Select therapeutic use:

Arthritis/rheumatic disorders:

Indications for IMURAN:

To reduce signs/symptoms of active rheumatoid arthritis.

Adult:

Initially 1mg/kg per day in 1–2 divided doses. After 6–8 weeks, if needed, increase by 0.5mg/kg per day increments every 4 weeks; max 2.5mg/kg/day. Maintenance: use lowest effective dose; can decrease by 0.5mg/kg/day (approx. 25mg daily) every 4 weeks. May continue use of aspirin, NSAIDs, and/or low dose steroids during therapy. Concomitant allopurinol: reduce azathioprine to ⅓ or ¼ of usual dose.

Children:

Not established.

Contraindications:

Rheumatoid arthritis: pregnancy; prior treatment with alkylating agents (eg, cyclophosphamide, chlorambucil, melphalan, others).

Boxed Warning:

Malignancy.

Warnings/Precautions:

Increased risk of lymphoma, other malignancies (esp. skin). Risk of hepatosplenic T-cell lymphoma in inflammatory bowel disease (eg, Crohn's disease, ulcerative colitis). Monitor CBCs with platelets weekly during 1st month, then twice monthly for 2nd and 3rd months, then monthly or more frequently during dose adjustments. Reduce dose or suspend if rapid fall in or persistently low leukocyte count, or other bone marrow depression develops. Consider TPMT or NUDT15 testing in patients with severe myelosuppression; use alternative therapy if homozygous TPMT or NUDT15 deficiency and reduce dose if heterozygous deficiency. Risk of serious infections (eg, bacterial, viral, fungal, protozoal, opportunistic, including reactivation of latent ones). Discontinue if hepatic veno-occlusive disease is suspected. Avoid sun, UV light. Renal impairment: give lower doses. Pregnancy (Cat.D); avoid. Nursing mothers: not recommended.

Pharmacologic Class:

Immunosuppressant (antimetabolite).

Interactions:

See Contraindications. Concomitant febuxostat, DMARDs: not recommended. Anemia, leukopenia with ACEIs. Pancytopenia, myelotoxicity with ribavirin. Exaggerated leukopenia with cotrimoxazole. Caution with concomitant aminosalicylates (eg, sulfasalazine, mesalazine, olsalazine). May antagonize warfarin.

Adverse Reactions:

Leukopenia, thrombocytopenia, anemia, GI toxicity, secondary infection, malignancy, hepatotoxicity, rash, alopecia, fever, arthralgias, diarrhea, steatorrhea, others; progressive multifocal leukoencephalopathy (consider reducing dose).

How Supplied:

Tabs—100

Pricing for IMURAN

50mg tablet (Qty: 60)
Appx. price $27
GoodRx

Organ rejection prophylaxis:

Indications for IMURAN:

Adjunct for the prevention of rejection in renal homotransplantation.

Adult:

Individualize. Initially 3–5mg/kg once daily starting day of, or in some cases 1–3 days before, transplant. Maintenance: may reduce to 1–3mg/kg daily. Concomitant allopurinol: reduce azathioprine to ⅓ or ¼ of usual dose.

Children:

Not established.

Contraindications:

Rheumatoid arthritis: pregnancy; prior treatment with alkylating agents (eg, cyclophosphamide, chlorambucil, melphalan, others).

Boxed Warning:

Malignancy.

Warnings/Precautions:

Increased risk of lymphoma, other malignancies (esp. skin). Risk of hepatosplenic T-cell lymphoma in inflammatory bowel disease (eg, Crohn's disease, ulcerative colitis). Monitor CBCs with platelets weekly during 1st month, then twice monthly for 2nd and 3rd months, then monthly or more frequently during dose adjustments. Reduce dose or suspend if rapid fall in or persistently low leukocyte count, or other bone marrow depression develops. Consider TPMT or NUDT15 testing in patients with severe myelosuppression; use alternative therapy if homozygous TPMT or NUDT15 deficiency and reduce dose if heterozygous deficiency. Risk of serious infections (eg, bacterial, viral, fungal, protozoal, opportunistic, including reactivation of latent ones). Discontinue if hepatic veno-occlusive disease is suspected. Avoid sun, UV light. Renal impairment: give lower doses. Pregnancy (Cat.D); avoid. Nursing mothers: not recommended.

Pharmacologic Class:

Immunosuppressant (antimetabolite).

Interactions:

See Contraindications. Concomitant febuxostat, DMARDs: not recommended. Anemia, leukopenia with ACEIs. Pancytopenia, myelotoxicity with ribavirin. Exaggerated leukopenia with cotrimoxazole. Caution with concomitant aminosalicylates (eg, sulfasalazine, mesalazine, olsalazine). May antagonize warfarin.

Adverse Reactions:

Leukopenia, thrombocytopenia, anemia, GI toxicity, secondary infection, malignancy, hepatotoxicity, rash, alopecia, fever, arthralgias, diarrhea, steatorrhea, others; progressive multifocal leukoencephalopathy (consider reducing dose).

How Supplied:

Tabs—100

Pricing for IMURAN

50mg tablet (Qty: 60)
Appx. price $27
GoodRx