AZATHIOPRINE

• Class: Immunosuppressive,an analogue of mercaptopurine

• Action Suppresses cell-mediated hypersensitivities; alters antibody production and may reduce inflammation.

• Indications Adjunct for prevention of rejection in renal homotransplantation; treatment in adults for severe, active, erosive rheumatoid arthritis not responsive to conventional management.

• Unlabeled use(s): Treatment of chronic ulcerative colitis, Crohn's disease, myasthenia gravis and Behcet's syndrome

• Contraindications Pregnancy in patients with rheumatoid arthritis

Route/Dosage

• Renal Transplantation• ADULTS & CHILDREN: IV/PO Initiate with 3 to

5 mg/kg/day as single daily dose. Maintenance levels are 1 to 3 mg/kg/day.

• Rheumatoid Arthritis

• ADULTS: PO Initial dose is 1 mg/kg given as single dose or twice daily. Dose is increased by 0.5 mg/kg/day at 6 to 8 wk, then every 4 wk if there are no serious toxicities and if initial response is unsatisfactory.

• Max dose is 2.5 mg/kg/day. IV Reserved for patients unable to tolerate oral medications.

• Adverse Reactions

• DERM: Rash. GI: Nausea; vomiting.• HEMA: Leukopenia; thrombocytopenia;

macrocytic anemia; bleeding; selective erythrocyte aplasia.

• OTHER: Serious infections; neoplasias.

• Interactions• Allopurinol• Nondepolarizing muscle relaxants (eg,

tubocurarine, pancuronium)

Precautions

• Pregnancy: Category D.• Lactation: Excreted in breast milk. • Children: Safety and efficacy not established. • Carcinogenesis/mutagenesis• GI toxicity• Hematologic effects• Superinfection

NURSES RESPONSIBILITY

• Administration/Storage• Do not vigorously shake solution when

reconstituting IV preparations. • Divide daily dosage to reduce GI upset. • Administer with food or immediately after meals. • Store in a tightly-closed container in a cool location. • Discard reconstituted IV preparations after 24 hr.

Follow any procedures required for proper disposal of immunosuppressant/antimetabolite

Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.

• Review baseline CBC, renal studies and liver studies. • Assess for signs of infection before administration. • Monitor I&O and daily weight during therapy. • Monitor patient for signs of superinfection during

therapy. • Notify physician if patient displays sudden, severe

dyspnea, bleeding from the gums or mucous membranes or blood in urine or stools.

• Instruct patient that if once-daily dose is forgotten to skip the dose, but if 2 daily doses are missed to call the physician. Next dose may be doubled.

• Explain importance of precautions regarding contact with individuals who have active infections and individuals who have recently received oral polio vaccine.

• Identify signs of transplant rejection

• Explain that frequent follow-up appointments• Instruct patient to report the following

symptoms to physician: Unusual bleeding, decreased urine output, abdominal pain.

• Caution patient not to take otc medications without consulting physician

Thank you ……………..