azathioprine Nursing Considerations & Management

Drug Name

Generic Name: azathioprine

Brand Name: Azasan, Imuran

Classification: Immunosuppressant

Pregnancy Category D

Dosage & Route
  • PO Rheumatoid arthritis Initial: 1 mg/kg/day for 6-8 wk. May adjust dose gradually to 2.5 mg/kg/day if needed. Prevention of rejection in organ and tissue transplantation 1-5 mg/kg/day. Auto-immune diseases 1-3 mg/kg/day.
Therapeutic actions
  • Azathioprine is an immunosuppressant, which inhibits DNA, RNA and protein synthesis and antagonises purine synthesis. It also inhibits mitosis and interferes with cellular metabolism of susceptible organisms. Azathioprine inj should be discontinued as soon as oral therapy can be introduced
  • Renal homotransplantation: Adjunct for prevention of rejection
  • Rheumatoid arthritis: Use only with adults meeting criteria for classic rheumatoid arthritis and not responding to conventional management
  • Unlabeled use: Treatment of chronic ulcerative colitis, myasthenia gravis, Behçet’s syndrome, Crohn’s disease
Adverse effects
  • Fever, chills; bone marrow depression characterised by leucopenia, thrombocytopenia or anaemia; anorexia, nausea, diarrhoea; arthralgias; secondary infections; hepatotoxicity, rash, alopoecia.
  • Potentially Fatal: Myelosuppression, mutagenicity and carcinogenicity; veno-occlussive liver disease.
  • Hypersensitivity; previous treatment with alkylating agents; pregnancy, lactation.
Nursing considerations
  • History: Allergy to azathioprine; rheumatoid arthritis patients previously treated with alkylating agents; pregnancy or male partners of women trying to become pregnant; lactation
  • Physical: T; skin color, lesions; liver evaluation, bowel sounds; LFTs, renal function tests, CBC
  • Give drug IV if oral administration is not possible; switch to oral route as soon as possible.
  • Administer in divided daily doses or with food if GI upset occurs.
  • BLACK BOX WARNING: Monitor blood counts regularly; severe hematologic effects may require the discontinuation of therapy; increases risk of neoplasia.
Teaching points
  • Take drug in divided doses with food if GI upset occurs.
  • Avoid infections; avoid crowds or people who have infections. Notify your physician at once if you are injured.
  • Notify your health care provider if you think you are pregnant or wish to become pregnant, or if you are a man whose sexual partner wishes to become pregnant.
  • You may experience these side effects: Nausea, vomiting (take drug in divided doses or with food), diarrhea, rash.
  • Report unusual bleeding or bruising, fever, sore throat, mouth sores, signs of infection, abdominal pain, severe diarrhea, darkened urine or pale stools, severe nausea and vomiting.