AZATHIOPRINE
Generic Name: Azethioprine
Brand Name:  Azasan and Imuran
Classification: Immunosuppressive
Dosage: 50MG/100MG
Indication
Azathioprine was the
first antimetabolite used
in liver transplant but its
use has since decreased
dramatically over time.
Azathioprine is an
imidazolyl derivative of
mercaptopurine and
antagonizes purine
metabolism. The result is
an inhibition in synthesis
of DNA, RNA, and
proteins
Contraindication Mechanism of Side effects Nursing
Action Considerations
Who should not take Azathioprine inhibits What are the possible side  Monitor signs of
AZATHIOPRINE? purine synthesis. Purines effects of azathioprine
are needed to produce (Imuran) hypersensitivity reactions,
 A bad infection. DNA and RNA. By especially signs of serum
 Significant anemia. inhibiting purine synthesis,  Increased stomach sickness such as muscle
 Decreased blood less DNA and RNA are irritation, abdominal
aches, joint pains, fever,
platelets. produced for the synthesis pain.
 Severe decrease in of white blood cells, thus  Nausea and vomiting. and skin rash. Notify
white blood cells. causing  Changes in hair color physician or nursing staff
 A blood clot in a vein immunosuppression. and texture, along with immediately if these
of the liver. hair loss.
reactions occur.
 Acute inflammation  Loss of appetite.
of the pancreas.  Blood in the urine or
 Pregnancy. stool.  Watch for and report signs
 Malignant  Unusual bruising. of leukopenia (fever, sore
lymphoma.  Fatigue. throat, signs of infection),
 Development of mouth
thrombocytopenia
sores and ulcers.
(bruising, nose bleeds, and
bleeding gums), or unusual
weakness and fatigue that
might be due to anemia or
other blood dyscrasias.
Periodic blood tests may
be needed to monitor
 WBC and RBC counts.

 Assess any breathing

problems or signs of
pulmonary edema such as
rales/crackles chest pain,
shortness of breath, and
difficult or labored
breathing. Monitor pulse
oximetry and perform
pulmonary function tests
(See Appendices I, J, K) to
quantify suspected
changes in ventilation and
respiratory function.

 If treating rheumatoid
arthritis, periodically
assess patient's
impairments (pain, range
of motion), functional
ability, and disability to
help document whether
antirheumatic drug therapy
is successful.

 Assess any new or

increased joint pain to rule
out musculoskeletal
pathology; that is, try to
 determine if pain is drug
induced rather than caused
by arthritis or anatomic
and biomechanical
problems.

 Monitor signs of
Raynaud's phenomenon as
indicated by decreased
circulation to the fingers
and toes resulting in pain,
numbness, swelling, and
color changes in the
affected digits. Report
these signs to the
physician, and educate
patient about how to avoid
the onset of symptoms
(keep hands warm, avoid
caffeine, stress, and other
triggers).

 If treating inflammatory
bowel diseases, monitor
any changes in symptoms
(decreased abdominal
pain, decreased diarrhea,
improved appetite) to help
document whether drug
therapy is successful.