Azathioprine and mercaptopurine belong to the group of drugs called immunosuppressants. Azathioprine and mercaptopurine reduce inflammation by damping down over-activity of the cells of the immune system.
Azathioprine and mercaptopurine are slow-acting. It may take three to six months before you notice benefits. This means some people will need to be treated with other immunosuppressants, such as steroids, until azathioprine or mercaptopurine have started working. Search Login. How soon will I feel the effects of azathioprine?
Most patients start to feel the positive effects of azathioprine at weeks, with maximum benefit at months. Side effects can occur earlier. What are the possible side effects of azathioprine? Stomach upset, including nausea and vomiting Skin Rash Lower blood counts Liver irritation Increased risk for lymphoma How can I lower the risk of side effects?
Follow the directions your physician has provided. A very small percentage of people lack the enzyme which processes the active metabolite of azathoprine in the body, placing increased risk for developing serious side effects. By starting at a low dose and completing regular blood work, your doctor can safely monitor you to reduce this risk. Do your regularly scheduled bloodwork as requested by your doctor.
Are there any medications to avoid when taking azathioprine? Doses are also based on the levels of certain enzymes in your body that break down the medicines. Your doctor may alter your dose of azathioprine or mercaptopurine later. If azathioprine or mercaptopurine make you feel better, you should be able to keep taking the medicine for some years.
Generally after four years, you and your IBD team will make a decision about whether to continue the medicine. Some people can continue to take the medicine for many years longer. Talk to your IBD team if you would like to think about stopping treatment.
Biologic Medicines Azathioprine is sometimes given together with biologic medicines such as infliximab or adalimumab. This can be more effective at bringing on and maintaining remission than taking biologic medicines alone. This combination may also reduce the likelihood of anti-drug antibodies being produced against these biological medicines, which can reduce how effective they are.
But the risk of infection can be higher when azathioprine and biological medicines are used together. Allopurinol Allopurinol is a medicine that is usually used to treat gout, a type of arthritis. But it also changes how azathioprine is broken down and increases the levels of medicine in the bloodstream. Sometimes when azathioprine is broken down by the body, it can release products that harm the liver. This happens with 1 in 5 people.
Your doctor may suggest taking a low dose of azathioprine together with allopurinol, which will boost the levels of azathioprine. Before you start treatment your IBD team will check that this treatment is right for you.
Levels of the TPMT thiopurine methyl transferase. This can cause serious side such as suppressed bone marrow function. If you have low TPMT levels the dose of azathioprine or mercaptopurine can be reduced. Screening to check that you are immune to specific infections. You may be screened for previous exposure to Epstein Barr virus which causes glandular fever, as people who have never had this virus are at an increased risk of lymphoma.
Vaccinations You should have all the vaccinations you need before you start treatment. These medicines can reduce normal bone marrow function causing changes in the blood and occasionally liver complications.
This may happen over time, so regular tests are important. Blood tests Azathioprine affects the way your body produces new blood cells. These will include full blood count and liver function tests. Eventually tests are likely to be every three months. Because azathioprine and mercaptopurine affect the way your immune system works, you may be more likely to get infections. Even a mild infection such as a cold or sore throat could develop into a more serious illness. Being immune suppressed can be a problem.
I always make sure I wash my hands thoroughly and with antibacterial soap to try and prevent infection. Live vaccines contain viruses that have been weakened, but not destroyed. People who are taking medicines which affect the immune system may not be able to produce antibodies quickly enough and risk becoming infected by the disease.
Live vaccines include oral polio, yellow fever, rubella German measles , BCG tuberculosis , chickenpox, MMR measles, mumps and rubella and shingles. However, you may be able to have the inactivated polio vaccine. Flu vaccines given by injection are safe. The Department of Health recommends that everyone on medicines which suppress the immune system should have an annual flu vaccination. But if anyone in your family or household is due to have a live vaccine, check with your IBD team whether you need to take any special precautions.
When starting on azathioprine, I made sure I was up-to-date with my vaccinations. I had a pneumonia vaccine and I make sure I have a flu jab every year. Before you take any new medicines, check with your doctor, pharmacist or IBD team, because they may interact with azathioprine or mercaptopurine and cause unexpected side effects.
This also applies to over-the-counter medicines and herbal, complementary or alternative medicines and treatments. You should also always tell anyone else treating you that you are taking azathioprine or mercaptopurine.
Tell your doctor if you become or are thinking of becoming pregnant while you or your partner are taking azathioprine or mercaptopurine. Mothers The companies that make azathioprine and mercaptopurine say the medicines should only be taken when necessary during pregnancy or when trying to conceive, just to be safe.
But studies have shown increased rates of anaemia low haemoglobin in babies born to mothers on these medicines, so a haemoglobin check for the baby may be considered. The companies that make azathioprine and mercaptopurine say the medicines should only be taken when necessary during breastfeeding.
However, azathioprine and mercaptopurine are generally considered safe for use by breastfeeding mothers. Although a low dose of the drug has been found in breast milk for four hours after taking the medication, so you could consider expressing and discarding milk during this time. Talk to your consultant if you want to breastfeed whilst taking these drugs. All medicines can cause unwanted side effects, although not everyone will get them.
Side effects occur in around 1 in 3 people taking azathioprine or mercaptopurine, and this can be at any time during treatment. Immediate reactions.
Any medication can cause an allergic reaction. Tell your doctor immediately if you develop any of the following symptoms:. Common side effects experienced by around 1 in 10 people may include the following:. Other side effects Because azathioprine acts on the immune system it can have some more serious side effects.
Your IBD team will continue to monitor you to minimise risks but let them know if you:.
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