azathioprine

Question 1

Monitoring

Answer 1

FBC WEEKLY FOR 4 WEEKS

THEN EVERY 3 MONTHS.

Question 2

Side effects

Answer 2

Bone marrow depression (dose-related)- . inexplicable bruising or bleeding, infection.

Hypersensitivity reactions - Immediate withdrawal.

Neutropenia (dose dependent) and thrombocytopenia

Nausea - Use divided daily doses, taking doses after food, prescribing concurrent antiemetics or temporarily reducing the dose.

Question 3

TPMT activity- PRE SCREENING

Answer 3

the risk of myelosuppression is increased in patients with reduced activity of the enzyme.

Seek specialist advice for those with reduced= SPECIALIST or absent TPMT activity= DO NOT START.

Monitor for toxicity throughout treatment.

Question 4

Interaction

Answer 4

Increased risk of haematological toxicity with Allopurinol - reduce azathioprine dose by 1/4.