07-26-2006, 02:01 AM
Has anyone had an experience with the chemo drug Imuran - I believe that is the spelling. I am having trouble with low platelet counts, and Decadron does not seem to be working. I have had some preliminary tests to see if I have the proper enzymes to metabolize the Imuran, but don't know much about the drug itself, or potential side effects - or good effects! Any personal experiences?
07-29-2006, 09:24 AM
Imuran is the trade name for azathioprine, an immunosuppressive medication. It is used to reduce the body's natural immunity in patients. It is one of the steroid-sparing drugs. The others are listed below:
Brand Name Chemical Name
Rheumatrex, MTX, Folex methotrexate sodium
CellCept mycophenolate mofetil
Neoral, Sandimmune cyclosporine (cyclosporin A)
Cyclophosphamide (Cytoxan) and methotrexate sodium are also referred to as cytotoxic medications.
Imuran tablets and injection contain the active ingredient azathioprine, which is a type of medicine called an immunosuppressant. Azathioprine is used to dampen down the activity of cells in the immune system.
Here is information that I found about Imuran - I hope that it is helpful to you:
The immune system normally recognises and protects the body from foreign substances such as bacteria and viruses. It also recognises and attacks transplanted tissue and cells that have become cancerous.
Sometimes however, the immune system can react excessively, or mount an attack against normal healthy tissues. This can result in various disorders known as autoimmune diseases. For example, in rheumatoid arthritis the immune system attacks the joints, causing pain and inflammation. In systemic lupus erythematosus the immune system attacks the skin and internal organs. The activity of the immune system can also be a problem following organ transplants, because it recognises the transplanted tissue as foreign and attacks it, causing the organ to be rejected. In situations such as these it is useful to suppress the activity of the immune system.
The immune system relies on different types of white blood cells that are produced in the bone marrow and lymph glands. Azathioprine works by decreasing the production of these white blood cells. It does this by interfering with the production of the cells genetic material, DNA, which stops the cells from dividing and multiplying.
The decrease in the numbers of white blood cells reduces the ability of the immune system to reject organ transplants. In autoimmune diseases it reduces the immune system attack on normal tissues and so reduces the severity of the symptoms, and in many cases halts the progress of the disease. However, it can take weeks to months of treatment for the full effect of the medicine to become apparant.
Unfortunately white blood cells are needed to fight invading micro-organisms, so during treatment the body becomes more susceptible to infections. Azathioprine also interferes with the growth and division of other types of blood cells in the bone marrow. Reduced production of red blood cells can cause anaemia and reduced production of platelets can cause problems with blood clotting. For this reason, your doctor will monitor the levels of all your blood cells.
Azathioprine is often used in combination with other immunosuppressants such as corticosteroids. When combined with corticosteroids it can often allow a reduced dose of corticosteroid to be used.
What is it used for?
Abnormal destruction of liver cells by the body's immune system (active chronic autoimmune hepatitis)
Abnormal destruction of red blood cells by the body's immune system (autoimmune haemolytic anaemia)
Blistering skin disorder caused by abnormal attack of the skin cells by the body's immune system (pemphigus vulgaris)
Abnormal destruction of blood platelets by the body's immune system (chronic idiopathic thrombocytopenic purpura)
Inflammatory disease of the skin and muscles (dermatomyositis)
Inflammatory disease of the muscles (polymyositis)
Long-term inflammation of skin and internal organs due to abnormal attack of the body tissues by the immune system (systemic lupus erythematosus)
Inflammation of the walls of arteries (polyarteritis nodosa)
Preventing the body from rejecting transplanted organs, eg heart, liver, kidney transplants
Severe inflammatory disease of the joints caused by abnormal attack on the joints by the immune system (severe rheumatoid arthritis)
This medicine decreases the normal amounts of blood cells in your blood. For this reason you will need to have regular blood tests to monitor the levels of your blood cells. You should consult your doctor immediately if you experience any of the following symptoms, as they may indicate a problem with your blood cells: unexplained bruising or bleeding, purple spots, sore throat, mouth ulcers, high temperature (fever), feeling tired or general illness or infection.
People having long term or intense immunosuppressive treatment are at increased risk of developing lymphomas and other cancers, particularly skin cancer. For this reason you should minimise your exposure to strong sunlight and UV light by wearing protective clothing and using a sunscreen with a high protection factor, in order to reduce your risk of skin cancer. Discuss this with your doctor.
If you suffer from liver problems your doctor should monitor your liver function while you are taking this medicine.
Tell your doctor immediately if you experience any of the following symptoms, as they may suggest that you are allergic to this medicine: dizziness, nausea, vomiting, diarrhoea, fever, shivering, skin rash, or pain in the muscles or joints.
Use with caution in
Decreased kidney function
Decreased liver function
Inherited deficiency of an enzyme called thiopurine methyltransferase (TPMT)
Not to be used in
Allergy to mercaptopurine
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and Breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
Women should use effective contraception to avoid getting pregnant and men should use effective contraception to avoid fathering a child during treatment with this medicine. Women who do get pregnant while they or their partner is receiving treatment should consult their doctor immediately. Azathioprine may increase the risk of premature birth, low birth weight and miscarriage. Seek medical advice from your doctor.
This medicine passes into breast milk. Seek medical advice from your doctor before using this medicine during breastfeeding.
Take Imuran tablets with or after food.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
Decreased production of blood cells by the bone marrow (bone marrow suppression)
Decreased white blood cell count (leucopenia)
Decreased platelet count (thrombocytopenia)
Increased susceptibility to infections
Damage to the liver
Yellowing of the skin and eyes (jaundice)
Loss of hair
Allergic reaction - see warnings above for symptoms
Inflammation of the pancreas (pancreatitis)
Inflammation of the lungs due to chest infection (pneumonitis)
The side effects listed above may not include all of the side effects reported by the drug's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.
The blood level of azathioprine is greatly increased if it is taken with allopurinol. If you are taking both these medicines together your doctor will prescribe you a lower than normal dose of azathioprine to prevent the increased blood level and increased risk of side effects.
This medicine may reduce the anti-blood-clotting effect of anticoagulant medicines such as warfarin. If you are taking this medicine with warfarin your blood-clotting time (INR) should be monitored.
There may be an increased risk of blood cell abnormalities if azathioprine is taken with the following medicines:
Co-trimoxazole or trimethoprim, particularly in individuals who have had a kidney transplant
ACE inhibitors such as captopril
Aminosalicylates such as mesalazine, olsalazine, sulfasalazine.
Vaccines may be less effective in people receiving immunosuppressant medicines, because the immunosuppressant can prevent the body forming adequate antibodies. Live vaccines should be not be given because they may cause infection. Live vaccines include the following: oral polio; rubella; measles, mumps and rubella (MMR); BCG; yellow fever and oral typhoid vaccines.
07-29-2006, 11:11 AM
Thanks for all the info on Imuran. I still have a hard time understanding why they want to give me a drug that suppresses platelet counts, when my problem is low platelet counts. I will talk to my doc about this next week - maybe there is something more appropriate. I know they want me on lower decadron - me too! I saw the link to the Women's Lupus Center in Pittsburgh - this is less than 100 miles from my house, and it sounds like a good place to get second opinion. It actually sounds like a wonderful place, I read all the patient essays, and was quite inspired by what I read. I am so glad to have found the wehavelupus website, that seems filled with serious, insightful and generous women!