This information guidance about Azathioprine used to treat Autoimmune Hepatitis
If you need to get in touch with a member of the team about this medicine, or anything else to do with your liver disease, please use the contact details below:
Leeds Liver Unit
Dose of Azathioprine
A sample of an Azathioprine dosage record can be found on page four of the resource LN005166 Azathioprine for treatment of autoimmune hepatitis
Blood test monitoring
Blood tests are required regularly whilst on Azathioprine. Initially, this is every two weeks for the first two months and then monthly, for four months. Once you are on a stable dose, you will need this every three months.
A sample of a blood test monitoring record can be found on page four of the resource LN005166 Azathioprine for treatment of autoimmune hepatitis
Why have I been given this leaflet?
This information will help you to remember what your doctor has told you about this medicine. It will also help you to decide whether you want to go ahead with the treatment. It also aims to provide more specific information regarding azathioprine for your liver condition than the manufacturer’s patient information leaflet found in your box of azathioprine.
What is Azathioprine and how does it work?
Your blood contains both white and red blood cells. The white cells in the blood form part of the immune system and these can cause damage to the liver. Azathioprine helps to reduce the effectiveness of the white blood cells and is used to try to reduce the inflammation and scarring they cause in the liver tissue.
Azathioprine does not work immediately and it can take weeks to months before any benefits are noticed.
How should I take Azathioprine?
- Azathioprine is usually taken as a tablet once per day and your doctor may increase this as necessary. The dose you are given depends on your body weight.
- Azathioprine is made in two different strengths, 25 mg and 50 mg. Always check you have been given the right strength by your doctor or pharmacist. Do not take the tablets if you think you have the wrong strength and check with your doctor or pharmacist as soon as possible.
- Depending upon how well the tablets work for you, the dose and number of tablets that you need to take may change.
- The tablets should be swallowed with a glass of water. Azathioprine may be taken with food or on an empty stomach. It is important that you take it at the same time each day, especially with respect to food (i.e. always take with food or always take without). Some patients experience nausea when first given azathioprine – taking after meals may help with this. Azathiopine should not be taken with milk or dairy products. It should be taken at least 1 hour before or 2 hours after milk or dairy products.
- Take care to handle the tablets as little as possible and wash your hands after handling them. Store them at room temperature and out of reach of children.
- If you miss a dose, you should not ‘double up’. Take the next dose at the normal time and completely omit the missed dose.
- If you miss several doses, then contact your doctor or specialist nurse for advice on what to do next. If you can’t contact them straightaway; for example, if it is a weekend or you are on holiday, then let them know when you can.
When should Azathioprine not be used?
You will find a list of conditions that mean you should not take azathioprine in the manufacturer’s patient information leaflet found in your box of azathioprine.
Please tell your doctor if you have any of the conditions listed above or in the manufacturer’s leaflet.
Pregnancy and Breastfeeding
Talk to your doctor if you are pregnant, plan to get pregnant or think you are pregnant to ensure Azathioprine is still appropriate.
Azathioprine is one of the safer options in pregnancy; therefore, please do not stop taking Azathioprine if you discover you are pregnant without discussing with the team.
Azathioprine can also be found in breast milk. If you are breastfeeding or planning to breastfeed, talk to your doctor or pharmacist before taking Azathoprine.
Do I need any special checks while on Azathioprine?
Azathioprine reduces the production of blood cells, which can put you at risk of infections and can sometimes affect the liver. Blood tests will show if you are developing any side-effects. If you are being affected, your treatment will be changed or stopped immediately.
It is important that you do not miss your blood tests. You should not take Azathioprine unless you are having regular blood tests.
Information on when blood tests are needed can be found on page four of LN005166 Azathioprine for treatment of autoimmune hepatitis. Your doctor may increase or decrease the number of tablets you take at each dose, depending upon the results of your tests.
Are there any side-effects?
Most medicines cause side-effects. The manufacturer’s leaflet contains a list of the known side-effects for this medicine.
Things to tell your doctor immediately
If you have any of the following, tell your doctor immediately.
- Infections including fever, chills or a sore throat.
- Yellowing of the skin or generalised itching.
- Bleeding gums, black tarry stools, or unexpected bleeding or bruising.
- Severe and continuing diarrhoea, vomiting or stomach pains.
See your doctor if you develop any new symptoms after starting Azathioprine.
Will Azathioprine affect any other medicines?
Full information on medicines that can interfere with Azathioprine can be found in the manufacturer’s patient information leaflet found in your box of Azathioprine.
If you take any of the following medications, tell your doctor or pharmacist and they will advise you.
The main medication there is an issue with is allopurinol. Make sure the liver team are aware you are on this before you start taking Azathioprine.
Make sure the liver team are aware of all the other medicines you take. This includes any medicines you have had prescribed by another doctor as well as medicines bought from a pharmacy or supermarket and any herbal remedies.
Whenever you are prescribed a new medicine or want to buy a medicine e.g. from a pharmacy or supermarket, it is important that you tell the doctor or pharmacist about all the medicines that you take, including Azathioprine. You should also tell your dentist when you see him / her.
Will Azathioprine affect any vaccinations?
- Live vaccinations should be avoided in patients on Azathioprine and certain non-live vaccinations may be less effective.
Which vaccinations are safe?
- The pneumonia vaccine, flu vaccines are safe and COVID vaccines are all safe and recommended.
Can I drink alcohol while I am taking Azathioprine?
- Yes, it safe to drink alcohol while you are taking Azathioprine; however, large quantities of alcohol should be avoided. It is recommended that you do not exceed the national guidelines.
Where should I store Azathioprine at home?
- Store Azathioprine in a cool, dry place away from direct sunlight.
Where do I get my next supply?
When you are on a steady dose of Azathioprine, your GP should take over prescribing it. Until then, this will be supplied from hospital.
You must make sure you get any repeat prescriptions to the pharmacy in good time. The pharmacy may not have the medicine in stock and may need a few days to arrange a supply.
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