What is Imuran (Azathioprine)?

A Look at Imuran (Azathioprine)

There are several medications to treat lupus.
There are several medications to treat lupus. Yuri_Arcurs/Getty Images

What is Azathioprine?

Azathioprine, which goes by brand names Imuran and Azasan, is an immunosuppressant drug often used in people with lupus in addition to or instead of steroid therapy.

Immunosuppresives are potent drugs that help control disease activity in major organs. These medications may also reduce or eliminate the need for steroids.

Azathioprine is available only by prescription.

Please note that mycophenolic acid has been shown to significantly reduce steroid dosage for patients with lupus nephritis or treatment-resistant systemic lupus erythematosus, and it's considered a first-line therapy for lupus nephritis, replacing azathioprine.

Based on murine (mouse and rat) and human studies, azathioprine is considered a weak immunosuppressive agent. However, azathioprine is cheaper than other immunosuppressive agents and can be used instead of steroids. Specifically, azathioprine works well after initiation of treatment with cyclophosphamide or mycophenolate, other agents used to treat autoimmune disease like lupus.

How Does Azathioprine Work?

The immune systems of lupus patients produce autoantibodies at a rapid rate. Azathioprine works by suppressing the cells involved in the hyperactive immune response.

More specifically, Azathioprine works by inhibiting gene replication and subsequent T cell activation; azathioprine inserts itself into DNA and thus messes with replication.

Who Shouldn't Take Azathioprine?

  • Pregnant and nursing mothers
  • Those planning to get pregnant (both women and men)
  • Those taking allopurinol, tubocurarine, penicillamine, captopril, warfarin, cimetidine, indometacin, cytostatic drugs, balsalazide, mesalazine, olsalazine or sulfasalazine
  • Those who are suffering from liver or kidney disease
  • Those who produce little thiopurine methyltransferase
  • Those with Lsech-Nyhan Syndrome

How to Take Azathioprine

Though dosage varies by patient, most people take the drug once a day. Your physician will determine your regimen.

What are Possible Adverse Effects of Azathioprine?

Contact your doctor immediately if you develop any of the following symptoms:

  • Feeling sick and/or being sick
  • Diarrhea
  • Fever
  • Shivering or chills
  • Skin rash
  • Muscle and bone pain
  • Changes in quantity and color of urine passed (may signal kidney problems)
  • Tiredness
  • Dizziness

Hair loss is another possible adverse effect of Azathioprine; however, hair loss in those taking this medication is rare (1 in 1,000 patients). Hair often returns, even while the drug is still being used.

What Are Serious Adverse Effects of Azathioprine?

More serious adverse effects of azathioprine include the following:

  • Fever
  • Respiratory or other infection
  • Unexpected bruising or bleeding
  • Bad diarrhea
  • Abdominal pain
  • Jaundice
  • Serious skin reactions
  • Lumps on the body or patches on the skin

Who Makes Imuran and Azasan?

Azathioprine goes by brand names Azasan, made by the pharmaceutical company Salix, and Imuran, produced by GlaxoSmithKline.

Sources:
Imuran. GlaxoSmithKline. Our Products

Azathioprine. MedlinePlus Drug Information. U.S. National Library of Medicine. National Institutes of Health.

Immune Suppressants. Lupus Foundation of America.

Glomerular Diseases. National Kidney and Urological Diseases Information Clearinghouse. NIH Publication No. 07–4358. April 2006.

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