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Limited evidence suggests that Imuran is not beneficial to patients with hypoxanthine-guanine-phosphoribosyltransferase deficiencyLesch-Nyhan syndromeThereforegiven the abnormal metabolism in these patientsit is not prudent to recommend that these patients should receive Imuran.

Symptoms of an allergic reaction usually happen within the first few weeks of treatmentThey include:

Limited immunologic and other abnormalities have occurred in a few infants born of renal allograft recipients on IMURANIn a detailed case report13 documented lymphopeniadiminished IgG and IgM levelsCMV infectionand a decreased thymic shadow were noted in an infant born to a mother receiving 150 mg azathioprine and 30 mg prednisone daily throughout pregnancyAt 10 weeks most features were normalizedDeWitte et al reported pancytopenia and severe immune deficiency in a preterm infant whose mother received 125 mg azathioprine and 12.5 mg prednisone daily14 There have been two published reports of abnormal physical findingsWilliamson and Karp described an infant born with preaxial polydactyly whose mother received azathioprine 200 mg daily and prednisone 20 mg every other day during pregnancy15 Tallent et al described an infant with a large myelomeningocele in the upper lumbar regionbilateral dislocated hipsand bilateral talipes equinovarusThe father was on long-term azathioprine therapy16.

Azathioprine is well absorbed following oral administrationMaximum serum radioactivity occurs at 1 to 2 hours after oral 35 S-azathioprine and decays with a half-life of 5 hoursThis is not an estimate of the half-life of azathioprine itselfbut is the decay rate for all 35 S-containing metabolites of the drugBecause of extensive metabolismonly a fraction of the radioactivity is present as azathioprineUsual doses produce blood levels of azathioprineand of mercaptopurine derived from itwhich are low1,2,3 For Caucasians and African Americansapproximately 10of the population inherit one non-functional TPMT alleleheterozygousconferring intermediate TPMT activityand 0.3inherit two TPMT non-functional alleleshomozygousfor low or absent TPMT activityNon-functional alleles are less common in AsiansTPMT activity correlates inversely with 6-TGN levels in erythrocytes and presumably other hematopoietic tissuessince these cells have negligible xanthine oxidaseinvolved in the other inactivation pathwayactivitiesleaving TPMT methylation as the only inactivation pathwayPatients with intermediate TPMT activity may be at 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 IMURAN4-9 TPMT genotyping or phenotypingred blood cell TPMT activitycan help identify patients who are at an increased risk for developing IMURAN toxicity2,3,7,8,9 Accurate phenotypingred blood cell TPMT activityresults are not possible in patients who have received recent blood transfusionsSee WARNINGSPRECAUTIONSDRUG INTERACTIONSPRECAUTIONSLaboratory Tests and ADVERSE REACTIONS sections.

There are individuals with an inherited deficiency of the enzyme thiopurine methyltransferaseTPMTwho may be unusually sensitive to the myelosuppressive effect of azathioprine and prone to developing rapid bone marrow depression following the initiation of treatment with ImuranThis problem could be exacerbated by co-administration with drugs that inhibit TPMTsuch as olsalazinemesalazine or sulfasalazineAlso it has been reported that decreased TPMT activity increases the risk of secondary leukaemias and myelodysplasia in individuals receiving 6-mercaptopurinethe active metabolite of azathioprinein combination with other cytotoxicssee section 4.8 Undesirable effects

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what i would imuran is to test yourself for celiac disease or at least end with that cellsept right.

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