Azathioprine (Imuran) for Skin Disorders

Azathioprine (Imuran®) is an immunosuppressive medication approved by the FDA for suppressing organ rejection in transplant patients and for treating severe rheumatoid arthritis.

Azathioprine has also been used by dermatologists for over 30 years to treat blistering diseases such as bullous pemphigoid, cicatricial pemphigoid, and pemphigus vulgaris.

Although not approved by the FDA for these skin diseases, many studies have been done which justify using azathioprine for these conditions.

There are few drug interactions with azathioprine. If you take allopurinol, captopril, coumarin or methotrexate, be sure to let the doctor know so that appropriate adjustments can be made in your medication dose.

Azathioprine should not be used by women who are pregnant or nursing.

The most common adverse effects of azathioprine are gastrointestinal. Taking the medication with food often helps. If symptoms of nausea, vomiting or diarrhea occur, the dose may need to be divided or decreased. Other adverse effects are rare, but include bone marrow failure, infections, and allergic reactions.

The most worrisome adverse effect is an increased risk of cancer due to the immunosuppressive action of azathioprine. This risk is related to dose of the medication as well as the underlying disease being treated. Lymphomas and leukemias have been reported in patients being treated for rheumatoid arthritis, but not for patients with blistering skin diseases. Nevertheless, all patients who take azathioprine are monitored for blood disorders that could be related to the drug.

Regular skin exams are also done to screen for skin cancers, which can be seen in increased numbers in patients on azathioprine.

A number of blood tests are typically obtained prior to starting azathioprine, and are then repeated monthly for the first few months of treatments as the dose is increased. After that, monitoring is done every 2 to 3 months.

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Last updated: 1/8/2019