Dermatology (Skin conditions)

Azathioprine

What is azathioprine?

Azathioprine is one of a group of drugs known as immunosuppressants. These drugs are used to damp down the body’s immune reactions. It is not a steroid and it is considered to be safer in the long-term than steroid tablets.

What skin diseases are treated with azathioprine?

  • Common skin diseases such as severe eczema.
  • It is also used to treat several less common skin conditions.

How is azathioprine taken?

  • Azathioprine comes in tablet form.
  • It is usually taken in a single daily dose (or sometimes twice daily).
  • The tablets come in two strengths, 25mg and 50mg.
  • Swallow tablets whole with some water.
  • Usually tablets are taken after a meal, especially if you experience an upset stomach when you first start taking them.
  • The dose will vary between people and severity of the skin condition. Your doctor will work out the most appropriate dose for you.

Who should not be prescribed azathioprine?
Azathioprine may be unsuitable for some people with other medical problems. Your doctor will take a full medical history from you to check that there are no reasons why you should not take azathioprine.

Tablets which should not be prescribed with azathioprine

  • Some medicines can interact with azathioprine.
  • Before you can be given azathioprine your doctor will ask you to list all medicinesthat you are taking.
  • Always tell any doctor treating you that you are taking azathioprine.
  • Allopurinol (for gout) should never be taken together with azathioprine.

Is azathioprine safe in pregnancy or if my partner and I are trying for a child?

  • Women should avoid becoming pregnant while taking azathioprine and should therefore use a reliable form of contraception.
  • Similarly, men on azathioprine are also recommended to use adequate contraception.
  • Women who are breast feeding should not take azathioprine.

Can azathioprine cause side-effects?

  • Most patients experience no problems with azathioprine.
  • Rarely, patients may be allergic to azathioprine. This causes severe ‘flu’-like symptoms (severe aches and pains, high fever and shaking). If at any point you develop these stop the drug and contact your doctor as soon as possible.
  • Mild sickness and headaches are quite common on starting azathioprine (or after an increase in dose). These settle in most people after a few weeks.
  • Some people develop more severe sickness and vomiting with azathioprine.
  • These symptoms may disappear on a lower dose, but occasionally azathioprine will have to be stopped completely.
  • If you develop severe stomach or back pain with nausea and vomiting, you should stop the drug and speak to the doctor who prescribed the treatment.
  • Patients taking azathioprine treatment may have a slightly increased number of common infections such as coughs, colds and cold sores.
  • If you have never had chicken pox you should avoid any people who have chicken pox or shingles. Consult your doctor if you are exposed to either of these.
  • Patients taking azathioprine for many years are at a slightly increased risk of some cancers. When used in the short or medium term azathioprine does not appear to increase cancer risk.

What monitoring will be required?

  • Azathioprine can affect the function of the liver or bone marrow and all patients taking the drug will require regular blood tests to check on this.
  • There is a way of predicting severe bone marrow problems with a blood test. This is usually checked in everyone before starting azathioprine. Those few people at high risk will not be given the drug.
  • Consult your doctor urgently if you develop unexplained bruising, severe sore throat or fever. These are signs of bone marrow problems, but are very unlikely if you are having regular blood tests.

How frequently will blood tests be needed?
Blood tests will be checked weekly for the first 4-8 weeks of treatment. After this tests will be taken every 1-3 months.

Does azathioprine interfere with vaccinations?

  • Live’ vaccines such as polio, German measles (rubella) and yellow fever are not recommended whilst taking azathioprine.
  • Other members of your household should be given inactive (rather than live) polio vaccine.
  • Flu and pneumococcal vaccines are safe.

Can alcohol be drunk with azathioprine?
Yes. However, it is probably better to drink in moderation (if at all), as both alcohol and occasionally azathioprine can affect the liver.
 

How long will azathioprine take to work?
Azathioprine does not work straightaway. It may take between 2 and 8 weeks to have a noticeable effect.

Further information
Please note: this information sheet does not give a full list of all the rarer sideeffects of azathioprine.

Please feel free to ask your doctor any further questions you may have about azathioprine, or any alternative treatments.

If you are taking azathioprine and have any worries in between hospital appointments, please ring 0191 233 6161 between Monday-Friday 9am to 5pm, and ask to speak to your dermatologist’s secretary.


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