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1. Presentation on Azathioprine
By :
Sanjay kumar yadav

2. Contents
1. Rheumatoids arthritis ( introduction , Etiology /
Pathopsysiology & symptoms)
2. Introduction of Azathioprine
3. Mechanism of action
4. Indication
5. Contraindication
6. Routes/dosages
7. Adverse reaction
8. Interactions
9. precautions

3. Rheumatoids arthritis
It is an autoimmune disease.
it is reffered as a systemic illness.
systemic means it affects the entirely body in the
case of rheumatoid arthritis multiple organs in
the body can be affected.
 It is chronic progressive and disabiling
autoimmune disease that causes inflammation
and pain in the joints and other organs.

5. Cont…
Etiology / Pathopsysiology:
RA is an immune disease.
 This means that the bodies immune system
mistakenly attacks the tissue it is supposed to
protect.
RA antibodies are formed in synovium against bodies
IgG antigens.
This leads to formation of immune complexes (RF -
IgG complex)
which causes inflammation of synovium-synovitis.

7. Cont…
Symptoms:
1. Joint pain
2. joint swelling
3. joint redness
4. fever
5. fatigue
6. anaemia
7. joint warmth
8. joint stiffness

9. Introduction of Azathioprine :
 class of Immunosuppressive
 an analogue of mercaptopurine
Mechanism of Action:
Suppresses cell-mediated hypersensitivities
 alters antibody production
 may reduce inflammation.

10. Mechanism of action
• Azathioprine antagonizes purine metabolism
and may inhibit synthesis of DNA, RNA, and
proteins.
• It may also interfere with cellular
metabolism and inhibit mitosis.
• Its mechanism of action is likely due to
incorporation of thiopurine analogues into
the DNA structure, causing chain
termination and cytotoxicity.

11. Indications:
 Adjunct for prevention of rejection in renal
homo-transplantation
 treatment in adults for severe, active, erosive
rheumatoid arthritis not responsive to
conventional management.
Contraindications:
Pregnancy in patients with rheumatoid
arthritis

12. Route/Dosage:
1. 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.

13. 2. 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.

14. Adverse Reactions:
DERM: Rash.
 GI: Nausea; vomiting.
HEMA: Leukopenia; thrombocytopenia;
macrocytic anemia; bleeding; selective
erythrocyte aplasia.
OTHER: Serious infections; neoplasias.

15. Interactions:
• allopurinol ↔ azathioprine:
cause fever, chills, sore throat, body aches,
weakness, muscle pain, easy bruising or bleeding,
mouth sores, pale stools, darkened urine, or severe
nausea, vomiting, and diarrhea.
• Azathioprine ↔ Bone Marrow Depression:
cause severe leukopenia, thrombocytopenia,
macrocytic anemia
• Cilazapril may increase the myelosuppressive
activities of Azathioprine.
• Candoxatril may increase the myelosuppressive
activities of Azathioprine.

16. Precautions
• Pregnancy
• Lactation: Excreted in breast milk.
• Children
• Carcinogenesis/mutagenesis
• GI toxicity
• Hematologic effects
• Super-infection

17. References
1. https://www.drugs.com/disease-
interactions/azathioprine.html#Bone_Marro
w_Depression
2. http://onlinelibrary.wiley.com/doi/10.1046/j.
1365-2036.2000.00812.x/full
3. https://www.slideshare.net/stephystanly/aza
thioprineppt
4. http://www.webmd.com/drugs/2/drug-
13771/azathioprine-oral/details

18. Thank you ……………..