Generic Azathioprine

Introduction

Azathioprine is an oral immunosuppressive medication widely used in the United Kingdom for the long‑term management of autoimmune and inflammatory disorders. The active compound, azathioprine, belongs to the purine‑analogue class and is listed under the medication group “Pain Relief” because it can reduce inflammation‑related discomfort in conditions such as inflammatory bowel disease. Its utility stems from the ability to dampen an over‑active immune response, thereby preventing tissue damage and chronic pain.

What is Azathioprine?

Azathioprine is a synthetic purine analogue that interferes with lymphocyte proliferation. It was first synthesised in the 195s and introduced clinically in the 196s by the pharmaceutical company Schering‑Plough (now part of Merck & Co.). The drug is marketed under several brand names, the most recognisable being Imuran and Azasan.

Azathioprine is the generic version of Imuran, containing the same active compound azathioprine. Our online pharmacy provides this generic alternative as a cost‑effective treatment option.

In the UK, azathioprine is prescribed as tablets of 25 mg, 50 mg, or 100 mg strength, each containing the active ingredient and a set of inert excipients that aid tablet integrity and absorption.

How Azathioprine Works

Azathioprine is a pro‑drug that is rapidly converted in the body to 6‑mercaptopurine (6‑MP). 6‑MP is then metabolised into thio‑inosine monophosphate, which competitively inhibits the de novo synthesis of purine nucleotides. Lymphocytes, especially activated T‑ and B‑cells, rely heavily on this pathway for DNA replication; consequently, azathioprine selectively reduces the proliferation of these immune cells.

The suppression of lymphocyte activity leads to a decrease in the release of pro‑inflammatory cytokines such as interleukin‑2 and interferon‑γ. Clinically, this translates into reduced tissue inflammation, lower pain scores, and slower disease progression. Onset of immunosuppression typically occurs within 2–4 weeks, with maximal effect reaching around 3–6 months of continuous therapy. The drug is eliminated primarily via hepatic metabolism and renal excretion, with a mean plasma half‑life of 5 hours for 6‑MP and 1–2 hours for azathioprine itself.

Conditions Treated with Azathioprine

• Rheumatoid arthritis – reduces joint inflammation and structural damage when used with methotrexate or biologics.
• Systemic lupus erythematosus (SLE) – adjunctive therapy for skin, renal, or musculoskeletal involvement.
• Inflammatory bowel disease (IBD) – maintenance therapy for Crohn’s disease and ulcerative colitis, decreasing flare frequency.
• Autoimmune hepatitis – controls hepatic inflammation and prevents progression to cirrhosis.
• Organ transplantation – part of standard immunosuppressive regimens to prevent graft rejection.

In the United Kingdom, the National Institute for Health and Care Excellence (NICE) lists azathioprine as a second‑line agent for many of these conditions when first‑line treatments are insufficient or contraindicated. Its role is especially valuable for patients who cannot tolerate biologic agents or who require a steroid‑sparing strategy.

Who is Azathioprine For?

Azathioprine is indicated for adult patients with confirmed autoimmune or inflammatory disease who need long‑term immune modulation. Typical candidates include:

• Individuals with moderate‑to‑severe rheumatoid arthritis who have an inadequate response to conventional DMARDs.
• Patients with chronic IBD who have experienced at least one relapse despite optimal mesalamine therapy.
• Adults with SLE presenting with renal or central nervous system involvement where steroid reduction is a priority.
• Recipients of solid‑organ transplants who require maintenance immunosuppression in combination with calcineurin inhibitors.

The drug is not suitable for:

• Pregnant or breastfeeding women (category D) due to teratogenic risk.
• Patients with known hypersensitivity to azathioprine, mercaptopurine, or any excipients.
• Individuals with severe hepatic impairment (Child‑Pugh C) or marked bone‑marrow suppression at baseline.

Prior to initiation, baseline laboratory assessments (full blood count, liver enzymes, renal function, and thiopurine methyltransferase activity where available) are mandatory to identify patients at higher risk of toxicity.

Risks, Side Effects, and Interactions

Common

• Nausea, vomiting, or loss of appetite.
• Mild leukopenia or lymphopenia.
• Elevated liver enzymes (ALT, AST).
• Transient rash or mild fever.

Rare

• Drug‑induced pancreatitis.
• Severe alopecia.
• Photosensitivity reactions.

Serious

• Bone‑marrow aplasia or pancytopenia.
• Hepatotoxicity leading to cholestatic hepatitis.
• Opportunistic infections (e.g., cytomegalovirus, Pneumocystis jirovecii).
• Increased risk of malignancies, notably non‑melanoma skin cancer and lymphoproliferative disorders.

Drug–drug interactions

• Allopurinol or febuxostat: synergistic inhibition of 6‑MP metabolism, raising azathioprine levels; dose reduction (by up to 66 %) is recommended.
• Warfarin: azathioprine may potentiate anticoagulant effect; monitor INR closely.
• Live vaccines: contraindicated while on azathioprine because of impaired immune response.

Patients should inform their physician of all concomitant medicines, including over‑the‑counter products and herbal supplements.

Practical Use: Dosing, Missed Dose, Overdose

• Standard adult dosing: 1–2 mg/kg per day, divided into one or two doses. For rheumatoid arthritis, typical starting doses are 50 mg daily, titrated up to 200 mg based on clinical response and laboratory monitoring.
• Missed dose: Take the missed tablet as soon as remembered unless the next scheduled dose is within 6 hours; in that case, skip the missed dose and resume the regular schedule. Do not double‑dose.
• Overdose: Excessive ingestion may cause severe bone‑marrow suppression and gastrointestinal toxicity. Seek immediate medical attention; treatment is supportive, possibly involving growth‑factor therapy (e.g., G‑CSF).

Practical precautions

• Take tablets with food to minimise gastrointestinal upset.
• Avoid excessive alcohol, which can exacerbate hepatotoxicity.
• Regular laboratory monitoring (every 2–4 weeks for the first 3 months, then quarterly) is essential.
• Inform the prescribing clinician before any elective surgery, as azathioprine may impair wound healing.

Buying Azathioprine from Our Online Pharmacy

Azathioprine can be purchased safely from our online pharmacy in the UK. We source the medication from licensed overseas suppliers who meet European Union Good Manufacturing Practice (GMP) standards, ensuring that each batch matches the purity and potency of the original brand.

Key benefits of ordering through us:

• Affordable pricing – our costs are close to manufacturer wholesale rates, passing savings directly to the patient.
• Verified quality – every shipment is inspected by a qualified pharmacist before dispatch.
• Guaranteed delivery – discreet packaging with tracked shipping; express delivery in 7 days, regular airmail within ~3 weeks.
• Privacy‑focused service – as a pharmacy broker, we handle personal data in compliance with the UK Data Protection Act, providing a confidential experience for those who prefer not to use a local pharmacy.

Our platform enables patients with limited access to specialist clinics or restrictive insurance formularies to obtain a reliable, generic alternative to brand‑name azathioprine.

FAQ

• Is azathioprine available in both brand‑name and generic forms in the UK?
  Yes. The most widely recognised brand is Imuran, but generic azathioprine tablets containing the same active compound are also licensed and subsidised by the NHS.

• Does azathioprine require refrigeration?
  No. The tablets are stable at room temperature (15‑30 °C). They should be kept away from moisture and direct sunlight, preferably in the original container.

• What does the packaging look like when ordered online?
  Tablets are supplied in sealed, tamper‑evident blister packs or bottles, each labelled with batch number, expiry date, and dosage strength. The outer box bears our pharmacy logo and a discreet outer label.

• Can azathioprine be imported for personal use without a prescription?
  In the UK, personal import of prescription‑only medicines is permitted only with a valid prescription from a UK‑registered prescriber. Import without a prescription may be seized by customs.

• Are there specific warnings for patients of Asian ancestry?
  Individuals of Asian descent often have reduced activity of the enzyme thiopurine methyltransferase (TPMT), increasing the risk of myelosuppression. Baseline TPMT testing is recommended before therapy.

• How does the formulation differ between the EU and the US?
  EU‑licensed azathioprine tablets usually contain lactose as an excipient, while some US formulations may use corn‑starch. These differences are minor and do not affect clinical efficacy, but patients with specific intolerances should check the ingredient list.

• Will azathioprine affect routine blood tests for other conditions?
  Yes. Because azathioprine can cause leukopenia and liver enzyme elevation, clinicians often interpret complete blood counts and liver panels with caution, attributing changes to the drug when appropriate.

• Is it safe to travel internationally while taking azathioprine?
  Travellers should carry a doctor’s letter confirming the medication, keep the tablets in original packaging, and avoid exposure to infectious disease hotspots without appropriate prophylaxis, as immunosuppression increases infection risk.

• Can azathioprine be taken with contraceptive pills?
  There is no known pharmacokinetic interaction, but as azathioprine can be teratogenic, effective contraception is essential for women of child‑bearing potential.

• What is the historical significance of azathioprine in transplant medicine?
  Introduced in the 196s, azathioprine was one of the first agents that made long‑term organ transplantation feasible by providing reliable, oral immunosuppression before the advent of modern calcineurin inhibitors.

Glossary

Immunosuppressant

A drug that reduces the activity of the immune system, often used to prevent rejection of transplanted organs or to control autoimmune disease.

Thiopurine methyltransferase (TPMT)

An enzyme that metabolises azathioprine; genetic variations can lead to reduced activity and higher risk of toxicity.

Pancytopenia

A severe reduction in red cells, white cells, and platelets, leading to anemia, infection risk, and bleeding tendency.

Steroid‑sparing

A therapeutic approach that aims to minimise the use of corticosteroids by using alternative agents like azathioprine.

⚠️ Disclaimer

The information provided about Azathioprine is for general knowledge only. It does not replace professional medical consultation. All treatment decisions should be made under the supervision of a qualified healthcare provider. We assume all readers are responsible adults capable of making informed decisions about their health. Our online pharmacy offers access to Azathioprine for individuals who may have limited availability through traditional pharmacies, prescription‑based insurance schemes, or who are seeking affordable generic alternatives. Always consult your doctor before starting, changing, or discontinuing any medication.