Imuran

How does it work?

Imuran tablets and injection contain the active ingredient azathioprine, which is a type of medicine called an immunosuppressant. (NB. Azathioprine tablets are also available without a brand name, ie as the generic medicine.) Azathioprine is used to dampen down the activity of cells in the immune system. The immune system normally recognises and protects the body from foreign substances such as bacteria and viruses. It also recognises and attacks transplanted tissue and cells that have become cancerous. Sometimes however, the immune system can react excessively, or mount an attack against normal healthy tissues. This can result in various disorders known as autoimmune diseases. For example, in rheumatoid arthritis the immune system attacks the joints, causing pain and inflammation. In systemic lupus erythematosus the immune system attacks the skin and internal organs. The activity of the immune system can also be a problem following organ transplants, because it recognises the transplanted tissue as foreign and attacks it, causing the organ to be rejected. In situations such as these it is useful to suppress the activity of the immune system. The immune system relies on different types of white blood cells that are produced in the bone marrow and lymph glands. Azathioprine works by decreasing the production of these white blood cells. It does this by interfering with the production of the cells genetic material, DNA, which stops the cells from dividing and multiplying. The decrease in the numbers of white blood cells reduces the ability of the immune system to reject organ transplants. In autoimmune diseases it reduces the immune system attack on normal tissues and so reduces the severity of the symptoms, and in many cases halts the progress of the disease. However, it can take weeks to months of treatment for the full effect of the medicine to become apparant. Unfortunately white blood cells are needed to fight invading micro-organisms, so during treatment the body becomes more susceptible to infections. Azathioprine also interferes with the growth and division of other types of blood cells in the bone marrow. Reduced production of red blood cells can cause anaemia and reduced production of platelets can cause problems with blood clotting. For this reason, your doctor will monitor the levels of all your blood cells. Azathioprine is often used in combination with other immunosuppressants such as corticosteroids. When combined with corticosteroids it can often allow a reduced dose of corticosteroid to be used.

What is it used for?

Abnormal destruction of liver cells by the body's immune system

Abnormal destruction of red blood cells by the body's immune system (autoimmune haemolytic anaemia)

Blistering skin disorder caused by abnormal attack of the skin cells by the body's immune system (pemphigus vulgaris)

Abnormal destruction of blood platelets by the body's immune system

Inflammatory disease of the skin and muscles (dermatomyositis)

Inflammatory disease of the muscles (polymyositis)

Long-term inflammation of skin and internal organs due to abnormal attack of the body tissues by the immune system (systemic lupus erythematosus)

Inflammation of the walls of arteries (polyarteritis nodosa)

Preventing the body from rejecting transplanted organs, eg heart, liver, kidney transplants

Severe inflammatory disease of the joints caused by abnormal attack on the joints by the immune system

Warning!

This medicine decreases the normal amounts of blood cells in your blood. For this reason you will need to have regular blood tests to monitor the levels of your blood cells. You should consult your doctor immediately if you experience any of the following symptoms, as they may indicate a problem with your blood cells: unexplained bruising or bleeding, purple spots, sore throat, mouth ulcers, high temperature (fever), feeling tired or general illness or infection.

People having long term or intense immunosuppressive treatment are at increased risk of developing lymphomas and other cancers, particularly skin cancer. For this reason you should minimise your exposure to strong sunlight and UV light by wearing protective clothing and using a sunscreen with a high protection factor, in order to reduce your risk of skin cancer. Discuss this with your doctor.

If you suffer from liver problems your doctor should monitor your liver function while you are taking this medicine.

Tell your doctor immediately if you experience any of the following symptoms, as they may suggest that you are allergic to this medicine: dizziness, nausea, vomiting, diarrhoea, fever, shivering, skin rash, or pain in the muscles or joints.

Use with caution in

Decreased kidney function

Decreased liver function

Elderly people

Inherited deficiency of an enzyme called thiopurine methyltransferase (TPMT)

Not to be used in

Allergy to mercaptopurine

Pregnancy

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

Women should use effective contraception to avoid getting pregnant and men should use effective contraception to avoid fathering a child during treatment with this medicine. Women who do get pregnant while they or their partner is receiving treatment should consult their doctor immediately. Azathioprine may increase the risk of premature birth, low birth weight and miscarriage. Seek medical advice from your doctor.

This medicine passes into breast milk. Seek medical advice from your doctor before using this medicine during breastfeeding.

Label warnings

Take Imuran tablets with or after food.

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