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Benefit versus risk must be weighed carefully before use of IMURAN in patients of reproductive potentialThere are no adequate and well-controlled studies in pregnant womenIf this drug is used during pregnancy or if the patient becomes pregnant while taking this drugthe patient should be apprised of the potential hazard to the fetusWomen of childbearing age should be advised to avoid becoming pregnant.

One of the pathways for inactivation of azathioprine is inhibited by allopurinolPatients receiving IMURAN and allopurinol concomitantly should have a dose reduction of IMURANto approximately 1/3 to 1/4 the usual doseIt is recommended that a further dose reduction or alternative therapies be considered for patients with low or absent TPMT activity receiving IMURAN and allopurinol because both TPMT and XO inactivation pathways are affectedSee CLINICAL PHARMACOLOGYWARNINGSPRECAUTIONSLaboratory Tests and ADVERSE REACTIONS sections.

Severe leukopeniathrombocytopeniaanemias including macrocytic anemiaand/or pancytopenia may occur in patients being treated with IMURANSevere bone marrow suppression may also occurPatients with intermediate thiopurine S-methyl transferaseTPMTactivity may be at an increased risk of myelotoxicity if receiving conventional doses of IMURANPatients with low or absent TPMT activity are at an increased risk of developing severelife-threatening myelotoxicity if receiving conventional doses of IMURANTPMT genotyping or phenotyping can help identify patients who are at an increased risk for developing IMURAN toxicity2-9See PRECAUTIONSLaboratory TestsHematologic toxicities are dose-related and may be more severe in renal transplant patients whose homograft is undergoing rejectionIt is suggested that patients on IMURAN have complete blood countsincluding platelet countsweekly during the first monthtwice monthly for the second and third months of treatmentthen monthly or more frequently if dosage alterations or other therapy changes are necessaryDelayed hematologic suppression may occurPrompt reduction in dosage or temporary withdrawal of the drug may be necessary if there is a rapid fall in or persistently low leukocyte countor other evidence of bone marrow depressionLeukopenia does not correlate with therapeutic effecttherefore the dose should not be increased intentionally to lower the white blood cell count.

Tell your doctor and pharmacist about all of your drugsprescription or OTCnatural productsvitaminsand health problemsYou must check to make sure that it is safe for you to take Imuranazathioprine tabletswith all of your drugs and health problemsDo not startstopor change the dose of any drug without checking with your doctor.

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drinking alcohol can increase your risk of side effects from imuran.