Imuran (Azathioprine) for Lupus

Overview
Imuran, also known by its drug name, Azathioprine, is a prescription medication approved by the Food and Drug Administration (FDA) in 1968 to help prevent rejection in people who had kidney transplants. More recently, it has been used to treat autoimmune diseases including lupus. In lupus, Imuran can reduce damage to joints, decrease the risk for disability, and improve conditions in cases where lupus affects the kidneys (lupus nephritis) or liver. Imuran is often prescribed to be taken with a corticosteroid. Imuran makes it possible to take lower doses of the steroid, and to withdraw it more quickly, thereby sparing worse side effects.

Imuran is not appropriate for pregnant women, women who are breastfeeding, or people who have shown an oversensitivity to the drug.

Imuran is an immunomodulator, or in other words, a drug that modulates the immune system. It is an antimetabolite which blocks the synthesis of purine, a protein the body needs in order to produce lymphocytes. Lymphocytes are a type of white blood cell active in the immune system. Imuran is believed to work by blocking the synthesis of lymphocytes, decreasing their numbers, and preventing them from attacking the digestive system in IBD.

How do I take it?
Imuran is taken orally in tablet form. It is usually prescribed to be taken once or twice daily. Taking Imuran with meals may decrease some side effects. Your doctor may start you on a low dose at first to gauge any side effects, and then slowly increase the dosage. However, some doctors begin immediately with the full dosage. It is important to note that while you may see results after only two weeks of taking Imuran, it usually requires three to four months to begin working, and may take as long as six or 12 months.

Your doctor may order regular complete blood count (CBC) and liver function tests while you are taking Imuran in order to monitor your risk for serious side effects.

It is important for both men and women to use effective birth control while taking Imuran. Also note that Imuran can lower the effectiveness of intrauterine devices (IUDs).

Imuran raises your risk for developing skin cancer. Wear protective clothing and sunblock with a high protection factor while taking Imuran.

Always follow your doctor’s instructions exactly when taking Imuran.

Results
A retrospective study published in 1999 and revised in 2000 analyzed outcomes for 26 people with lupus nephritis who were treated with Prednisolone[LINK] and Azathioprine (Imuran) over 4.5 years. The researchers found that Azathioprine was well-tolerated and provided similar outcomes as pulse Cyclophosphamide[LINK].

Side effects
Common side effects of Imuran include nausea, vomiting, loss of appetite and diarrhea.

Tell your doctor if you experience rare but serious side effects such as hair loss, muscle loss, greasy-looking stools, mouth sores, sensations of cold or numbness in the fingers, or pain or difficulty when swallowing.

Seek immediate medical attention if you experience signs of liver problems including yellowing of the skin or eyes, swollen or painful abdomen, black stools, or vomit that contains blood or a substance that looks like coffee grounds.

Imuran can weaken your immune system, making it less able to fight off infections. Inform your doctor if you experience signs of infection such as fever, chills and aches. Ask your doctor before receiving any vaccination or immunization while taking Imuran.

In rare cases, chronic use of Imuran has contributed to the development of cancers including lymphoma and skin cancer.

Another rare but serious side effect of taking Imuran is an increased risk of developing a brain infection called progressive multifocal leukoencephalopathy (PML). Seek immediate medical attention if you begin experiencing seizures, problems speaking or moving, vision changes, confusion or difficulty concentrating.

Many drugs can cause allergic reactions which, in the most serious cases, can result in death. Seek immediate medical help if you experience signs of a severe allergic reaction such as difficulty breathing or swelling in the face, throat, eyes, lips or tongue.