a mercaptopurine derivative used as an immunosuppressive agent for prevention of transplant rejection in organ transplantation ; as a disease-modifying antirheumatic drug for treatment of severe, progressive rheumatoid arthritis unresponsive to other agents; and for treatment of a number of autoimmune diseases ; administered orally as the base or intravenously as the sodium salt.
Apo-Azathioprine (CA), Azasan, Gen-Azathioprine (CA), Immunoprin (UK), Imuran, Novo-Azathioprine (CA)
Pharmacologic class: Purine antagonist
Therapeutic class: Immunosuppressant
Pregnancy risk category D
FDA Box Warning
• Drug may cause chronic immunosuppression, increasing neoplasia risk. Physicians using it should be familiar with this risk and with possible hematologic toxicities and mutagenic potential in both sexes.
Prevents proliferation and differentiation of activated B and T cells by interfering with synthesis of purine, DNA, and RNA
Injection: 100-mg vial
Tablets: 50 mg, 75 mg, 100 mg
⊘ Indications and dosages
➣ To prevent rejection of kidney transplant
Adults and children: Initially, 3 to 5 mg/kg/day P. O. or I. V. as a single dose. Give on day of transplantation or 1 to 3 days before day of transplantation; then 3 to 5 mg/kg/day I. V. after surgery until patient can tolerate P. O. route. Maintenance dosage is 1 to 3 mg/kg/day P. O.
➣ Rheumatoid arthritis
Adults and children: Initially, 1 mg/kg P. O. or I. V. in one or two daily doses. Increase dosage in steps at 6 to 8 weeks and thereafter at 4-week intervals; use dosage increments of 0.5 mg/kg/day, to a maximum dosage of 2.5 mg/kg/day. Once patient stabilizes, decrease in decrements of 0.5 mg/kg/day to lowest effective dosage.
• Renal disease • Concurrent allopurinol therapy • Elderly patients
• Crohn's disease • Myasthenia gravis • Chronic ulcerative colitis
• Hypersensitivity to drug • Pregnancy or breastfeeding
Use cautiously in: • chickenpox, herpes zoster, impaired hepatic or renal function, decreased bone marrow reserve • previous therapy with alkylating agents (cyclophosphamide, chlorambucil, melphalan) for rheumatoid arthritis • elderly patients • women of childbearing age.
• Give after meals. • Be aware that I. V. administration is intended for use only when patients can't tolerate oral medications.
GI: nausea, vomiting, diarrhea, stomatitis, esophagitis, anorexia, mucositis, pancreatitis
Hematologic: anemia, thrombocytopenia, leukopenia, pancytopenia
Hepatic: jaundice, hepatotoxicity
Musculoskeletal: muscle wasting, joint and muscle pain
Skin: rash, alopecia
Other: chills, fever, serum sickness, neoplasms, serious infection
Drug-drug. Allopurinol: increased therapeutic and adverse effects of azathioprine
Angiotensin-converting enzyme (ACE) inhibitors, co-trimoxazole: severe leukopenia
Anticoagulants, cyclosporine: decreased actions of these drugs
Atracurium, pancuronium, tubocurarine, vecuronium: reversal of these drugs' actions
Drugs affecting bone marrow and bone marrow cells (such as ACE inhibitors, co-trimoxazole): severe leukopenia
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, amylase, aspartate aminotransferase, bilirubin: increased levels
Albumin, hemoglobin, uric acid: decreased levels
Urine uric acid: decreased level
Drug-herbs. Astragalus, echinacea, melatonin: interference with immunosuppressant action
☞ Monitor CBC, platelet level, and liver function test results. • Assess for signs and symptoms of hepatotoxicity (clay-colored stools, pruritus, jaundice, and dark urine). • Watch for signs and symptoms of infection. • Monitor for bleeding tendency and hemorrhage.
☞ Tell patient that drug lowers resistance to infection. Instruct him to immediately report fever, cough, breathing problems, chills, and other symptoms.
☞ Instruct patient to immediately report unusual bleeding or bruising. • Tell patient that drug effects may not be obvious for up to 8 weeks in immunosuppression and up to 12 weeks for rheumatoid arthritis relief.
☞ Emphasize importance of avoiding pregnancy during therapy and for 4 months afterward. • Caution patient to avoid activities that may cause injury. Tell him to use soft toothbrush and electric razor to avoid gum and skin injury. • Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids. • Tell patient he'll undergo regular blood testing during therapy. • As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.
A derivative of 6-mercaptopurine, used as a cytotoxic and immunosuppressive agent.
/aza·thio·prine/ ( az″ah-thi?o-prēn ) a 6-mercaptopurine derivative used as the base or the sodium salt as an immunosuppressant for prevention of transplant rejection and for treatment of rheumatoid arthritis and various autoimmune diseases.
An immunosuppressive agent used to prevent organ rejection in kidney transplant recipients and to treat severe rheumatoid arthritis.
indications It is prescribed to prevent organ rejection after transplantation and to treat lupus erythematosus and other systemic inflammatory diseases, such as rheumatoid arthritis unresponsive to other agents.
contraindications Known hypersensitivity to this drug prohibits its use. It is contraindicated in rheumatoid arthritis and in pregnant women.
adverse effects Among the most serious adverse reactions are bone marrow depression and hepatotoxicity. Nausea and fever are common.
A thiolated purine analogue/immunosuppressant used to prevent rejection of heart, kidney, lung and other allografts, acting primarily on T cells; it is used in rheumatoid arthritis and myasthenia gravis.
Adverse effects Dose-related marrow suppression—leukopaenia, thrombocytopaenia, macrocytic anaemia); GI tract—nausea, vomiting, diarrhoea, fever, malaise, myalgia, liver enzyme defects, hepatotoxicity, pancreatitis. Azathiprineshould not be given with allopurinol.
Chemistry Azathioprine is 6-mercaptopurine with a side chain to protect the labile sulfhydryl group, which is split off in the liver; full metabolic activity follows addition of ribose 5-phosphate from phosphoribosyl pyrophosphate that is metabolised to the cytotoxic derivative 6-mercaptopurine.
Imuran ® Immunology An immunosuppressant used to prevent rejection of heart, kidney, lung and other allografts, acting primarily on T-cells; it is used in rheumatoid arthritis, myasthenia gravis Adverse effects BM suppression–leukopenia, thrombocytopenia, macrocytic anemia, GI tract–N&V, diarrhea, fever, malaise, myalgia, LFT abnormalities, hepatotoxicity, pancreatitis; should not be given with allopurinol. See Heart transplant, Kidney transplant, Lung transplant. Transplantation.
A drug used to suppress the immune system so as to avoid rejection of donor transplants. Immune suppression may have serious side effects such as the flare-up of latent infections and an increased risk of malignant tumours such as lymphomas, but azathioprine is safer than other immunosuppressive drugs. Also used to treat rheumatism. The drug is on the WHO official list. A brand name is Imuran.
immunosuppressive agent used in the treatment of autoimmune and chronic inflammatory conditions, e. g. severe rheumatoid arthritis and psoriasis, when corticosteroid treatment alone is no longer effective
Drugs that prevent or reduce the immune response. They are used in the treatment of a variety of severe inflammations such as uveitis, scleritis, keratoconjunctivitis sicca, Behcet's syndrome, sympathetic ophthalmia, and to prevent corneal graft rejection. They include the corticosteroids (e. g. prednisolone), ciclosporin (cyclosporine), tacrolimus, and cytotoxic agents (e. g. azathioprine, chlorambucil, cyclophosphamide, methotrexate). It must be noted that immunosuppressants render the patient more susceptible to infection because immunity is reduced.
Derivative of 6-mercaptopurine, used as cytotoxic and immunosuppressive agent.
azathioprine (az´əthīōprēn) ,
n brand name: Imuran; drug class: immunosuppressant; action: inhibits purine synthesis in cells, thereby preventing RNA and DNA synthesis; uses: renal transplants to prevent graft rejection, refractory rheumatoid arthritis, bone marrow transplants, glomerulonephritis.
a mercaptopurine derivative used as a cytotoxic and immunosuppressive agent in the treatment of leukemia and autoimmune diseases and in transplantation therapy.
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1. being highly resistant to a disease because of the formation of humoral antibodies or the development of immunologically competent cells, or both, or as a result of some other mechanism, as interferon activities in viral infections.
2. characterized by the development of humoral antibodies or cellular immunity. or both, following antigenic challenge .
3. produced in response to antigenic challenge, as immune serum globulin.
immune response the reaction to and interaction with substances interpreted by the body as not-self. the result being humoral and cellular immunity. Called also immune reaction. The immune response depends on a functioning thymus and the conversion of stem cells to B and T lymphocytes. These lymphocytes contribute to antibody production, cellular immunity, and immunologic memory.
Disorders of the Immune Response. Pathologic conditions associated with an abnormal immune response (immunopathy) may result from (1) immunodepression, that is, an absent or deficient supply of the components of either humoral or cellular immunity, or both; (2) excessive production of gamma globulins; (3) overreaction to antigens of extrinsic origin, that is, antigens from outside the body; and (4) abnormal response of the body to its own cells and tissues.
Those conditions arising from immunosuppression include agammaglobulinemia (absence of gamma globulins ) and hypogammaglobulinemia (a decrease of circulating antibodies). Factors that may cause or contribute to suppression of the immune response include (1) congenital absence of the thymus or of the stem cells that are precursors of B and T lymphocytes; (2) malnutrition, in which there is a deficiency of the specific nutrients essential to the life of antibody-synthesizing cells; (3) cancer, viral infections, and extensive burns, all of which overburden the immune response mechanisms and rapidly deplete the supply of antigen-specific antibody; (4) certain drugs, including alcohol and heroin, some antibiotics, antipsychotics, and the antineoplastics used in the treatment of cancer.
Overproduction of gamma globulins is manifested by an excessive proliferation of plasma cells ( multiple myeloma ). hypersensitivity is the result of an overreaction to substances entering the body. Examples of this kind of inappropriate immune response include hay fever. drug and food allergies. extrinsic asthma. serum sickness. and anaphylaxis .
Autoimmune diseases are manifestations of the body's abnormal response to and inability to tolerate its own cells and tissues. For reasons not yet fully understood, the body fails to interpret its own cells as self and, as it would with other foreign ( not-self ) substances, utilizes antibodies and immunologically competent cells to destroy and contain them.
immune system a complex system of cellular and molecular components whose primary function is distinguishing self from nonself and defense against foreign organisms or substances; see also immune response. The primary cellular components are lymphocytes and macrophages. and the primary molecular components are antibodies and lymphokines ; granulocytes and the complement system are also involved in immune responses but are not always considered part of the immune system per se.
Major organs and tissues of the immune system in the child. From McKinney et al. 2000.
immune complex disease local or systemic disease caused by the formation of circulating antibody-antigen immune complexes and their deposition in tissue, due to activation of complement and to recruitment and activation of leukocytes in type III hypersensitivity reactions .
1. a set or series of interconnected or interdependent parts or entities (objects, organs, or organisms) that act together in a common purpose or produce results impossible by action of one alone.
2. an organized set of principles or ideas. adj. adj systemat´ic, system´ic.
The parts of a system can be referred to as its elements or components; the environment of the system is defined as all of the factors that affect the system and are affected by it. A living system is capable of taking in matter, energy, and information from its environment (input), processing them in some way, and returning matter, energy, and information to its environment as output.
An open system is one in which there is an exchange of matter, energy, and information with the environment; in a closed system there is no such exchange. A living system cannot survive without this exchange, but in order to survive it must maintain pattern and organization in the midst of constant change. Control of self-regulation of an open system is achieved by dynamic interactions among its elements or components. The result of self-regulation is referred to as the steady state; that is, a state of equilibrium. homeostasis is an assemblage of organic regulations that act to maintain steady states of a living organism.
A system can be divided hierarchically into subsystems, which can be further subdivided into sub-subsystems and components. A system and its environment could be considered as a unified whole for purposes of study, or a subsystem could be studied as a system. For example, the collection of glands in the endocrine system can be thought of as a system, each endocrine gland could be viewed as a system, or even specific cells of a single gland could be studied as a system. It is also possible to think of the human body as a living system and the endocrine system as a subsystem. The division of a system into a subsystem and its environment is dependent on the perspective chosen by the person studying a particular phenomenon.
Systems, subsystems, and suprasystems. Within the environment there are suprasystems, such as human society, and systems within the suprasystem, such as the educational and industrial systems and the health care delivery system. Within the health care delivery system are subsystems, such as the patient, family members, the nurse, the physician, and allied health care professionals and paraprofessionals.
behavioral system in the behavioral system model of nursing, the patterned, repetitive, and purposeful behaviors of an individual.
cardiovascular system the heart and blood vessels, by which blood is pumped and circulated through the body; see also circulatory system .
CD system ( c luster d esignation ) a system for classifying cell-surface markers expressed by lymphocytes based on a computer analysis of monoclonal antibodies against hla antigens. with antibodies having similar specificity characteristics being grouped together and assigned a number (CD1, CD2, CD3, etc.); these CD numbers are also applied to the specific antigens recognized by the various groups of monoclonal antibodies . See also CD antigen .
centimeter-gram-second system (CGS) (cgs) a system of measurements in which the units are based on the centimeter as the unit of length. the gram as the unit of mass. and the second as the unit of time .
centrencephalic system the neurons in the central core of the brainstem from the thalamus to the medulla oblongata, connecting the cerebral hemispheres .
client system in the general systems framework and theory of goal attainment. the composite of physiological, psychological, sociocultural, and developmental variables that make up the total person.
colloid system ( colloidal system ) colloid (def. 3).
conduction system ( conductive system (of heart) ) the system of atypical cardiac muscle fibers, comprising the sinoatrial and atrioventricular nodes, internodal tracts, atrioventricular bundle, bundle branch, and terminal ramifications into the Purkinje network.
Emergency Medical Services (EMS) system a comprehensive program designed to provide services to the patient in the prehospital setting. The system is activated when a call is made to the EMS operator, who then dispatches an ambulance to the patient. The patient receives critical interventions and is stabilized at the scene. A communication system allows the health care workers at the scene to contact a trauma center for information regarding further treatment and disposition of the patient, followed by transportation of the patient to the most appropriate facility for treatment.
endocrine system the system of ductless glands and other structures that produce internal secretions ( hormones ) that are released directly into the circulatory system, influencing metabolism and other body processes; see endocrine glands .
expert system a set of computer programs designed to serve as an aid in decision making.
gateway system a software interface between an online searcher and one or more search systems, facilitating the use of the system by searchers who are unfamiliar with it, or with online retrieval in general.
genitourinary system the organs concerned with production and excretion of urine, together with the reproductive organs. (See Plates.) Called also urogenital system .
haversian system a haversian canal and its concentrically arranged lamellae, constituting the basic unit of structure in compact bone ( osteon ).
Haversian system: Structures of compact and spongy bone with the central haversian canal surrounded by the lamellae. From Applegate, 2000.
heterogeneous system a system or structure made up of mechanically separable parts, as an emulsion or suspension.
His-Purkinje system the intraventricular conduction system from the bundle of His to the distal Purkinje fibers, which carries the impulse to the ventricles.
Home Health Care Classification system see home health care classification system .
homogeneous system a system or structure made up of parts that cannot be mechanically separated, as a solution.
hypophyseoportal system ( hypophysioportal system ) ( hypothalamo-hypophysial portal system ) the venules connecting the hypothalamus with the sinusoidal capillaries of the anterior lobe of the pituitary gland ; they carry releasing substances to the pituitary.
interpersonal system in the general systems framework and theory of goal attainment. two or more individuals interacting in a given situation.
lay health system a system comprising an informal referral network and sources of treatment outside the formal biomedical sources of health care; it includes individual consultation and information-seeking through significant others and peers concerning health behaviors, symptoms, and evaluation of treatment before, during, and after consultation with health care professionals.
legal system in the omaha system. anything connected with law or its administration; it includes legal aid, attorney, courts, or Child Protective Services (CPS), and many other agencies and officials.
limbic system a system of brain structures common to the brains of all mammals, comprising the phylogenetically old cortex (archipallium and paleopallium) and its primarily related nuclei. It is associated with olfaction, autonomic functions, and certain aspects of emotion and behavior.
lymphoid system the lymphoid tissue of the body, collectively; it consists of primary (or central) lymphoid tissues, the bone marrow, and thymus, and secondary (or peripheral) tissues, the lymph nodes, spleen, and gut-associated lymphoid tissue (tonsils, Peyer's patches).
mononuclear phagocyte system the group of highly phagocytic cells that have a common origin from stem cells of the bone marrow and develop circulating monocytes and tissue macrophages, which develop from monocytes that have migrated to connective tissue of the liver ( kupffer's cells ), lung, spleen, and lymph nodes. The term has been proposed to replace reticuloendothelial system. which includes some cells of different origin and does not include all macrophages.
nursing system in the self-care model of nursing, all the actions and interactions of nurses and patients in nursing practice situations; nursing systems fall into three categories: wholly compensatory, partly compensatory, and supportive-educative.
oxygen delivery system a device that delivers oxygen through the upper airways to the lungs at concentrations above that of ambient air. There are two general types: the fixed performance or high flow type, which can supply all of the needs of a patient for inspired gas at a given fractional inspired oxygen; and the variable performance or low flow type, which cannot supply all of the patient's needs for oxygen and delivers fractional inspired oxygen that varies with ventilatory demand.
peripheral nervous system the portion of the nervous system consisting of the nerves and ganglia outside the brain and spinal cord.
personal system in the general systems framework and theory of goal attainment. the unified self, a complex whole that is rational, conscious, and feeling and that sets goals and decides on the means of achieving them.
portal system an arrangement by which blood collected from one set of capillaries passes through a large vessel or vessels and another set of capillaries before returning to the systemic circulation, as in the pituitary gland (the hypothalamo-hypophysial portal system ) or the liver (the hepatic portal circulation).
respiratory system the group of specialized organs whose specific function is to provide for the transfer of oxygen from the air to the blood and of waste carbon dioxide from the blood to the air. The organs of the system include the nose. the pharynx. the larynx. the trachea. the bronchi. and the lungs. See also respiration and Plates 7 and 8.
social system in the general systems framework and theory of goal attainment. an organized boundary system of social roles, behaviors, and practices developed to maintain balance for growth, development, and performance, which involves an exchange of energy and information between the person and the environment for regulation and control of stressors.
support system in the omaha system. the circle of friends, family, and associates that provide love, care, and need gratification; it may include church, school, workplace, or other groupings.
unit dose system a method of delivery of patient medications directly to the patient care unit. Following review by a nurse, a copy of the physician's original order is sent to the pharmacy, where the pharmacist reviews it again. The pharmacist then fills the order and delivers the medication to the patient care unit, usually in a 24-hour supply. Each patient has an individual supply of medications prepared and labeled by the pharmacist.
urinary system the system formed in the body by the kidneys. ureters. urinary bladder. and urethra. the organs concerned in the production and excretion of urine .
vasomotor system the part of the nervous system that controls the caliber of the blood vessels.
an intricate complex of interrelated cellular, molecular, and genetic components that provides a defense, the immune response, against foreign organisms or substances and aberrant native cells.
The integrated body system of organs, tissues, cells, and cell products such as antibodies that differentiates self from nonself and neutralizes potentially pathogenic organisms or substances.
a system of tissues, organs, and cells that protects the body against pathogenic organisms and other foreign bodies. The principal components of the immune system include the bone marrow, the thymus, and the lymphoid tissues. The system also uses peripheral organs, such as the lymph nodes, the spleen, and the lymphatic vessels. The immune system protects the body initially by creating local barriers and inflammation. The local barriers provide chemical and mechanical defenses through the skin, the mucous membranes, and the conjunctiva. Inflammation draws polymorphonuclear leukocytes and neutrophils to the site of injury, where these phagocytes engulf the invading pathogens. If these first-line defenses fail or are inadequate to protect the body, the humoral immune response and the cell-mediated immune response are activated. See also immune response.
An intricate complex of interrelated cellular, molecular, and genetic components, which provides a defense (immune response) against foreign organisms or substances and aberrant native cells.
that system of cells and tissues which enables vertebrate animals to create a defence mechanism against invading organisms and often allows them to establish long-lasting immunity.
The system of the body that is responsible for producing various cells and chemicals that fight off infection by viruses, bacteria, fungi, and other foreign invaders. In autoimmune disease, these cells and chemicals are turned against the body itself.
the body's protective measures against threats of damage or disease from invading antigens (micro-organisms, foreign proteins, implants or grafts) or in pathological conditions from 'self antigens' (malignant cells, healthy or damaged tissue). antibodies (immunoglobulins) are produced, each specific against a particular antigen, and circulate in the blood plasma and tissue fluids. The immune response involves interaction of antigen and antibody. See also allergy. anaphylaxis. immunity. lymphatic system.
n the group of organs, cells, and chemicals that protect the body from harmful viruses, bacteria, and abnormal cells. It includes bone marrow, proteins, the thymus, the spleen, the lymphocytes, and other white blood cells.
Intricate complex of interrelated cellular, molecular, and genetic components that provides a defense, the immune response, against foreign organisms or substances and aberrant native cells.
n a biochemical complex that protects the body against pathogenic organisms and other foreign bodies. It incorporates the humoral immune response, which produces antibodies to react with specific antigents, and the cell-mediated response, which uses T cells to mobilize tissue macrophages in the presence of a foreign body. It also protects the body from invasion by creating local barriers and inflammation. The principal organs include the bone marrow, the thymus, and the lymphoid tissues.
immune system, duality of ,
n the division of lymphocyte white blood cells into two classes of cells, types B and T. Type B cells help develop humoral immunities, while type T cells are active in cellular immunity.
1. being highly resistant to a disease because of the formation of humoral antibodies or the development of immunologically competent cells, or both, or as a result of some other mechanism, such as interferon activities in viral infections.
2. characterized by the development of antibodies or cellular immunity. or both, following exposure to antigen.
3. produced in response to antigen, such as immune serum globulin. The essential feature of antibody and cell-mediated immunity is that they are highly antigen specific.
the binding of antibody-antigen-complement complexes to complement receptors found on red blood cells.
immune complex disease
disease induced by the deposition of or association with antigen-antibody-complement complexes in the microvasculature of tissues. Fixation of complement component C3 by the complexes initiates inflammation. See also serum sickness, hypersensitivity .
immune complex reaction
immune deficiency disease
one in which animals have inadequate immune responses and so are more susceptible to infectious disease. The defect may be primary (inherited), or secondary (acquired) which usually develops after birth because of toxins or infectious agents. See also combined immune deficiency syndrome. hypogammaglobulinemia. agammaglobulinemia. inherited parakeratosis. chediak-higashi syndrome and canine granulocytopathy syndrome.
see immune-mediated hemolytic anemia (below).
immune reaction fever
aseptic fever occurring in anaphylaxis, angioedema.
the specific response to substances interpreted by the body as not-self, the result being humoral and cellular immunity. The immune response depends on a functioning thymus and the conversion of stem cells to B and T lymphocytes. These B and T lymphocytes contribute to antibody production, cellular immunity and immunological memory. See also humoral immunity .
immune response (Ir) genes
see immune response genes.
the detection by lymphocytes, especially T lymphocytes, of new antigens, particularly on tumor cells.
consists of the primary lymphoid organs (thymus and Bursa of Fabricius or its equivalent (bone marrow) in mammals) and secondary lymphoid organs (lymph nodes, spleen and other lymphoid tissue).
Patient discussion about Immune system
Q. Why does the body attack itself in autoimmune diseases? And if it’s possible - How come it doesn’t happen most of the time?
A. Some say cell-wall deficient (CWD) bacteria can live inside your cells (were apparently photographed in immune cells under electron microscope). See www. marshallprotocol. com and autoimmunityresearch. org (run by the autoimmunity research foundation). Also see bacteriality. com. I have been on the MP for just over a year. It has helped a lot of my symptoms, including lowering my TSH (thyroid) from hashimoto's thyroiditis (autoimmune thyroid condition). I hope that my thyroid will eventually regain all of it's function (still taking some thyroid hormone supplement, but less). The MP is not without "side effects," which are said to be from bacterial die-off and cell death when the bacteria are killed. It is experimental and should only be undertaken with that in mind. The marshallprotocol. com website is currently moderated by volunteers. There needs to be more research on CWD bacterial colonies and their possible role in autoimmune diseases. Please mention this to your doctor(s).
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