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Azathioprine (AZA) is a medication used in the management and treatment of active rheumatoid arthritis (RA) and the prevention of kidney transplant rejection. This activity reviews the indications, action, and contraindications for azathioprine as a valuable agent in treating RA and other disorders when applicable. This activity will highlight the mechanism of action, adverse event profile, and other key factors (e.g., off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions) pertinent for members of the interprofessional team in the treatment of patients with RA and related conditions. Objectives: Describe the mechanism of action of azathioprine. Identify the most common adverse events associated with azathioprine therapy. Explain the importance of monitoring for patients on azathioprine therapy. Outline the importance of collaboration and coordination among the interprofessional team to enhance patient care when monitoring azathioprine to improve patient outcomes. Access free multiple choice questions on this topic.

Toxicity symptoms include gastrointestinal symptoms, bradycardia, hepatotoxicity, myelosuppression.[33] Acute toxicity usually happens when more than 1.5 times of daily dose is taken by the patient. In the acute setting, activated charcoal may help with decreasing the symptoms within two hours of ingestion.[34] No specific antidote is known for AZA. In severe cases of toxicity, dialysis is permissible as AZA is dialysable. In cases of hepatic sinusoidal obstruction syndrome, it must discontinue permanently. If severely leukopenic, thrombocytopenic, or infected, treatment should stop.

Azathioprine is an immunomodulator associated with several serious adverse effects. Susceptibility to its toxicity varies with age, genetic differences, and medication dosage. Its adverse effects are a limiting factor in the patient's compliance. Therefore regular follow-up and frequent laboratory workups are crucial to avoiding its complications. Clinicians and pharmacists should be aware of potential adverse effects of AZA, even in asymptomatic patients. Pharmacists should verify dosing is appropriate to the condition treated and report any discrepancies to the rest of the healthcare team. Nursing will often function at the "front lines" in seeing the patients and are often the first to know about adverse events, which they can report to the team. Nursing will also be in charge of administration, so they should verify dosing to ensure optimal therapeutic results with minimal adverse effects. In summary, azathioprine therapy requires an interprofessional team approach, including clinicians, specialists, mid-level practitioners, specialty-trained nurses, and pharmacists, all collaborating across disciplines to achieve optimal patient results. [Level 5]