Vomiting azathioprine

With azathioprine and 6-MP, monitor for hypersensitivity reactions, including severe skin rashes and pancreatitis. Educate the patient regarding signs and symptoms of pancreatitis (nausea, vomiting, and abdominal pain). 

Azathioprine can be administered both orally and intravenously. It is well absorbed orally and after its rapid conversion to 6-mercaptopurine it is inactivated by xanthine oxidase which converts 6-mercaptopurine to 6-thiouric acid. This final metabolite is then excreted in the urine. In combination with the xanthine oxidase inhibitor allopurinol dose adjustments of azathioprine are needed. Renal disease also raises 6-mercaptopurine concentrations and can make dose adjustments necessary. Azathioprine is still used in organ transplantation programs and for the management of several autoimmune diseases. Its adverse effects include nausea, vomiting, diarrhea and, more seriously, bone marrow suppression and hepatotoxicity. Azathioprine is not thought to cause fetal malformation. 

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. 

Adverse Side Effects. Azathioprine is relatively toxic, with more frequent and more severe side effects than other DMARDs.97 The primary side effects include fever, chills, sore throat, fatigue, loss of appetite, and nausea or vomiting these effects often limit the use of this drug. 

Adverse Effects. The primary side effects of azathioprine are related to suppression of bone marrow function, including leukopenia, megaloblastic anemia, and similar blood dyscrasias. Other side effects include skin rash and gastrointestinal distress (appetite loss, nausea, vomiting) hepatic dysfunction can also occur when higher doses are used. 

Dose-related toxicities of azathioprine or 6-mercaptopurine include nausea, vomiting, bone marrow depression (leading to leukopenia, macrocytosis, anemia, or thrombocytopenia), and hepatic toxicity. Routine laboratory monitoring with complete blood count and liver function tests is required. Leukopenia or elevations in liver chemistries usually respond to medication dose reduction. Severe leukopenia may predispose to opportunistic infections leukopenia may respond to therapy with granulocyte stimulating factor. Hypersensitivity reactions to azathioprine or 6-mercaptopurine occur in 5% of patients. These include fever, rash, pancreatitis, diarrhea, and hepatitis. 

Gastrointestinal disturbances with nausea, vomiting, and diarrhea are frequent in patients taking azathioprine or mercaptopurine. Diarrhea may be isolated or part of the azathioprine hypersensitivity sjmdrome. In two patients with azathioprine-induced diarrhea proven by positive rechallenge, the period of sensitization ranged from 1 week to 1 year (19). 

Mycophenolate has also been studied in various chronic inflammatory disorders, such as rheumatoid arthritis, pemphigus vulgaris, and psoriasis. In 70 patients with chronic active Crohn s disease, mycophenolate plus glucocorticoids produced benefit on disease activity comparable to azathioprine plus glucocorticoids (7). Two of the 35 patients randomized to mycophenolate had significant adverse effects that required drug withdrawal, namely rashes and vomiting. 

One month after transplantation, a 19-year-old man who was taking tacrolimus, azathioprine, and prednisone, developed nausea and vomiting. He reported a 2-week history of painful spontaneous penile erections lasting 2-3 minutes and had had no previous episodes of priapism. An episode of spontaneous erection was confirmed during a medical examination that found no physical abnormalities. The tacrolimus blood concentration was 28 ng/ml. The digestive symptoms and priapism resolved after the tacrolimus concentration had fallen. Sickle cell disease was ruled out. 

Dose-limiting adverse effects of azathioprine are often hematologic (see Table 87-4). Leukopenia, anemia, and thrombocytopenia can occur within the first few weeks of therapy and can be managed by dose reduction or discontinuation of azathioprine. Other common adverse effects include nausea and vomiting, which can be minimized by taking azathioprine with food. Alopecia, hepatotoxicity and pancreatitis are less common adverse effects of azathioprine they generally are reversible on dose reduction or discontinuation. ... 

In 22 patients with inflammatory bowel disease who had adverse reactions to azathioprine, mercaptopurine was tolerated for longer (median 219, range 3-503 days) than azathioprine (median 14, range 2-180 days) [112 ]. The adverse reactions to azathioprine were nausea and vomiting (n = 14), flu-like symptoms (n = 5), myalgia/arthral-gia (n = 6), headaches (n = 6), and diarrhea (n = 2). 

Observational studies in 106 patients with Crohn s disease taking azathioprine, there was at least one adverse reaction in 56, and 18 had to stop taking it, often because of hypersensitivity reactions, there was nausea and vomiting in 29 and leukopenia in 36 [125 =]. 

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