NAME OF DRUG
azathioprine

CLASSIFICATION

Immuno-suppressive agent
Cytotoxic agent

ALTERNATE NAME

IMURAN

INDICATIONS

• prevention of rejection of renal transplants
• prevention of rejection of heart, lung, pancreas and liver transplants (investigational)

RECONSTITUTION AND STABILITY

• stable at room temperature
• all doses of azathioprine are prepared in pharmacy and will be sent to the ward with a label indicating storage conditions and the expiry date.  All cytotoxic waste including bags, sets, tubing, gloves, etc. must be properly disposed of in the cytotoxic waste containers on the nursing unit.

COMPATIBILITY

• compatible with D5W, NS, 0.45% Saline
• incompatible with other drugs

ROUTES OF ADMINISTRATION

• IV Direct - 10 mg/mL administered over 3-5 minutes
• IV Intermittent - 1 mg/mL administered over 30-60 minutes

VH & HSC ADMINISTRATION POLICY

E - Direct IV route can be administered by nurses on general nursing units provided a venous access has been established, and according to policies and recommendations stated in this manual.

G - Cytotoxic agent - See Drug Table G for specific administration guidelines.

DOSAGE

• Begin therapy within 24 hours of transplantation
• Day of transplant:  3-5 mg/kg/24 hours

(occasionally given 1-3 days before transplant)

Maintenance dose:  1-3 mg/kg/24 hours

• Dosage must be adjusted in the presence of renal dysfunction. Contact Pharmacy for guidelines.

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

IMPORTANT IMPLICATIONS

• principle toxic effect is dose dependent bone marrow depression manifested by leukopenia, macrocytic anemia, pancytopenia and thrombocytopenia
• other adverse reactions include nausea, vomiting, hepatotoxicity, oral lesions, and skin rash
• monitor CBC and liver function tests
• observe for signs of infection or of unusual bleeding/bruising
• concomitant allopurinol administration requires a dose reduction to 1/3 or 1/4 of the usual azathioprine dose

Rev. January 2002