Indications 

Imuran is a prescription medication used as an adjunct to prevent organ rejection in kidney transplant patients. Organ rejection occurs when the immune system perceives the transplanted organ as a foreign body and attacks it. 

Imuran is also used to manage symptoms of active rheumatoid arthritis, a condition characterized by the body’s immune system attacking its own joints, resulting in pain, swelling, and decreased mobility. 

As an immunosuppressant, Imuran works by weakening the immune system, thereby facilitating the acceptance of a new kidney as if it were a part of the recipient’s own body or preventing additional harm to joints affected by rheumatoid arthritis. 

Uses and Dosage 

Before taking Imuran and every time you get a refill, carefully review its medication guide and patient information leaflet. For any questions or clarifications, do not hesitate to consult your physician or pharmacist. 

Imuran dosage is adjusted based on the intended use. It is usually taken once or twice a day after meals or as directed by the doctor. 

In rheumatoid arthritis treatment, Imuran is initiated at a low dose and gradually increased after 6-8 weeks, with further dose adjustments made no more frequently than once every 4 weeks. 

Conversely, in kidney transplant patients, Imuran may be initiated at a high dose and gradually decreased as the body adjusts to the transplant. In either case, the dosage will be gradually reduced as the condition stabilizes. 

To optimize the benefits of Imuran, take it regularly around the same time each day. Always follow your physician’s instructions precisely and avoid taking this medication in amounts greater or less than prescribed, or with greater frequency than advised. 

Continue Imuran treatment even if you are feeling better. Discontinuing the medication should only be done after consulting your doctor. 

Side Effects 

Possible side effects associated with the use of Imuran are listed below. If any of them persist or worsen, promptly inform your doctor or pharmacist. 

Common Side Effects 

• Gastrointestinal symptoms (e.g., nausea, diarrhea, stomach pain) 
• Hair loss 
• Skin rash 

Serious Side Effects 

• Signs of infection such as:
  • Fever
  • Chills
  • Weakness
  • Flu-like symptoms
  • Sore throat
  • Cough
  • Pain
  • Burning during urination 
• Severe nausea, vomiting, or diarrhea 
• Easy bruising or unusual bleeding 
• Rapid heartbeats or shortness of breath 
• Pale skin or cold extremities 
• Urine that is dark in color or yellowing of the skin or eyes (jaundice) 

Call your doctor at once if you experience any of the serious side effects listed above. 

Discontinue Imuran use immediately and contact your physician without delay if you experience any of the following symptoms of lymphoma:  

• Fever, swollen glands, body aches, night sweats, general malaise 
• Skin that appears pale, a rash, increased susceptibility to bruising, or a tendency to bleed easily. 
• Cold extremities, lightheadedness, or shortness of breath 
• Pain in the upper abdomen that may radiate to the shoulder 
• Early satiety, unintended weight loss 

Imuran use may increase the risk of a severe brain infection that can result in disability or death. Notify your physician immediately if you experience speech, thought, vision, or muscle movement difficulties. These symptoms may appear gradually but worsen rapidly. 

Allergic Reactions 

Although rare, a severe allergic reaction to Imuran may occur. If you experience any of the following symptoms below, seek immediate medical attention. 

• Rash 
• Facial, tongue, or throat itching or swelling  
• Severe dizziness 
• Trouble breathing 

The side effects of Imuran listed here are not complete. If any unmentioned side effects arise and cause discomfort, inform your doctor promptly. 

Cautions 

Before taking Imuran, inform your physician or pharmacist if you have any known hypersensitivities, especially to azathioprine or any other medications. 

You may want to seek further information from your pharmacist, as this medication may contain inactive ingredients that can cause allergic reactions or other complications. 

To determine whether Imuran is safe for you, disclose your medical history to your doctor, particularly of: 

• Kidney disease 
• Liver disease 
• Cancer 
• Certain enzyme disorders such as TPMT deficiency or NUDT15 deficiency 

Febuxostat and certain cancer drugs (such as cyclophosphamide and melphalan) may interact with Imuran. 

Other drugs that weaken the immune system or increase the risk of infection, such as rituximab and tofacitinib, may also interact with Imuran. 

To prevent such drug interactions, inform your doctor and pharmacist of all the medications, including prescription and non-prescription drugs, vitamins, supplements, or herbal products you are taking. 

Refrain from using medications that contain mercaptopurine while taking azathioprine, as the two drugs are very similar. 

To reduce the risk of developing skin cancer, avoid sunlight or tanning beds while taking Imuran. When going outside, wear protective clothing and apply sunscreen with a sun protection factor (SPF) of 30 or higher. 

Imuran affects your immune system, increasing susceptibility to infections, some of which may be severe or deadly. Avoid sick individuals, or those with infections, and immediately inform your physician if you exhibit any signs of infection. 

Refrain from getting a “live” vaccine while taking Imuran as it may not provide complete protection against disease and may be less effective. Vaccines that use live viruses include measles, mumps, rubella (MMR), polio, rotavirus, typhoid, yellow fever, varicella (chickenpox), and zoster (shingles). 

Pregnant or potentially pregnant women should avoid handling Imuran or inhaling dust from the tablets, as it can be absorbed through the skin and lungs, potentially harming the fetus. 

Imuran may cause fetal harm and should not be administered to pregnant women without carefully weighing the risk versus benefits.  

Consult with your healthcare provider about effective contraception methods when taking this medication, and immediately tell your doctor if you get pregnant during the treatment or if you plan to become pregnant. 

The use of Imuran in nursing mothers is not recommended, as azathioprine or its metabolites can be transferred at low levels through breast milk and transplacentally.