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Azathioprine, also known as Imuran, comes with several critical safety considerations that patients and healthcare providers should be aware of. It is important to understand these risks and take appropriate precautions while using this medication.

• Cancer Risk: Azathioprine may increase the likelihood of developing certain types of cancer, including lymphoma and skin cancer. This risk is particularly elevated for individuals using the drug after an organ transplant and for children or young adults being treated for bowel diseases such as Crohn's disease or ulcerative colitis. To mitigate this risk, limit your exposure to sunlight and ultraviolet light, use sunblock, and wear protective clothing. Regular medical and lab appointments should be maintained. Contact your doctor immediately if you notice unusual skin changes, changes in moles, unusual growths or lumps, swollen lymph nodes, a swollen abdomen, unexplained weight loss, or night sweats.

• Reduction of Blood Cells: This medication can impair bone marrow function, leading to a decrease in red and white blood cells and platelets. This could result in anemia, increased susceptibility to infections, or easy bruising and bleeding. Inform your healthcare provider promptly if you experience symptoms such as unusual tiredness, pale skin, persistent sore throat, fever, chills, or easy bruising/bleeding.

• Increased Infection Risk: Long-term use of azathioprine may increase your vulnerability to infections. Avoid contact with sick individuals and practice good hygiene by washing your hands frequently. Additionally, certain vaccines, particularly live vaccines like varicella (chickenpox), yellow fever, or the MMR vaccine, should not be administered as azathioprine can weaken your immune response. Seek medical advice immediately if you develop muscle weakness, changes in speech or vision, or a fever.

• Liver Health: Azathioprine can cause an increase in liver enzymes, indicating potential liver damage, especially within the first six months of treatment. This situation usually resolves after discontinuing the medication. Regular liver function tests are recommended to monitor any adverse effects.

In case of an overdose, immediate medical attention is crucial. Always follow your healthcare provider’s instructions and report any concerning symptoms as soon as they arise.

When taking this medication, some people may experience mild side effects such as nausea, vomiting, or temporary hair loss. Taking the medication after meals might help reduce nausea and vomiting. If these effects continue or worsen, it's important to consult your healthcare provider.

In some cases, more serious side effects can occur, including diarrhea, new or worsening joint or muscle pain, tiredness, fever, and infections due to lowered white blood cell count (leukopenia). Additionally, this medication can sometimes cause liver damage. It's crucial to inform your healthcare provider if you notice symptoms related to liver issues, such as persistent nausea, stomach pain, dark urine, or yellowing of the eyes or skin.

Rare but severe side effects include a very serious brain infection known as progressive multifocal leukoencephalopathy (PML), which requires immediate medical attention. Symptoms might include clumsiness, sudden changes in thinking, difficulty talking or walking, seizures, or vision changes. Also, watch for signs of a serious allergic reaction, like swelling of the face, tongue, or throat, severe dizziness, or trouble breathing, which necessitate urgent medical care.

If you notice any other unusual effects, it's advisable to reach out to your doctor or pharmacist for guidance. Your health and safety are priorities, so it’s essential to communicate any concerns you may have while using this medication.

Azathioprine, marketed as Imuran, can interact with various medications. It is crucial to inform your doctor and pharmacist about all drugs and supplements you are taking, including over-the-counter medications and herbal products.

Certain interactions are particularly significant. For example, using azathioprine with Febuxostat is not recommended, as it may lead to harmful effects. If your doctor prescribes both, they may need to modify your treatment plan.

Other drugs, like certain cancer treatments (e.g., Cyclophosphamide, Melphalan), and medications that suppress the immune system or increase infection risk (such as rituximab and Tofacitinib), may also interact with azathioprine. Additionally, azathioprine should not be used alongside Mercaptopurine due to their similarity, which could amplify side effects.

Some combinations might increase the risk of side effects but could be necessary for your treatment. In such cases, your doctor will adjust dosages or how frequently you take the medications. This includes drugs such as acenocoumarol, Cyclosporine, phenprocoumon, and Warfarin.

Always consult with your healthcare provider before making any changes to your medication regimen to ensure safe and effective use of azathioprine.