprine metabolism: pharmacokinetics of 6-mercaptopurine, 6-thiouric acid and 6-thioguanine nucleotides in renal transplant patients." J Clin Pharmacol 30 (1990): 358-63
  5. Chan GL, Erdmann GR, Gruber SA, et al "Pharmacokinetics of 6-thiouric acid and 6-mercaptopurine in renal allograft recipients after oral administration of azathioprine." Eur J Clin Pharmacol 36 (1989): 265-71
  6. McHenry PM, Allan JG, Rodger RS, Lever RS "Nephrotoxicity due to azathioprine." Br J Dermatol 128 (1993): 106
  7. Duttera MJ, Carolla RL, Gallelli JF, et al "Hematuria and crystalluria after high-dose 6-mercaptopurine administration." N Engl J Med 287 (1972): 292-4
  8. Singh G, Fries JF, Spitz P, Williams CA "Toxic effects of azathioprine in rheumatoid arthritis: a national post-marketing perspective." Arthritis Rheum 32 (1989): 837-43
  9. Ding TL, Gambertoglio JG, Amend JC, et al "Azathioprine (AZA) bioavailability and pharmacokinetics in kidney transplant patients." Clin Pharmacol Ther 27 (1980): 250
  10. Whisnant JK, Pelkey J "Rheumatoid arthritis: treatment with azathioprine (IMURAN (R)): clinical side-effects and laboratory abnormalities." Ann Rheum Dis 41 (1982): 44-7
  11. Trotta F, Menegale G, Fiocchi O "Azathioprine-induced hypotension with oliguria." Arthritis Rheum 25 (1982): 1388-9
View all 11 references
Moderate

Azathioprine (Includes Imuran) ↔ Liver Disease

Moderate Potential Hazard, Moderate plausibility

Applies to: Liver Disease

Azathioprine is metabolically converted to the pharmacologically active 6-mercaptopurine (6-MP). Conversion to 6-MP and metabolism of 6-MP may be impaired in patients with liver disease. Therapy with azathioprine should be administered cautiously in patients with liver disease. Monitoring liver function is recommended in these patients.

References

  1. Farge D, Parfrey PS, Forbes RD, Dandavino R, Guttmann RD "Reduction of azathioprine in renal transplant patients with chronic hepatitis." Transplantation 41 (1986): 55-9
  2. Hohlfeld R, Michels M, Heininger K, Besinger U, Toyka KV "Azathioprine toxicity during long-term immunosuppression of generalized myasthenia gravis." Neurology 38 (1988): 258-61
  3. Read AE, Wiesner RH, LaBrecque DR, et al "Hepatic veno-occlusive disease associated with renal transplantation and azathioprine therapy." Ann Intern Med 104 (1986): 651-5
  4. Small P, Lichter M "Probably azathioprine hepatotoxicity: a case report." Ann Allergy 62 (1989): 518-20
  5. Millard PR, Herbertson BM, Evans DB, Calne RY "Azathioprine hepatotoxicity in renal transplantation." Transplantation 16 (1973): 527-30
  6. Singh G, Fries JF, Spitz P, Williams CA "Toxic effects of azathioprine in rheumatoid arthritis: a national post-marketing perspective." Arthritis Rheum 32 (1989): 837-43
  7. DePinho RA, Goldberg CS, Lefkowitch JH "Azathioprine and the liver: evidence favoring idiosyncratic, mixed cholestatic-hepatocellular injury in humans." Gastroenterology 86 (1984): 162-5
  8. Cooper C, Minihane N, Cotton DW, Cawley MI "Azathioprine hypersensitivity manifesting as acute focal hepatocellular necrosis." J R Soc Med 79 (1986): 171-3
  9. Jeurissen ME, Boerbooms AM, van de Putte LB, Kruijsen MW "Azathioprine induced fever, chills, rash, and hepatotoxicity in rheumatoid arthritis." Ann Rheum Dis 49 (1990): 25-7
  10. Katska DA, Saul SH, Jorkasky D, Sigal H, Reynolds JC, Soloway RD "Azathioprine and hepatic venocclusive disease in renal transplant patients." Gastroenterology 90 (1986): 446-54
  11. Gerlag PG, van Hooff JP "Hepatic sinusoidal dilatation with portal hypertension during azathioprine treatment: a cause of chronic liver disease after kidney transplantation." Transplant Proc 19 (1987): 3699-703
  12. Liano F, Moreno A, Matesanz R, et al "Veno-occlusive hepatic disease of the liver in renal transplantation: is azathioprine the cause?" Nephron 51 (1989): 509-16
  13. Sterneck M, Wiesner R, Ascher N, et al "Azathioprine hepatotoxicity after liver transplantation." Hepatology 14 (1991): 806-10
  14. Meys E, Devogelaer JP, Geubel A, Rahier J, de Deuxchaisnes CN "Fever, hepatitis and acute interstitial nephritis in a patient with rheumatoid arthritis. Concurrent manifestations of azathioprine hypersensitivity." J Rheumatol 19 (1992): 807-9
  15. Lemley DE, Delacy LM, Seeff LB, Ishak KG, Nashel DJ "Azathioprine induced hepatic veno-occlusive disease in rheumatoid arthritis." Ann Rheum Dis 48 (1989): 342-6
  16. Duvoux C, Kracht M, Lang P, Vernant JP, Zafrani ES, Dhumeaux D "Hyperplasie nodulaire regenerative du foie associee a la prise d'azathioprine." Gastroenterol Clin Biol 15 (1991): 968-73
View all 16 references

Imuran (azathioprine) drug Interactions

There are 332 drug interactions with Imuran (azathioprine)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

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