Drug: Azathioprine | Class: Purine Analogue Immunosuppressant / DMARD | Brand: Imuran (Aspen/GSK); Azoran (Sun Pharma India) | Indication: Rheumatoid arthritis (DMARD), organ transplant rejection prevention, IBD (Crohn’s, UC), autoimmune hepatitis, SLE, myasthenia gravis | Dose: RA/IBD: 1–2
Azathioprine is an immunosuppressant with multiple roles: DMARD for rheumatoid arthritis, steroid-sparing agent for inflammatory bowel disease (Crohn’s and ulcerative colitis), organ transplant rejection prevention, and treatment of autoimmune conditions including lupus, autoimmune hepatitis, and myasthenia gravis. It works by suppressing lymphocyte proliferation. Its onset is slow (3–6 months), requiring patience and regular blood monitoring. TPMT enzyme testing before starting helps identify patients at risk of severe bone marrow suppression.
Azathioprine contains Azathioprine, a purine analogue immunosuppressant / dmard for rheumatoid arthritis (dmard), organ transplant rejection prevention, ibd (crohn’s, uc), autoimmune hepatitis, sle, myasthenia gravis. ACR-recognised DMARD; ECCO guideline first-line for Crohn’s disease steroid-sparing; established transplant immunosuppressant since 1960s.
| Attribute | Details |
|---|---|
| Generic Name | Azathioprine |
| Drug Class | Purine Analogue Immunosuppressant / DMARD |
| Brand Reference | Imuran (Aspen/GSK); Azoran (Sun Pharma India) |
| Indication | Rheumatoid arthritis (DMARD), organ transplant rejection prevention, IBD (Crohn’s, UC), autoimmune hepatitis, SLE, myasthenia gravis |
| Standard Dose | RA/IBD: 1–2.5mg/kg/day (typically 50–150mg daily). Transplant: 1–5mg/kg/day. Start low and titrate. Takes 3–6 months for full effect |
| Form | Tablet |
| Route | Oral |
| Prescription | Yes |
| Evidence | ACR-recognised DMARD; ECCO guideline first-line for Crohn’s disease steroid-sparing; established transplant immunosuppressant since 1960s |
Metabolised to 6-mercaptopurine (6-MP) and 6-thioguanine nucleotides — incorporated into DNA blocking purine synthesis and lymphocyte proliferation, suppressing T and B cell-mediated immunity.
Azathioprine’s immunosuppressive effect develops over 3–6 months as active metabolites accumulate in lymphocytes. For IBD steroid-sparing, significant benefit is often not apparent until month 3–4. For RA, clinical improvement takes similarly long. This slow onset means azathioprine should be started early in parallel with faster-acting treatments (steroids, NSAIDs) while awaiting the full DMARD effect.
Thiopurine methyltransferase (TPMT) is the enzyme metabolising azathioprine. Patients with low or absent TPMT activity accumulate toxic metabolites causing severe bone marrow suppression at standard doses. TPMT genotyping or phenotyping before starting azathioprine guides dosing: normal TPMT — standard dose; intermediate — reduce dose by 50%; deficient — azathioprine is contraindicated.
Full blood count (CBC) weekly for the first month, every 2 weeks for 3 months, then monthly. Liver function tests (LFTs) every 3 months. Sudden reduction in white blood cells or platelets requires immediate dose reduction or cessation. Annual skin cancer check is recommended as azathioprine increases skin malignancy risk with long-term use.
Both are DMARDs but methotrexate is generally preferred as first-line due to faster onset, better tolerability profile, and superior RA trial evidence. Azathioprine is used when methotrexate is contraindicated (renal impairment, hepatic disease) or has failed. For IBD (where methotrexate is used less commonly), azathioprine is typically first-line steroid-sparing therapy.
Long-term azathioprine use increases risk of non-melanoma skin cancer and lymphoma — due to sustained immunosuppression impairing tumour immune surveillance. Lifetime sun protection is essential for patients on long-term azathioprine. Annual skin checks are recommended. The absolute risk is small but increases with duration; this is a class effect of all immunosuppressants.
Store at 15–30°C away from sunlight and moisture. Keep out of reach of children.
Orders ship from our India Head Office within 1–2 business days of confirmation. We include full customs documentation — HS codes, certificates of origin, and pharmaceutical export permits.
Estimated delivery: 3–7 business days to UK. 7–10 business days to UAE, Saudi Arabia and Gulf countries. 10–15 days for USA and Asian countries.
All packages arrive in plain, unmarked brown boxes. No pharmacy name or medication details on the outside.
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