Dr. Gbemudu received her B.S. in Biochemistry from Nova Southeastern University, her PharmD degree from University of Maryland, and MBA degree from University of Baltimore. She completed a one year post-doctoral fellowship with Rutgers University and Bristol Myers Squibb.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Azathioprine is an immunosuppressant, that is, a drug that is
used to suppress the immune system. It is used to treat patients who have
undergone kidney transplantation and for diseases in which activity of the
immune system is important. Azathioprine is a prodrug (a precursor of a drug)
which is converted in the body to its active form called mercaptopurine
(Purinethol). The exact mechanism of action of azathioprine is not known.
Like
other immunosuppressants, it suppresses the proliferation of T and B
lymphocytes, types of white blood cells that are part of the immune system and
defend the body against both infectious diseases and foreign materials. For
example, in the case of organ transplantation, immunosuppressants prevent the
body from immunologically rejecting the new organ. In the case of autoimmune
diseases (diseases caused by an abnormal immune reaction against the body's own
tissues) such as rheumatoid arthritis, suppressing the immune system reduces the
inflammation that accompanies immune reactions and slows damage to the joints
caused by the inflammation.
STORAGE: Azathioprine should be stored at 15-25 C (59-77 F) in a dry
place and protected from light.
PRESCRIBED FOR: Azathioprine is used for preventing rejection of transplanted
kidneys. Azathioprine also is used for the treatment of severe, active,
rheumatoid arthritis in patients who do not respond to rest,
aspirin, or other
nonsteroidal antiinflammatory drugs.
Non-FDA approved uses for azathioprine
include multiple sclerosis, where several clinical trials have shown decreases
in relapses but no slowing in progression of the disease. There also is limited
data on the safety of azathioprine in multiple sclerosis. Other non-FDA
(off-label) uses of azathioprine include Crohn's disease, myasthenia gravis,
chronic ulcerative colitis, and autoimmune hepatitis (in combination with
prednisone).
DOSING: Azathioprine should be taken with food.
DRUG INTERACTIONS:Allopurinol (Zyloprim) that is used for treating increased
blood levels of uric acid and preventing gout increases azathioprine levels in
the blood which may increase the risk of side effects from azathioprine.
Therefore, it is important to reduce the dose of azathioprine by approximately
1/3 to 1/4 in patients taking allopurinol. The use of
angiotensin-converting
enzyme (ACE) inhibitors to control high blood pressure in patients taking
azathioprine has been reported to induce anemia (low levels of red blood cells)
and severe leukopenia (low levels of white blood cells). Azathioprine reduces
blood levels of the blood thinner, warfarin (Coumadin), and thus may reduce the
blood thinning effect of warfarin. Safety and efficacy of azathioprine in
children have not been established
PREGNANCY: Azathioprine can cause fetal harm when given to
pregnant women and
whenever possible should be avoided.
NURSING MOTHERS: Azathioprine is found in
breast milk and should not be used
in nursing mothers.
SIDE EFFECTS: The most common serious side effects of azathioprine involve
the cells of the blood and gastrointestinal system. Azathioprine can cause
serious lowering of the white blood cell count, resulting in an increased risk
of infections. This effect is reversed when the dose of azathioprine is reduced
or temporarily discontinued. Azathioprine can cause nausea,
vomiting, and loss
of appetite, which may resolve when the daily dose is reduced or divided and
taken more than once a day. Azathioprine can cause liver toxicity (for example,
in less than 1% of rheumatoid arthritis patients). All patients taking
azathioprine require regular testing of blood for blood cell counts and liver
tests to monitor for side effects of azathioprine. Other side effects
encountered less frequently include fatigue, hair loss, joint pains, and
diarrhea.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
Sjögren's syndrome is an autoimmune disease involving the abnormal production of extra antibodies that attack the glands and connective tissue. Sjögren's syndrome with gland inflammation (resulting dry eyes and mouth, etc.) that is not associated with another connective tissue disease is referred to as primary Sjögren's syndrome. Sjögren's syndrome that is also associated with a connective tissue disease, such as rheumatoid arthritis, systemic lupus erythematosus, or scleroderma, is referred to as secondary Sjögren's syndrome. Though there is no cure for Sjögren's syndrome, the symptoms may be treated by using lubricating eye ointments, drinking plenty of water, humidifying the air, and using glycerin swabs. Medications are also available to treat dry eye and dry mouth.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Multiple sclerosis (MS) is a disease which progressively injures the nerves of the brain and spinal cord, reflected by alterations of virtually every sensory or motor function in the body. The cause of MS is primarily unknown. There are different types of MS including relapsing-remitting MS, primary-progressive MS, and secondary-progressive MS. Symptoms of MS rang from mild to severe and examples include visual disturbances, muscle weakness, spasm, and fatigue. Decreased concentration, memory loss, and impaired judgment. Treatment for MS is generally with medications.
Sarcoidosis, a disease resulting from chronic inflammation, causes small lumps (granulomas) to develop in a great range of body tissues and can appear in almost any body organ. However, sarcoidosis most often starts in the lungs or lymph nodes.
Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
Celiac disease is a result of an immune reaction to gluten, a protein found in wheat or related grains and present in many foods that we eat. Celiac disease causes impaired absorption and digestion of nutrients through the small intestine. Signs and symptoms of celiac disease include malabsorbption (diarrhea, foul smelling gas, bloating, and increased amounts of fat in the stool) and malnutrition (weight loss, edema, anemia, bruising easily, neuropathy, and infertility). Treatment for celiac disease is a gluten free diet, and at times if necessary, medications
Scleroderma is an autoimmune disease of the connective tissue. It is characterized by the formation of scar tissue (fibrosis) in the skin and organs of the body, leading to thickness and firmness of involved areas. Scleroderma is also referred to as systemic sclerosis, and the cause is unknown. Treatment of scleroderma is directed toward the individual features that are most troubling to the patient.
Henoch-Schonlein Purpura (HSP or anaphylactoid purpura), a type of blood vessel inflammation, results in rash, arthritis, and occasional abdominal cramping. HSP often resolves on its own. Joint pain may be treated with anti-inflammatory and cortisone medications.
Pulmonary fibrosis is scarring throughout the lungs. Pulmonary fibrosis can be caused by many conditions including chronic inflammatory processes, infections, environmental agents, exposure to ionizing radiation, chronic conditions, and certain medications. Symptoms include shortness of breath, coughing, and diminished exercise tolerance. Treatment options are dependent on the type of pulmonary fibrosis; lung transplant and/or medications are optons.
Myasthenia gravis, a chronic autoimmune neuromuscular disease. Varying degrees of weakness of the voluntary muscles of the body are the main characteristics. A defect in the transmission of nerve impulses ot the muscles is the cause of myasthenia gravis. Symptoms include weakness of th eye muscles, facial expression, and difficulty swallowing. Treatment of myasthenia gravis are medical therapies to control the symptoms of the disease.
Interstitial lung disease, is a term to describe a certain lung condition. Causes of interstitial lung disease include lung infection, exposure to toxins in the environment (asbestos for example), medications (chemotherapy), radiation therapy, and chronic autoimmune disorders. Common symptoms of interstitial lung disease include a dry cough and shortness of breath. Diagnosis and treatment depend upon the cause of the condition.
Optic neuritis is inflammation of the optic nerve, the structure that connects the eye to the brain. The precise cause of optic neuritis is unknown, but it is thought to be a type of autoimmune disorder. Optic neuritis most commonly develops due to an autoimmune disorder that may be triggered by a viral infection.
Wegener's granulomatosis, a condition that usually affects young or middle-aged adults, is an inflammation of the arteries supplying blood to the sinuses, lungs, and kidneys. Symptoms of Wegener's granulomatosis include bloody sputum, fatigue, weight loss, joint pain, sinusitis, shortness of breath, and fever. Wegener's granulomatosis may be fatal within months without treatment. Treatment aims to stop inflammation with high doses of prednisone and cyclophosphamide.
Microscopic colitis (lymphocytic colitis and collagenous colitis) is a disease of inflammation of the colon. Microscopic colitis is only visible when the colon's lining is examined under a microscope. The cause of microscopic colitis is not known. Symptoms of microscopic colitis are chronic watery diarrhea and abdominal pain or cramps. Microscopic colitis is diagnosed through biopsies of several areas of the colon. There is no standardized treatment for microscopic colitis; however, eliminating NSAIDs, and treatment medications such as Imodium, Lomotil, Petpo-Bismol, Entocort EC, and mesalamine (Asacol) have been helpful in some individuals.
Relapsing polychondritis is an uncommon, chronic disorder of the cartilage that is characterized by recurrent episodes of inflammation of the cartilage of various tissues of the body. Tissues containing cartilage that can become inflamed include the ears, nose, joints, spine, and windpipe (trachea). Tissues that have a biochemical makeup similar to that of cartilage such as the eyes, heart, and blood vessels, can also be affected. Nonsteroidal antiinflammatory medications (NSAIDs) is used as treatment for mild cases of the disease. Steroid-related medications also are usually required.
Weber-Christian disease is a rare inflammatory disease that affects the body's fat tissues. It's also known as relapsing febrile nodular panniculitis syndrome and idiopathic lobular panniculitis. The disorder appears on the skin as red or purple tender, raised lumps. The thighs and lower legs are the most frequently affected areas. Other symptoms may include nausea, vomiting, weight loss, joint pain, and abdominal pain. Though there is no cure for the disease, inflammation may be treated with various antiinflammatory medications.
Neuromyelitis optica (Devic's syndrome) is a disease of the CNS that affects the optic nerves and spinal cord. People with neuromyelitis optica develop optic neuritis and transverse myelitis. There is no cure for neuromyelitis optica; however, there are therapies to treat attacks when they occur.
Felty's syndrome is a complication of long-term rheumatoid arthritis. Felty's syndrome is defined by the presence of three conditions: rheumatoid arthritis, an enlarged spleen, and an abnormally low white blood count. Treatment of Felty's syndrome is not always required; however, treatment for patients with infections is available.
Scleroderma is an autoimmune disease of the connective tissue featuring skin thickening, spontaneous scarring, blood vessel disease, varying degrees of inflammation, associated with an overactive immune system. Autoimmune diseases are illnesses which occur when the body's tissues are attacked by its own immune system. Scleroderma is characterized by the formation of scar tissue (fibrosis) in the skin and organs of the body. This leads to thickness and firmness of involved areas. Scleroderma, when it's diffuse or widespread over the body, is also referred to as systemic sclerosis.
The cause of scleroderma is not known. Researchers have found some evidence that certain genes are important factors, but the environment seems to also play a role. The result is activation of the immune system in a susceptible individual, causing injury to tissues that result in injury similar to scar-tissue formation. The fact that genes seem to cause a predi...
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