Jaundice azathioprine

The chief toxic effect of azathioprine and mercaptopurine is bone marrow suppression, usually manifested as leukopenia, although anemia and thrombocytopenia may occur. Skin rashes, fever, nausea and vomiting, and sometimes diarrhea occur, with the gastrointestinal symptoms seen mainly at higher dosages. Flepatic dysfunction, manifested by very high serum alkaline phosphatase levels and mild jaundice, occurs occasionally, particularly in patients with preexisting hepatic dysfunction. 

METHOTREXATE AZATHIOPRINE t risk of hepatotoxicity Additive hepatotoxic effects Monitor closely for symptoms of liver failure e.g. flu-like symptoms, abdominal pain, dark urine, pruritus, jaundice, ascites and weight gain. Do LFTs at the beginning of treatment and weekly until stable, and repeat if there is clinical suspicion of liver disease... 

A 7-year-old boy with Duchenne muscular dystrophy and attention deficit hyperactivity disorder (ADHD) developed acute hepatic failure, with features of autoimmune hepatitis (2). The only medications he had taken were pemoline (56 mg/day) and cjrproheptadine (2 mg/day). Pemoline was withdrawn after 8 months as the presumed cause of his raised transaminases. Two weeks later he developed an altered mental state, jaundice, and encephalopathy. The histological features of the liver and his autoimmune antibody panel were consistent with autoimmune hepatitis. He was treated with corticosteroids and azathioprine and recovered. 

Azathioprine Myelosuppression, hepatotoxicity, lymphoproliferative disorders Symptoms of myelosuppression (extreme fatigue, easy bleeding or bruising, infection), jaundice... 

Mercaptopurine (CCS) Purine antimetabolite (S phase) bioactivated by HGPR transferase Acute lymphocytic leukemia immunosuppression (azathioprine forms 6-MP) BMS, hepatotoxicity (jaundice, necrosis), GI distress... 

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