Appropriate azathioprine dosage can depend on a patient’s condition, any underlying medical issues, and weight. This potent immunosuppressive drug must be used with care, as it can present significant risks to the patient. While on azathioprine, a patient may need to agree to regular blood tests and other monitoring to check for complications and adverse side effects. If a patient does develop a reaction to the drug, a care provider may terminate therapy or discuss available alternatives with the patient to determine how to proceed.
One consideration is why the patient needs the medication. It can be used to prevent transplant rejection, treat rheumatoid arthritis, and manage some autoimmune diseases like Crohn’s disease. The recommended doses vary depending on the use. With transplants, patients may need a high loading dose followed by a lower maintenance dose. Other patients start on a low azathioprine dosage which can be slowly increased to find the lowest possible dose that generates a response, with the goal of limiting side effects.
Care providers may need to consider potential contraindications or interactions with azathioprine dosage. One concern is renal instability. Patients with poor kidney health cannot process this medication as safely and efficiently as others, and may need a lower dose to compensate for this. The drug can also interact with other medications, which may need to be adjusted or terminated for azathioprine therapy.
The patient’s weight is used to determine the appropriate azathioprine dosage, which is calculated in milligrams per kilogram. Rather than being offered a standard generic dose of, for example, 50 milligrams daily, the dose needs to be carefully calculated for best results. Appropriate azathioprine dosage can range between 0.5 and 5 milligrams per kilogram daily or twice daily. Doses above three milligrams per kilogram are usually recommended only for a loading dose at the start of therapy, and not for sustained use, because they can be risky.
Side effects on azathioprine can vary, but may include the development of neoplasms. Immune function must be carefully monitored while on any azathioprine dosage. Patients also should to be careful about exposure to potentially infectious agents, because their weakened immune systems will be less able to fight infections. Even common diseases that usually don’t cause severe illness can be dangerous to those with compromised immune systems. If routine testing shows that a patient’s immune function has dropped particularly low, it may be necessary to enter isolation to give the immune system a chance to recover.