Azathioprine....

[Guest LittleGreys]

I am such a chicken when it comes to starting new drugs, especially that I am not real familiar with. I guess I am going to start Munchie on azathioprine tomorrow, in combo with her pred........

Any thing I should be worried about, watch out for, etc for the first few days.......??

 

[lovinggreysslp]

Clay was on azathioprine for a year and we never saw any side effects and his blood work was just fine. You probably know this, but you are not supposed to touch this medication. I gently shook a tablet onto his food. I did pick up a tablet a couple times (and lived). Also, the azathioprine takes time to work. In Clay's case, we saw improvement in about six weeks. I too was very nervous giving Clay something like azathioprine but it really helped him turn a corner when the vets did not expect him to survive. Best of luck!

[Guest LynnM]

IIRC, you shouldn't have to much more to expect than a bit of a "chemo hangover" (as a friend of mine on methotrexate calls it).

 

Lynn

[Burpdog]

It appears you should get CBC done every two weeks. Look for bruising, nausea, etc. Complete side effects listed below:

 

Imuran

 

Azathioprine (Imuran)

 

Pet Pharmacy

 

(for veterinary information only)

 

Brand Name: Imuran

 

Available in 50 mg tablets

 

Background

 

Diseases involving excessive activity of the immune system are called immune mediated diseases and they are treated by suppressing the immune system. The cornerstone medication of immune suppression is prednisone; however, this medication may have undesirable side effects with long term use thus it is helpful to look towards a second medication that can be used to reduce the prednisone amount used. Azathioprine is such a medication, though it is important to realize that it can have some of its own adverse side effects in some individuals. In patients who do not have any problems with azathioprine (and most do not), prednisone can be reduced and possibly even discontinued.

 

Azathioprine disrupts the synthesis of DNA and RNA. This means that it disrupts cell division and that tissues with relatively rapid cell division are especially prone to its effects. In the treatment of immune mediated diseases, it is the stimulated lymphocytes that are inappropriately attacking the body that become the prime target of azathioprine.

 

Because azathioprine can disrupt rapid cell division, its use also has application in treating cancers.

 

Because azathioprine is a DNA poison it has the potential to cause mutation.

 

How this Medication Works

 

Some typical immune mediated conditions that commonly require the use of azathioprine include:

 

Immune mediated hemolytic anemia

 

Immune mediated platelet destruction (thrombocytopenia)

 

Pemphigus type skin diseases (especially pemphigus foliaceus)

 

Severe forms of inflammatory bowel disease

 

Chronic active hepatitis (a progressive scarring disease of the liver)

 

Myasthenia gravis (immune mediated destruction of the nerve/muscle junctions)

 

Systemic lupus erythematosus

 

Rheumatoid/immune mediated arthritis

Azathioprine is typically started once a day and then tapered to every other day use and is almost always started in conjunction with other immune suppressive agents.

 

Side Effects

 

One of the main issues with azathioprine is a problem with the bone marrow suppression. Cells of the bone marrow are rapidly dividing and thus at risk for suppression from azathioprine. For this reason, at least in early stages of use, complete blood counts (CBCs) are monitored frequently, typically every 2 weeks for the first couple of months.

 

Signs of a bone marrow problem that might be observable at home include abnormal bruising or inappropriate bleeding (bloody nose, bloody stool, blood in urine, excess bleeding from a minor wound etc.) If bone marrow suppression has not occurred in the first couple of months of therapy, it is unlikely that it will occur later on.

 

Some patients develop a liver toxicity with azathioprine. This should resolve with discontinuation of the medication but it is important to watch for any signs of nausea, diarrhea, or appetite loss. If these occur, especially in the first few weeks of starting azathioprine, discontinue the medication and notify your veterinarian of these effects.

 

Similarly, azathioprine can promote pancreatitis. Again, signs of nausea/intestinal upset can result. If this occurs, discontinue azathioprine and notify your veterinarian.

 

Interactions with other Drugs

 

Because it can take a good month or two before the effects of azathioprine are seen, it is a good idea to begin azathioprine in conjunction with an aggressive prednisone course. The prednisone will hopefully control the disease rapidly such that by the time the azathioprine has kicked in, the prednisone can be tapered to a maintenance level.

 

Concurrent use of allopurinol can present a problem with azathioprine use. This normally would only come up in the event of a Dalmatian using allopurinol to control uric acid bladder stone issues. If azathioprine is to be used with allopurinol, the dose of azathioprine must be dramatically reduced.

 

Concerns and Cautions

 

 

Azathioprine tablets should be protected from light exposure. They should be kept in a colored plastic medication vial and stored in a drawer or cabinet if possible.

 

Azathioprine should not be used in pregnant pets nor should it be handled by pregnant owners.

 

Azathioprine should not be used in patients with pre-existing liver disease if possible. (It should be noted that most patients starting azathioprine have been on prednisone or other steroids and will have elevations in liver enzymes as a result of steroid exposure. This is not the same as having pre-existing liver disease and does not represent a problem.)

 

Many experts feel that azathioprine should not be used in the cat at all, due to extra sensitivity of the bone marrow in this species.

 

If azathioprine is to be discontinued after long term use, it is probably best to taper the dosage rather than discontinue abruptly as a rebound increase immune response can result.

 

It is a good idea to wash your hands after handling azathioprine tablets.

 

It is our policy not to give dosing information over the Internet.

 

 

 

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[2hounds]

Mia is on Azathiaprine, we started it with hopes of getting her off pred. It does have some liver side effect possibilities, but it is much safer than prednisone for long term use (according to my vet). We take her in every 2 weeks for CBCs to make sure her white blood cells and other bloodwork looks ok.

[Guest greyladydown]

I've had two dogs on Azathioprine for auto-immune problems and the biggest thing to watch for is a low white blood cell count. A CBC every two weeks is a must.

 

BTW, I found the cheapest prices at Discount Drug Mart.

 

Hope Munchie does well on the new meds.

 

 

[dmswartzfager]

Blitz was on it for a week or two for his IBD. I saw increased bruising, a decrease in appetite, and stool that became looser and looser the longer he was on it. Therefore, we discontinued it since we were trying to keep his appetite up and his stools firm.

 

I think his CBC came back okay (but he's had so many tests done since he came home with us in September...) - you will definitely want to get one done to monitor how things are going.

[ShantisMom]

I just talked to my vet. That is on the list of items for us if the round of antibiotics don't do it. We are running some more tests first. All this information is helpful!

[Guest jurygirl]

Jury was on it for just about a week but got sick a few times and the vet decided to go with different drugs for her, but she was one that always had side effects from most drugs.

[Guest LuckyGrey]

Princess has IBD and the doctor wants her to start this drug along with her prednisone because her Albumin is unstable. We are going to get a second opinion and then most likely try it. This forum has helped tremendously.