Generic Imuran (Azathioprine)

Introduction

Imuran (azathioprine) is an immunosuppressive medication prescribed primarily for autoimmune disorders and for preventing organ-rejection after transplantation. The active compound, azathioprine, is supplied in oral tablet form in two strengths-25 mg and 50 mg. It belongs to the class of antimetabolite immunosuppressants. Imuran is marketed under brand names such as Imuran and Azasan and is manufactured by Roche and several licensed generic producers. In addition to its approved uses, clinicians sometimes employ azathioprine for off-label indications supported by peer-reviewed evidence, although such practices require careful supervision.

What is Imuran?

Imuran is the commercial formulation of the synthetic purine analogue azathioprine. Developed in the s, azathioprine was the first widely used oral immunosuppressant and laid the groundwork for later agents such as mycophenolate and tacrolimus. Roche introduced Imuran as a branded product, and it is now available from multiple manufacturers as a generic tablet.

Imuran is the generic version of well-known medications, containing the active compound azathioprine. Our online pharmacy provides this generic alternative as a cost-effective treatment option.

How Imuran Works

Azathioprine is a pro-drug that is converted in vivo to 6-mercaptopurine (6-MP) and then to thioguanine nucleotides. These metabolites integrate into cellular DNA and RNA, inhibiting the synthesis of purine nucleotides. The result is a reduction in the proliferation of rapidly dividing cells, especially activated T- and B-lymphocytes. By dampening lymphocyte activity, azathioprine suppresses the immune response that drives inflammation and graft rejection.

Typical onset of immunosuppression occurs within 1-2 weeks, but full therapeutic effect may require 4-8 weeks of consistent dosing. The drug is metabolized primarily by hepatic enzymes (thiopurine methyltransferase, TPMT) and cleared renally; patients with low TPMT activity are at higher risk of myelosuppression.

Conditions Treated with Imuran

• Organ transplantation (kidney, liver, heart): Prevents acute and chronic rejection by attenuating T-cell mediated immune attacks on the graft.
• Rheumatoid arthritis (moderate-to-severe): Used when disease-modifying antirheumatic drugs (DMARDs) alone are insufficient, reducing joint inflammation and structural damage.
• Systemic vasculitis (e.g., granulomatosis with polyangiitis): Suppresses the vasculitic process, helping to preserve organ function.
• Inflammatory bowel disease (Crohn’s disease and ulcerative colitis): Maintains remission by controlling aberrant intestinal immune activity.

In each of these conditions, the drug’s ability to limit lymphocyte proliferation translates into decreased tissue injury and improved clinical outcomes.

Off-Label and Investigational Uses of Imuran

• Systemic lupus erythematosus (SLE): Small-scale trials and observational studies suggest azathioprine can reduce flare frequency when used alongside steroids.
• Autoimmune hepatitis: Evidence from randomized controlled trials indicates azathioprine, combined with corticosteroids, improves biochemical remission rates.
• Uveitis and ocular inflammatory disorders: Retrospective case series report reduced recurrence of intra-ocular inflammation with azathioprine therapy.
• Dermatologic autoimmune conditions (e.g., pemphigus vulgaris, dermatomyositis): Clinical reports demonstrate benefit in disease control when conventional agents are inadequate.

These applications have not received formal approval from the U.S. Food and Drug Administration (FDA) or the European Medicines Agency (EMA). Patients should only consider off-label use under direct supervision of a qualified healthcare provider, who can weigh the limited evidence against potential risks.

Is Imuran the Right Medication for You?

Imuran is most appropriate for adults who require long-term immunosuppression and who have demonstrated tolerance to other DMARDs or antimetabolites. It is commonly selected when:

• A solid-organ transplant recipient needs maintenance therapy beyond the immediate postoperative period.
• A rheumatoid arthritis patient has an inadequate response to methotrexate or biologics and seeks an oral alternative.
• A gastroenterologist requires a steroid-sparing agent for chronic inflammatory bowel disease.

Contraindications include:

• Known hypersensitivity to azathioprine or any tablet excipients.
• Severe hepatic impairment (Child-Pugh C).
• Active, uncontrolled infection (including hepatitis B/C, HIV, or tuberculosis).
• Pregnancy (category D) unless benefits outweigh fetal risks; teratogenicity has been reported.

Patients with a documented TPMT deficiency should avoid azathioprine because of a markedly increased risk of bone-marrow suppression.

Risks, Side Effects, and Interactions

Common

• Nausea, vomiting, or abdominal discomfort.
• Fatigue or mild headache.
• Transient leukopenia (especially during the first few weeks).

Rare

• Pancreatitis (often presenting as epigastric pain radiating to the back).
• Skin rash or photosensitivity.
• Elevated liver enzymes (ALT, AST) without overt hepatitis.

Serious

• Myelosuppression: Severe neutropenia, anemia, or thrombocytopenia can predispose to life-threatening infections or bleeding.
• Hepatotoxicity: Acute or chronic liver injury, potentially progressing to fibrosis.
• Increased risk of malignancy: Long-term immunosuppression is associated with a modest rise in lymphoproliferative disorders and skin cancers.
• Infections: Reactivation of latent viruses (e.g., herpes zoster, cytomegalovirus) and opportunistic infections.

Drug-drug interactions

• Allopurinol or febuxostat: Inhibit xanthine oxidase, leading to markedly increased azathioprine plasma levels and heightened myelosuppression; dose reduction of azathioprine to one-quarter of the usual amount is recommended.
• Warfarin: Azathioprine may potentiate anticoagulant effect; INR should be monitored more frequently.
• Live vaccines: Immunosuppressed patients should avoid live attenuated vaccines (e.g., varicella, yellow fever) while on azathioprine.
• Rifampin and other enzyme inducers: May lower azathioprine concentrations, reducing efficacy.

Food and lifestyle considerations

• Alcohol intake should be limited, as it can exacerbate hepatotoxicity.
• Adequate folic acid supplementation (≥1 mg daily) may mitigate some hematologic toxicity, especially when combined with other antimetabolites.

Use: Dosing, Missed Dose, Overdose

Standard dosing

• Initial dose: 1-3 mg/kg body weight per day, divided into a single daily tablet.
• Maintenance dose: Typically 1-2 mg/kg per day; many clinicians target 2 mg/kg for transplant recipients and 1 mg/kg for rheumatologic conditions.
• Tablets are available in 25 mg and 50 mg strengths; dosing is adjusted by counting whole tablets to achieve the prescribed mg amount.

Missed dose

• If a dose is forgotten and more than 12 hours have elapsed, take the missed tablet immediately and then continue with the regular schedule.
• Do not double-dose to compensate for a missed tablet, as this may increase toxicity.

Overdose

• Symptoms may include severe nausea, vomiting, diarrhea, and profound bone-marrow suppression.
• Patients suspected of overdose should seek immediate medical attention; treatment may involve gastric lavage, activated charcoal, and supportive care (e.g., granulocyte colony-stimulating factor for neutropenia).

Practical administration tips

• Imurin tablets can be taken with food or on an empty stomach; food may lessen gastrointestinal upset.
• Avoid alcohol and refrain from operating heavy machinery until you know how the medication affects you, especially during the titration phase.

FAQ

• Can I travel internationally while taking Imuran?

  • Yes, but you should carry a copy of the prescribing information and a letter from your clinician confirming the medical necessity. Some countries require documentation for immunosuppressive agents at customs.

• Do I need to store Imuran in the refrigerator?

  • No refrigeration is required. Store the tablets at room temperature, away from direct sunlight and moisture, and keep them in the original blister pack until use.

• What inactive ingredients are in the 25 mg and 50 mg tablets?

  • Common excipients include lactose monohydrate, microcrystalline cellulose, magnesium stearate, and hydroxypropyl methylcellulose. Patients with lactose intolerance should discuss alternatives with their pharmacist.

• Will Imuran affect standard drug testing (e.g., workplace urine screens)?

  • Azathioprine is not typically screened for in routine occupational drug tests and does not produce false-positive results for common illicit substances.

• Is it safe to receive the flu vaccine while on Imuran?

  • Inactivated influenza vaccines are considered safe and are recommended for immunosuppressed patients; however, the vaccine’s efficacy may be reduced.

• How long does it take for blood counts to normalize after stopping Imuran?

  • Hematologic recovery usually occurs within 2-4 weeks after discontinuation, but the exact timeline depends on the duration of therapy and the degree of suppression.

• Can I take Imuran with herbal supplements like echinacea?

  • Echinacea may stimulate immune activity and could theoretically counteract azathioprine’s immunosuppressive effect. Discuss any herbal products with a qualified health professional before combining them.

• What should I do if I develop a persistent skin rash while on Imurin?

  • Report the rash to your clinician promptly. While many rashes are mild, a severe or spreading eruption could signal an allergic reaction or an early sign of photosensitivity.

• Are there special considerations for elderly patients?

  • Older adults often have reduced renal and hepatic reserve, which can increase the risk of azathioprine toxicity. Dose adjustments and more frequent laboratory monitoring are typically advised.

• How does TPMT testing influence my treatment plan?

  • TPMT (thiopurine methyltransferase) genotype or phenotype testing identifies patients with low enzymatic activity who are at high risk for myelosuppression. Those with deficient TPMT may require a reduced dose (often ≤25 % of the standard dose) or an alternative therapy.

Glossary

Immunosuppressant

A medication that weakens or modulates the immune system, reducing its ability to attack the body’s own tissues or a transplanted organ.

Thiopurine methyltransferase (TPMT)

An enzyme that metabolizes azathioprine and related drugs; genetic variations can affect drug safety and dosing.

Myelosuppression

Decreased production of blood cells (red cells, white cells, platelets) by the bone marrow, often manifested as anemia, neutropenia, or thrombocytopenia.

Off-label use

Prescription of a medication for an indication, age group, or dosage that has not received formal regulatory approval.

Buying Imuran from Our Online Pharmacy

Patients who need azathioprine but face limited local availability, high out-of-pocket costs, or privacy concerns can obtain Imuran through our online pharmacy. We source the medication exclusively from licensed, internationally accredited suppliers, ensuring that every tablet meets stringent quality standards and reflects the original formulation.

• Affordable pricing: Our procurement model keeps prices close to manufacturer cost, providing a cost-effective alternative to retail pharmacy mark-ups.
• Verified quality: All batches undergo third-party testing for purity, potency, and compliance with pharmacopeial specifications before shipment.
• Discrete delivery: Orders are packaged in unmarked parcels and shipped via reputable carriers, with tracking options that protect your confidentiality. Typical delivery times are 7 days for express service or 2-3 weeks for standard airmail, depending on destination.
• Global access: As a pharmacy broker service, we work with overseas licensed pharmacies, enabling patients in regions with restricted formularies to obtain the medication legally and safely.

By choosing our platform, you gain a reliable, secure channel for obtaining Imuran without compromising on safety or privacy.

Disclaimer

The information presented about Imuran is intended for general educational purposes only and should not replace professional medical advice. All therapeutic decisions, including those concerning off-label applications, must be made under the direct supervision of a qualified healthcare provider. Readers are presumed to be responsible adults capable of making informed health choices. Our online pharmacy provides access to Imuran for individuals who may encounter limited availability through conventional pharmacies or insurance programs, or who seek a more affordable generic option. Always consult a qualified clinician before initiating, modifying, or discontinuing any medication.