AZATHIOPRINE/MERCAPTOPURINE TREATMENT FOR IBD PATIENTS. Patient Information

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1 AZATHIOPRINE/MERCAPTOPURINE TREATMENT FOR IBD PATIENTS Patient Information

2 This information leaflet is designed to answer common questions patients ask about their medicine. Further information can be found in the information leaflet supplied by the manufacturer or from your pharmacist or doctor. What are they? Azathioprine and Mercaptopurine are immunosuppressant drugs used in the treatment of inflammatory bowel disease. They are often prescribed when steroids have proved insufficient in bringing the condition under control. They allow a reduction in the dose of steroids, but may take weeks or more to become effective. NB. You may see it prescribed as 6-MP, this does not mean you take 6 times the dose prescribed! How is it taken? In tablet form, daily, with or after food. The dosage will be advised by your Gastroenterology specialist team. Are there any side effects? These drugs are an important part of the treatment of patients with inflammatory bowel disease, but a small number of patients may experience side effects that will prevent them from continuing with treatment. Should you develop symptoms that might be related to your treatment you should discuss them with your Doctor/Gastroenterologist/ IBD nurse specialist. Side effects that you should look out for include: Nausea/vomiting and loss of appetite. Abdominal pain - should this develop, the drug should be stopped immediately.

3 Hair loss Adverse effects on the blood Fever, weakness and fatigue (rare) Unusual bleeding/bruising (rare) Jaundice (rare) Rashes (rare) There are no special problems for children taking these medicines. Lower doses of these drugs may be used in patients aged over 60 years, as there may be a slight increased risk of side effects. Avoid driving and hazardous work until you have learned how Azathioprine/Mercaptopurine affects you as these drugs occasionally can cause dizziness. No Known problems with alcohol. Special monitoring Whilst taking this treatment, you will need regular blood tests. Once the dose of treatment is stable, the frequency of blood testing will be reduced. The testing will be supervised by your Gastroenterology specialist team or in a shared care arrangement with your General Practitioner. Full blood count (FBC) Liver function (LFT) Some centres will also arrange a test to measure Thiopurine Methyl Transferase (TPMT) pre treatment FBC and LFT will be checked weekly for six weeks post commencement, then fortnightly until dose is stable, then monthly for six months and two to three monthly thereafter if the results are stable. Any change in dosage will require similar monitoring. You may also be asked to have tests of kidney function from time to time. It is very important that you get your blood tests done as instructed, even if you have been on the drug for years. Other information Immunisation with LIVE vaccines should be avoided. (Influenza and pneumovax can be given). Please discuss with your General Practitioner or hospital specialist team. These drugs increase your sensitivity to sunlight and so the rates of certain types of skin cancer can also be increased. To reduce this risk you should use a high factor sunscreen and/or protective clothing and avoid prolonged exposure to the sun. You should avoid sun beds. It you develop a skin lesion that doesn t heal within four weeks please see your GP. There is a slight increased risk of a rare blood cancer called Lymphoma, a cancer that begins in the cells that fight infection. The risk is still very rare, between 3-6 people out of 10 thousand people. This may be due to the severity and the action of the disease itself, the drug or a combination of both. More of these cases were in adolescent and young adults. There are also risks of not controlling your disease and we believe they outweigh the rare risk of lymphoma. Symptoms to report immediately to your doctor are: Swelling in the lymph nodes, ie: in your neck, groin or armpits, when you haven t got an active infection or virus. Persistent high fever, weight loss, night sweats, unusual or easy bruising. Other medicines that you are prescribed may interact with azathioprine or Mercaptopurine. These include drugs used to treat gout (Allopurinol), the blood thinning treatment warfarin and certain antibiotics (Co-Trimoxazole and Trimetheroprim). You should discuss these with your doctor.

4 Special precautions Drugs like Azathioprine/Mercaptopurine can make you particularly vulnerable to infection; seek medical attention promptly if you think you have an infection. Try to avoid contact with infections such as chicken pox or measles. If you come into contact with chicken pox or shingles, and have not had chicken pox (or been vaccinated) yourself, then inform your doctor immediately. A blood test may be required to assess your immunity; if you are not immune, you may be offered specific immunoglobulin, or other treatment, to protect you against severe infection. Keep all medicines out of the reach of children. Never give any medication prescribed for you to anyone else. It may harm them even if their symptoms are the same as yours. For further information you can contact your IBD Nurse Specialist or Gastroenterology Specialist. Likewise, if you have not had MMR (or MR vaccine) and come into contact with a suspected case of measles, then you should seek advice from your doctor. Azathioprine/Mercaptopurine in pregnancy and breast feeding? Although the manufacturers of Azathioprine and Mercaptopurine advise avoiding in pregnancy (due to low birth, pre term delivery), there is now considerable data suggesting it is relatively safe. In Gastroenterology we advise keeping patients on these drugs as the risks of flare up (to mother and foetus) are higher than the risk of the drug. This recommendation comes from the national body, British Society of Gastroenterology. Breast feeding is generally not advised but emerging evidence suggests there is very little exposure to the infant. Please discuss this if needed with your consultant. The literature with respect to safety of Thiopurines in men whose partners are planning to conceive is mixed. Data and clinical experience suggest that the drug is safe in this context, although an increased risk of malformations have reported in other series.

5 PATIENT SERVICES DEPARTMENT It is important that you speak to the department you have been referred to (see the contacts section) if you have any questions (for example, about medication) before your investigation or procedure. If you are unhappy about the service you have received and would like to talk about it or make a formal complaint, please contact Patient Advice and Liaison Service on If you have a complaint and you want it to be investigated, you should write direct to the Chief Executive at Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester WR5 1DD or contact the Patient Services Department for advice. Please contact the Patient Services on if you would like this leaflet is another language or format (such as Braille or easy read). Bengali Urdu Portuguese Polish Chinese WR2042 Version 1 - Issued June 2010 WAHT-CG-553

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