Azathioprine
Inflammatory bowel diseases (IBD) like Crohn’s Disease and Ulcerative Colitis are characterized by chronic inflammation of areas of the gastrointestinal (GI) tract. The cause of IBD’s is unknown, though there is evidence that it may involve a genetic predisposition which causes the immune system to react inappropriately - mistaking food, bacteria, and other materials in the intestine for foreign or invading substances. In individuals with IBD’s, the body attacks these common substances by sending white blood cells into the lining of the intestines, where they produce chronic inflammation. These cells then generate harmful products that ultimately lead to ulcerations and bowel injury.
Azathioprine is in a class of drugs called Immunomodulators [such as
azathioprine and 6-mercapto-purine (6-MP) ] and reduce inflammation by
affecting the immune system. They are used for patients who have not responded
to 5-ASAs or corticosteroids or who are dependent on corticosteroids.
However, immunomodulators are slow-acting and may take up to 6 months before
the full benefit is seen. Patients taking these drugs are monitored for
complications including pancreatitis and hepatitis, a reduced white blood
cell count, and an increased risk of infection.
Azathioprine is an immunosuppressant, meaning it will supress your immune
system not just for the productions of the white cells that attack your
digestive tract, but all of your immune system, leaving you more
susceptible to infection and illnesses. It is used mainly in organ
transplantation to prevent the body from rejecting the new organ.
The drug is also used in patients with lupus who have damage to their
kidneys or other organs, muscle inflammation, or advanced arthritis. It is
also used more recently in patients with Inflammatory Bowel Disease.
Azathioprine helps to reduce symptoms and damage to the affected organs.
Another benefit of azathioprine is that it reduces or even eliminates the need
for corticosteroid therapy. This means that patients do not have to have the
unpleasant side effects that occur with corticosteroids.
Immunosuppressives like azathioprine, however, can have their own serious
side effects. Azathioprine is a very strong medicine.
AZATHIOPRINE CAS No. 446-86-6 First Listed in the Fourth Annual Report on Carcinogens Here is the entire abstract Azathioprine is known to be a human carcinogen based on sufficient evidence
of carcinogenicity in humans (IARC 1982, 1987). Two large prospective
epidemiological studies have shown that renal transplant patients, who
usually receive azathioprine as an immunosuppressant, become at high risk for
non-Hodgkin's lymphoma, squamous cell cancers of the skin, hepatobiliary
carcinomas, and mesenchymal tumors. Although this is true for each of the
various etiological entities resulting in the need for a transplant, a
commonality among these is heavy exposure to foreign antigens. Other patients
who have received azathioprine as an immunosuppressant, including those
with rheumatoid arthritis, systemic lupus and other"collagen" disorders,
inflammatory bowel disease, and certain skin and renal diseases, have also
been studied; the same array of malignancies was found to be in excess,
although to a lesser extent. For these patients, however, the picture is
still not completely clear, because patients with rheumatoid arthritis
constituted the largest category in the latter study, and some, but not all
studies, have found that this disease conveys a risk for non-Hodgkin's
lymphoma in the absence of treatment.
An IARC Working Group reported that there is limited evidence of
carcinogenicity of azathioprine in experimental animals (IARC 1981, 1982, 1987)
. Suggestive evidence was obtained that lymphomas were induced in mice after
intraperitoneal, subcutaneous, orintramuscular injection of azathioprine and
that thymic lymphomas and squamous cellcarcinomas of the ear duct were induced
in rats after oral administration, but there were limitations in the design
and reporting of these studies.
You and your doctor should talk about the need for this medicine and its risks. Even though azathioprine may cause side effects that could be very serious, remember that it may be required to treat your medical problem.
Common Side Effects:
Check with your doctor if any of the following side effects continue or are bothersome:
loss of appetite
nausea or vomiting
Less common:
Check with your doctor if any of the following side effects continue or are
bothersome: ALWAYS NOTIFY YOUR DOCTOR if any of the following presents itself
Skin rash
More common
Cough, hoarseness
fever or chills
lower back or side pain
painful or difficult urination
unusual tiredness, weakness
Less Common
Black, tarry stools
blood in urine or stools
pinpoint red spots on skin
unusual bleeding or bruising
Less Common or Rare
Fast heartbeat
fever (sudden)
muscle or joint pain
nausea, vomiting, and diarrhea (severe)
redness or blisters on skin
shortness of breath
sores in mouth, on lips
stomach pain
swelling of feet or lower legs
feeling of discomfort or illness (sudden)
Your doctor will watch for any liver problems this medicine may cause.
Because of the way this medicine acts on the body, there is a chance that it might cause other unwanted effects that may not occur until months or years after the medicine is used. These delayed effects may include certain types of cancer, such as leukemia, lymphoma, or skin cancer. The risk of cancer is lower in people taking azathioprine for arthritis, and you should discuss these possible effects with your doctor.
After you stop this medicine, there may still be some side effects. During this time notify your doctor as soon as possible if you notice any of the following:
black, tarry stools
blood in urine
cough or hoarseness
fever or chills
lower back or side pain
painful or difficult urination
pinpoint red spots on skin
unusual bleeding or bruising
Avoid exposure to infections. Stay away from crowds and people known to have
colds, the flu, or other infections.
Do not take this drug with other drugs, including over-the-counter
medications, without first checking with your nurse or doctor.
Over-the-counter medications are medications that you can buy without a
doctor’s prescription and include such drugs like acetominophen (like Tylenol), NSAIDS (non-steroidal anti-inflammatory Drugs) like Ibuprofen (Advil etc), naproxen sodium (like Aleve etc), cough syrups, inhalers, headache remedies, menstrual cramp remedies, joint pain and muscle remedies and ANYTHING YOU CAN BY WITHOUT A PRESCRIPTION. This includes aspirin, vitamin and mineral supplements, supplemental drinks and remedies whether labeled ALL NATURAL or not and always ask about the grapefruit juice risk.
Always tell your nurses, doctors, or dentist that you are taking azathioprine.
WARNING!
Use of this drug presents a definite risk to the fetus. Use an effective birth
control measure during treatment and for 12 weeks after ending treatment.
Azathioprine may pass into breast milk, so consult your doctor before
breastfeeding.
Other side effects not listed above may also occur in some patients. Remember, everyone is different, and every case is different. Inflammatory Bowel Diseases do not follow any specific set of criteria so be aware of your general condition before, during and after treatments of any kind.
If you notice any other effects like something not normal to your daily general health, like maybe blurred vision, headaches, lethargy, green-looking watery stools (like bile), blistering, red sore lumps on the extremities or in the eye, sore areas within the esophagus that you can feel when you swallow anything, fatty or greasy looking stools, extremely foul odors from stool or gas check with your doctor, these may be presenting as another underlying condition or extraintestinal manifestation that has been aggravated or induced by this medication. This information is meant only as a guideline - always consult a physician or pharmacist for complete information about prescription medications.
On behalf of learning, and use as teaching tools for those of us who need to
know about our disease, I have tried to supply you with as much information as
I could find on all of the drugs, treatments and disorders associated with
Inflammatory Bowel Diseases. I have tried to blend all facts supported by research
and also from personal experiences of other IBD sufferers into one readable webpage, and any and all information presented here is not entirely
from one source. Most information contained within these pages is found in the public domain.
At times you may find information used from another site, and as with all copyrighted materials you may find on these pages, I claim fair use under sections 107 through 118 of the Copyright Act (title 17, U.S. Code). Click here for more info
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