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Use this medicine only as directed by your doctor. Do not use more or less of it, and do not use it more often than your doctor ordered. The exact amount of medicine you need has been carefully worked out. Taking too much may increase the chance of side effects, while taking too little may not properly treat your condition.

This medicine is sometimes given together with certain other medicines. If you are using a combination of medicines, make sure that you take each one at the proper time and do not mix them up. Ask your health care professional to help you plan a way to remember to take your medicines at the right times.

Do not stop taking this medicine without first checking with your doctor.

Azathioprine sometimes causes nausea or vomiting. Taking this medicine after meals or at bedtime may lessen stomach upset. Ask your health care professional for other ways to lessen these effects.

If you vomit shortly after taking a dose of azathioprine, check with your doctor. You will be told whether to take the dose again or to wait until the next scheduled dose.

Dosing

The dose of azathioprine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of azathioprine. If your dose is different, do not change it unless your doctor tells you to do so.

The number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking azathioprine.

• For oral dosage form (tablets):
  • For transplant rejection:
    • Adults, teenagers, and children: Dose is based on body weight or size. The usual beginning dose is 3 to 5 milligrams (mg) per kilogram (kg) (1.5 to 2 mg per pound) of body weight a day. As time goes on, your doctor may lower your dose to 1 to 3 mg per kg (0.5 to 1.5 mg per pound) of body weight a day.
  • For rheumatoid arthritis:
    • Adults, teenagers, and children: Dose is based on body weight or size. The usual beginning dose is 1 mg per kg (0.5 mg per pound) of body weight a day. Your doctor will increase this dose as needed. The highest dose is usually not more than 2.5 mg per kg (1 mg per pound) of body weight a day. Your doctor may then lower your dose as needed.
• For injection dosage form:
  • For transplant rejection:
    • Adults, teenagers, and children: Dose is based on body weight or size. The usual beginning dose is 3 to 5 milligrams (mg) per kilogram (kg) (1.5 to 2 mg per pound) of body weight a day. As time goes on, your doctor may lower your dose to 1 to 3 mg per kg (0.5 to 1.5 mg per pound) of body weight a day.

Missed dose

If you miss a dose of this medicine and your dosing schedule is:

• One dose a day Do not take the missed dose at all and do not double the next one. Instead, go back to your regular dosing schedule and check with your doctor.
• More than one dose a day Take the missed dose as soon as you remember it. If it is time for your next dose, take both doses together, then go back to your regular dosing schedule. If you miss more than one dose, check with your doctor.

Storage

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For azathioprine, the following should be considered:

Allergies Tell your doctor if you have ever had any unusual or allergic reaction to azathioprine. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy Use of azathioprine is not recommended during pregnancy. It may cause birth defects if either the male or the female is using it at the time of conception. The use of birth control methods is recommended. If you have any questions about this, check with your doctor.

Breast-feeding Azathioprine passes into breast milk. Because this medicine may cause serious side effects, breast-feeding is generally not recommended while you are using it.

Children This medicine has been tested in children and, in effective doses, has not been shown to cause different side effects or problems than it does in adults.

Older adults Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults. Although there is no specific information comparing use of azathioprine in the elderly with use in other age groups, this medicine is not expected to cause different side effects or problems in older people than it does in younger adults.

Dental

The effects of azathioprine may cause increased infections and delayed healing. Dental work, whenever possible, should be completed prior to beginning this medicine.

Other medicines Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking or receiving azathioprine it is especially important that your health care professional know if you are taking any of the following:

• Allopurinol (e.g., Zyloprim) May interfere with removal of azathioprine from the body; effects of azathioprine (including toxicity) may be increased

• Chlorambucil (e.g., Leukeran) or
• Corticosteroids (cortisone-like medicine) or
• Cyclophosphamide (e.g., Cytoxan) or
• Cyclosporine (e.g., Sandimmune) or
• Mercaptopurine (e.g., Purinethol) or
• Muromonab-CD3 (monoclonal antibody) (e.g., Orthoclone OKT3) There may be an increased risk of infection and cancer because azathioprine reduces the body's ability to fight them

• Chickenpox (including recent exposure) or
• Herpes zoster (shingles) Risk of severe disease affecting other parts of the body

• Gout Allopurinol (used to treat gout) may increase wanted and unwanted effects of azathioprine

• Infection Azathioprine decreases your body's ability to fight infection

• Kidney disease or
• Liver disease Effects of azathioprine may be increased because of slower removal from the body

• Pancreatitis (inflammation of the pancreas) Azathioprine can cause pancreatitis