This leaflet contains information about Azathioprine to treat Interstitial Lung Disease (ILD). This leaflet will give you more information about this medication.
You will normally be under the care of:
Dr Beirne, Dr Boland or Dr Sutherland
If you need to get in touch with one of the doctors or the specialist nurses, their contact numbers are:
Dr Beirne’s, Dr Boland and Dr Sutherland’s Secretary:
0113 206 5113
Specialist Nurses:
0113 206 7120
Blood test monitoring
Blood tests are required regularly 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. Your GP practice will be asked to do them but if there are any problems, please let the specialist nurses know.
In addition to azathioprine, you should continue with prednisolone.
This leaflet contains information about azathioprine to treat interstitial lung disease.
It tells you:
- how the medicine works
- how you should take it
- whether there are any side-effects
Please also read the leaflet called Unlicensed Medicines: Information for Patients and any information provided by the manufacturer in the medicine package.
Why have I been given this leaflet?
The leaflet 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.
For most medicines, information is provided by the manufacturer in the medicine package. In the UK, this medicine does not have a licence for use in interstitial lung disease so the leaflet in the medicine package doesn’t tell you everything you need to know. We have written this leaflet to give you some extra information.
So this medicine does not have a licence. What does this mean?
The leaflet called Unlicensed Medicines: Information for Patients tells you more about medicine licensing regulations. It also tells you why unlicensed medicines are sometimes used.
Why does azathioprine not have a licence?
Sometimes a medicine has been licensed for a certain use and later use shows that it works for a different illness.
The manufacturer can choose whether they apply to the Government to have the more recent information added to the licence. This costs a lot of money so sometimes the manufacturer decides it is not worth their while Azathioprine is a medicine that is licensed for use by transplant patients to prevent organ rejection, and for the treatment of autoimmune diseases such as rheumatological (joint) conditions and dermatological (skin) conditions.
Remember that your doctor will have thought carefully about which medicine is best for your condition.
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 lungs. 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 lung tissue.
Azathioprine does not work immediately and it can take weeks or a few months before any benefits are noticed.
How should I take azathioprine?
Azathioprine is usually taken as a tablet once a day, initially at a low dose (e.g. 50mg each day), and your doctor may increase this as necessary. The dose you are given will depend on your body weight.
The tablets should be swallowed with a glass of water, with or after food. 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 children’s reach.
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 a few doses (two or more) then contact your doctor or specialist nurse for advice on what to do next. If you can’t contact them straight away, for example if it’s a weekend or you are on holiday, then let them know when you can.
When should azathioprine not be used?
Do not take or use this medicine if you:
- are pregnant or planning on getting pregnant
- are breast feeding
- have a hypersensitivity to azathioprine or 6-mercaptopurine
Take with extra care if you have:
- kidney or liver problems
Please tell your doctor if you have any of the conditions listed above or in the manufacturer’s leaflet.
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 must not take azathioprine unless you are having regular blood tests.
When you start azathioprine, you will need a blood test every two weeks for two months, then monthly for four months and then every three months when your dose is stable.
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.
Everyone reacts differently to medicines. You may have some side-effects or none at all. If you have any of these side-effects, you do not need to contact the doctors unless they persist for more than a few days or become unbearable.
However, there are some rare but serious side-effects that you would need to tell your doctor about immediately.
In some patients, azathioprine can cause a feeling of sickness, diarrhoea, loss of appetite, hair loss and skin rashes. Taking azathioprine can affect the blood count (one of the effects is that fewer blood cells are made). Your regular blood count test will check how well your bone marrow is working.
Possible indicators of bone marrow damage are anaemia, regularly catching infections, and bruising and bleeding easily.
Very occasionally, azathioprine causes liver disease. Your regular blood test will check how well your liver is working and detect any early signs of damage. Possible indicators of liver disease are yellowing of the skin or generalised itching.
There is a slightly increased risk of certain types of cancer, such as skin cancer and your doctor should explain this risk before starting treatment. Some people may become sensitive to sunlight (called photosensitivity), which may cause skin discolouration or a rash. Take care to avoid too much sun, cover up and use a sunscreen with a high protection factor to reduce the risk of skin cancer and photosensitivity.
If you have not had chickenpox but come into contact with someone who has chickenpox or shingles, or if you develop chickenpox or shingles, you should stop Azathioprine and see your doctor immediately as you may need special treatment.
This is because chickenpox and shingles can be severe in people on treatment such as azathioprine which has effects on the immune system. You may need treatment for this.
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?
If you take any of the following medications, tell your doctor or pharmacist and they will advise you.
- Allopurinol
- Aminosalicylates
- Acenocoumarol
- Captopril
- Cimetidine
- Enalapril
- Febuxostat
- Ribavirin
- Sulfamethoxazole
- Trimethoprim
- Warfarin
Tell your doctor or pharmacist about 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, such as yellow fever, should be avoided in patient treated with azathioprine and non-live vaccinations may be less effective, therefore you may need more than one vaccination. Pneumovax (which gives protection against the most common cause of pneumonia) and yearly flu vaccines are 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. These are two units a day for men and women. One pint of beer is two units; one pub measure of a spirit (25ml) is one unit; and one pub measure of wine (125ml) is one unit.
Where should I store Azathioprine at home?
Store azathioprine in a cool, dry place, away from direct sunlight.
It is important that all medicines are stored out of reach of children.
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 when you come to the Clinic. 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.
How can I find out more?
Your agreement should be obtained before prescribing any medicine.
This leaflet has been written to provide general information about azathioprine. If you have any further questions or concerns, please speak to your doctor or pharmacist.