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What is the most important information I should know about azathioprine?

Notify your doctor immediately if you develop a fever or chills, a sore throat, unusual bleeding or bruising, mouth sores, abdominal pain, pale stools, or darkened urine. These could be early symptoms of dangerous conditions.
Tell your doctor and dentist that you are taking this medication before having surgery, before starting any other medicines, and before receiving any vaccinations.

What is azathioprine?

Azathioprine is an immunosuppressant. Immunosuppressants decrease the effects of your body’s immune system.

Azathioprine is used to treat rheumatoid arthritis and to prevent your body from rejecting a kidney transplant.

Azathioprine may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before taking azathioprine?

Before taking azathioprine, tell your doctor if you have
liver disease;
a viral, bacterial, or fungal infection;
pancreatitis;
rheumatoid arthritis and have been treated with cyclophosphamide (Cytoxan), chlorambucil (Leukeran), melphalan (Alkeran), or another alkylating agent; or
any other serious or chronic medical condition.
You may not be able to take azathioprine, or you may require a lower dose or special monitoring if you have any of the conditions listed above.
Azathioprine is in the FDA pregnancy category D. This means that it is known to harm an unborn baby. Do not take this medication if you are pregnant. Azathioprine can also decrease sperm production. It is not known whether azathioprine taken by a man will harm an unborn baby at the time of conception.
Azathioprine passes into breast milk and may harm a nursing infant. Do not take azathioprine if you are breast-feeding a baby.

How should I take azathioprine?

Take azathioprine exactly as directed by your doctor. If you do not understand these directions, ask your doctor, nurse, or pharmacist to explain them to you.

Take each dose with a full glass of water.

Take azathioprine with food to lessen stomach upset.

Your doctor will want you to have regularly scheduled blood tests while taking azathioprine.

Store azathioprine at room temperature away from moisture and heat.

What happens if I miss a dose?

If you take more than one dose a day, take the missed dose as soon as you remember. If it is almost time for your next dose, take both doses together, then go back to your regular dosing schedule.

If you take only one dose a day, skip the dose you missed and just return to your regular dosing schedule. Do not take a double dose.

Notify your doctor if you miss a dose of this medication.

What happens if I overdose?

Seek emergency medical attention.
Symptoms of an azathioprine overdose include nausea, vomiting, abdominal pain, diarrhea, bleeding, and infection.

What should I avoid while taking azathioprine?

Avoid sources of infection. Azathioprine decreases your body’s immune system, and you are much more susceptible to infection. Notify your doctor at the first sign of fever, chills, or a sore throat.
Tell your doctor and dentist that you are taking this medication before having surgery, before starting any other medicines, and before receiving any vaccinations.

What other drugs will affect azathioprine?

Before taking azathioprine, tell your doctor if you are taking, have taken, or need to take any of the following medicines:

an anticoagulant (blood thinner) such as warfarin (Coumadin);
cyclosporine (Neoral, Sandimmune);
olsalazine (Dipentum);
cyclophosphamide (Cytoxan, Neosar);
chlorambucil (Leukeran);
melphalan (Alkeran);
methotrexate (Rheumatrex, Immunex);
allopurinol (Zyloprim);
an ACE inhibitor (heart medicine) such as benazepril (Lotensin), captopril (Capoten), fosinopril (Monopril), lisinopril (Prinivil, Zestril), quinapril (Accupril), ramipril (Altace), or others;
trimethoprim (Trimpex, Proloprim, Bactrim, Septra, others); or
any type of vaccination.

You may not be able to take azathioprine, or you may require a dosage adjustment or special monitoring if you are taking any of the medicines listed above.

Drugs other than those listed here may also interact with azathioprine. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

What are the possible side effects of azathioprine?

If you experience any of the following serious side effects, stop taking azathioprine and seek emergency medical attention or contact your doctor immediately:

  • an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
  • unusual tiredness or weakness;
  • cough, sore throat, fever, or chills;
  • painful or difficult urination;
  • pale stools or darkened urine;
  • severe nausea, vomiting, or diarrhea;
  • sores in the mouth or on the lips;
  • unusual bleeding or bruising; or
  • an overall feeling of illness.

Other, less serious side effects may also occur. Continue to take azathioprine and notify your doctor if you experience

  • upset stomach, nausea, vomiting, or loss of appetite;
  • hair loss; or
  • a rash.

The risk of immune system cancer is increased following treatment with any immunosuppressant.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.