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This leaflet provides information on azathioprine and will answer any questions you have about the treatment.Arthritis Research UK produce and print our booklets entirely from charitable donations.
Azathioprine is a type of drug known as a disease-modifying anti-rheumatic drug, or DMARD. These drugs have the effect of dampening down the underlying disease process, rather than simply treating symptoms. Azathioprine reduces the activity of the immune system (the body's own defence system), so it's always used with care.
At a glance
What type of drug is
How is it taken?
azathioprine (trade
It's usual y given as tablets, name Imuran)?
taken once or twice daily. The Azathioprine is a disease- dose depends on your weight, modifying anti-rheumatic but usual y starts at 50 mg and drug (DMARD).
is increased to 100–200 mg.
What does it do?
Are there any
It reduces the activity of the body's defence system In some patients azathioprine (immune system).
can cause nausea (feeling sick), vomiting, diarrhoea, What is it used for?
loss of appetite, hair loss and It's used to treat several skin rashes. It can also make different types of rheumatic you more likely to develop disease, including systemic infections. It can affect the liver lupus erythematosus (SLE), or blood so that you need to rheumatoid arthritis and have regular blood tests while other autoimmune and you're taking it.
Some side-effects
When and how do I take
can be reduced by
taking azathioprine
Azathioprine is taken in tablet form with food or last
either once or twice a day. It's usually
taken with or after food.
thing at night.
Your doctor will advise you about the correct dose. Usually you'll start on a low dose (e.g. 50 mg per day) and your doctor may increase this if necessary. The dose you're given will depend on your body weight, but is usually between 100 mg and 200 mg.
Why is azathioprine prescribed?
How long does azathioprine
Azathioprine is used to treat several different types of rheumatic disease, Azathioprine doesn't work immediately. including systemic lupus erythematosus It may be 6–12 weeks before you notice (SLE), rheumatoid arthritis and other any benefit.
autoimmune and inflammatory diseases.
Your doctors may also prescribe it if you're on steroid treatment so that your steroid dose can be reduced.
Record your dosage here to help you manage your treatment:
How many?
How often?
What are the possible
You may need antiviral treatment, which your doctor will be able to prescribe. If you develop chickenpox Azathioprine can cause nausea (feeling or shingles, you should contact your sick), vomiting, diarrhoea, loss of appetite doctor or nurse specialist immediately (this may be alleviated by taking with to discuss whether you need to stop food or last thing at night), hair loss and your azathioprine temporarily. There's a slightly increased risk of certain Taking azathioprine can affect the blood types of cancer with azathioprine. You count (one of the effects is that fewer should discuss this with your doctor.
blood cells are made) and can make you more likely to develop infections. It can also affect your liver. You should tell your What are the risks?
doctor or nurse specialist straight away Will it affect vaccinations?
if you develop any of the following after starting azathioprine: If you're on azathioprine it's recommended that you avoid live • a sore throat
vaccines such as yellow fever. However, • a fever
in certain situations a live vaccine may • any other symptoms of infection
be necessary (for example rubella vaccination in women of childbearing unexplained bruising or bleeding age), in which case your doctor will • jaundice (eyes or skin turning yellow)
discuss the possible risks and benefits • any other new symptoms or anything
of the vaccination with you.
else that concerns you.
Pneumovax (which gives protection against the commonest cause of What should I look out for?
pneumonia) and yearly flu vaccines You should stop azathioprine and see don't interact with azathioprine your doctor immediately if: and are recommended.
• any of the symptoms listed above
Can I drink alcohol while
• you haven't had chickenpox and you
come into contact with someone who You should only drink alcohol in small has chickenpox or shingles amounts because azathioprine and alcohol can interact and damage your you develop chickenpox or shingles.
liver. You should discuss this with Chickenpox and shingles can be severe your doctor.
in people on treatments that affect the immune system such as azathioprine. What else should I know
reducing the
activity of your
Are there any alternatives?
A number of other drugs are used in
the treatment of rheumatoid arthritis and related conditions. Your doctor and rheumatology nurse specialist will discuss these other options with you.
Will I need any special checks
while on azathioprine?
Your doctor may order a test called TPMT
Does azathioprine affect fertility
to find out whether you have adequate levels of this enzyme, which is used to remove azathioprine from the body. You shouldn't normally take azathioprine Low levels of this enzyme could mean when pregnant. If you're planning a you're at more risk of side-effects.
family or become pregnant while taking azathioprine, you should discuss this Because azathioprine can affect the blood with your doctor as soon as possible. count and can sometimes cause liver However, azathioprine is safer than many problems, your doctor wil arrange for other drugs during pregnancy because you to have a blood test before you start it's not activated in the baby's circulation. treatment and then regular blood checks This means that in necessary situations while on azathioprine. You may be asked your doctor may decide to continue the to keep a record of your blood test results medication because it's important for the in a booklet, and you should take it with mother's health to be kept at the best you when you visit your GP or the hospital.
possible level during pregnancy. You must not take azathioprine unless Does it affect breastfeeding?
you're having regular blood checks.
Azathioprine may pass into the breast milk. The decision whether or not to Can I take other medicines
breastfeed on azathioprine should be discussed with your doctor or nurse Azathioprine may be prescribed along specialist. Though in the past doctors with other drugs in treating your were very cautious about this, more condition. Some drugs interact with recent evidence suggests that it is safe. azathioprine (e.g. allopurinol, used in the Many mothers find they can breastfeed treatment of gout), so you should discuss safely on azathioprine.
any new medications with your doctor before starting them, and you should always tell any other doctor treating you
that you're on azathioprine. You should
also be aware of the following points:
• Azathioprine is not a painkiller.
If you're already on a non-steroidal
anti-inflammatory drug (NSAID)
or painkillers you can carry on taking
these as well as azathioprine, unless
your doctor advises otherwise.
• Do not take over-the-counter
preparations or herbal remedies
without discussing this first with your
doctor, rheumatology nurse specialist
or pharmacist.
Where can I get more
information?
Arthritis Research UK is the charity
leading the fight against arthritis.
We do this by funding high-quality
research, providing information
and campaigning. We publish over
60 information booklets which help
people to understand more about their
condition, its treatment, therapies and
how to help themselves.
If you would like any further information about azathioprine, or if you have any concerns about your treatment, you should discuss this with your doctor, rheumatology nurse specialist or pharmacist. You can help to take the pain away
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A team of people contributed to this booklet. It was Arthritis Research UK
written by Dr Ariane Herrick, who has expertise in the subject. It was assessed at draft stage by clinical nurse Copeman House, St Mary's Court, specialist Sue Brown, consultant rheumatologist Prof. St Mary's Gate, Chesterfield, Bhaskar Dasgupta and lead rheumatology educator Kate Derbyshire S41 7TD Gadsby. An Arthritis Research UK editor revised the text
to make it easy to read, and a non-medical panel, including
interested societies, checked it for understanding.
Tel 0300 790 0400
An Arthritis Research UK medical advisor, Prof. Anisur
Rahman, is responsible for the content overall.
calls charged at standard rate Please note: We have made every effort to ensure
that this content is correct at time of publication, but
remember that information about drugs may change.
This information sheet is for general education
only and does not list all the uses and side-effects
associated with this drug. For full details please see the
drug information leaflet that comes with your medicine.
Registered Charity No 207711 Your doctor will assess your medical circumstances and Arthritis Research UK 2011 draw your attention to any information or side-effects Published September 2011 2243/D-AZA/11-1 that may be relevant in your particular case.
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Source: http://www.pmskp.org/wp-content/uploads/2012/02/Azathioprine.pdf
The skinless work group: facing the uncertainty of resting on a void
International Journal of Applied Psychoanalytic StudiesInt. J. Appl. Psychoanal. Studies (2015)Published online in Wiley Online Library(wileyonlinelibrary.com) DOI: 10.1002/aps.1430 The Skinless Work Group: Facingthe Uncertainty of "Restingon a Void" MATÍAS SANFUENTES This paper examines the conflicts and resistances that contemporary organizationsface in the effort of generating new and challenging work opportunities. Assumingthe metaphoric and real character of the ‘body of the organization', differentdilemmas that work groups tackle in the generation of collaborative and productivespaces are described. Based on a socioanalytic consultancy carried out with agroup of Reichian body psychotherapists, the study illustrates the complexities todelineate a common strategy and to overcome the threatening porosity and incon-sistencies of the ‘institutional skin'. The lack of a body support is particularlyparadoxical for a group of psychotherapists that base their therapeutic method onbody techniques, and which crystallizes as an institution the place of rejectionand exclusion that Reich and the concern for the body have historically occupied.Copyright © 2015 John Wiley & Sons, Ltd.
Bjo_2016 569.576
Ear acupuncture or local anaesthetics as pain reliefduring postpartum surgical repair: a randomisedcontrolled trial S Kindberg,a,c L Klu¨nder,b J Strøm,a TB Henriksenc a Department of Research and Medical Education and b Department of Obstetrics and Gynaecology, Sønderborg Hospital, Denmarkc Perinatal Epidemiology Research Unit, Department of Obstetrics and Gynaecology, Aarhus University Hospital, Skejby, DenmarkCorrespondence: S Kindberg, Perinatal Epidemiology Research Unit, Aarhus University Hospital, Skejby, 8200 Aarhus North, Denmark.Email [email protected]