Azathioprine or 6-mercaptopurine

Why has my child been started on azathioprine or 6-mercaptopurine?

Azathioprine and 6-mercaptopurine are medicines designed to help induce and maintain remission of your child’s inflammatory bowel disease or auto-immune hepatitis. Your child has been started on this medicine because they need a medication which they can take long-term to help keep them well.

How do azathioprine and 6-mercaptopurine work?

Both medicines work in a similar way. They are called immunosuppressants, so they dampen down the immune system. Our immune systems helps us fight off infection but sometimes our immune system attacks its own tissue. This medication should stop your child’s immune system attacking itself but it can leave them slightly more susceptible to developing infections such as chest infection, coughs, colds and so on.

How quickly will azathioprine and 6-mercaptopurine take to make my child feel better?

These medicines do not work instantly and you should be prepared that you may not see any improvement for around 6 to 12 weeks.

How does my child take azathioprine or 6-mercaptopurine?

This medicine has to be taken by the mouth and comes in tablet or as syrup. It is recommended that you give your child this medicine after food with plenty of water. If you miss a dose of azathioprine or 6-mercaptopurine and are due to take their next dose, do not take the missed dose. You must not double up doses.

Where can I get the azathioprine and 6-mercaptopurine from?

These medications can only be prescribed by a doctor who has specialist training and experience in the care of patients with inflammatory bowel disease (IBD) or liver disease and are not usually available from your GP.

You will need to contact the gastro nurses at least a week before you run out of medication to order a repeat prescription. You will then be able to collect the medication from Rowlands Pharmacy at Sheffield Children’s.

If you live outside of Sheffield we can post a paper prescription to your home address for you to take to your local pharmacy so that they can dispense your medication.

Please be aware that for your safety we can only issue repeat prescriptions if your blood tests are up to date.

What monitoring do I need when taking azathioprine or 6-mercaptopurine?

Before your child starts taking azathioprine or 6-mercaptopurine, your doctor will need to do some extra blood tests to identify how likely they are are to suffer with adverse side effects. This blood test is known as detecting your TPMT level.

For the first 4 weeks, your child need to attend either your GP, local hospital or the blood labs at Sheffield Children’s every week to have a blood test.

After 4 weeks, if their blood tests are stable, they can be done monthly, and then once every 3 months when they have their optimum dose.

It is very important that you inform the gastro nurses when your child has had their blood test done, so the results can be checked. The usual blood test that are requested are full blood count (FBC), liver function tests (LFT), urea and electrolytes (U&E), amylase, ESR and CRP. You will be given a month’s supply of blood forms initially and will need to contact the gastro nurses when you need more blood forms.

What are the side effects of Azathioprine and 6-Mercaptopurine?

Unfortunately, all medicines have side effects. Some patients may suffer with several symptoms while others may not experience any of them at all. The symptoms to look out for include:

• dizziness
• hair loss
• skin rashes
• nausea and vomiting
• flu-like symptoms
• fever
• generally feeling unwell
• bruises
• bleeding easily
• tummy pain
• worsening diarrhoea
• increased sensitivity to the sun

Recent research has found that in patients using azathioprine and 6-mercaptoipurine, there is a slightly higher risk of developing cancer of the lymph glands. However, for the large majority of patients who safely take azathioprine and 6-mercaptopurine, the risks are very small and the benefits of the medication outweigh the negatives.

Is there anything I can do to stay as healthy as possible?

It is a good idea to try and stay away from people who already have or are suspected to have an infection such as those with chicken pox, measles virus, anyone with flu-like symptoms and so on.

If your child has not had chicken pox, you must inform the doctor straight away.

Patients on azathioprine and 6-mercaptopurine must avoid live vaccines such as polio, yellow fever, rubella, BCG and MMR. There is an inactivated form of polio that can be safely administered if necessary.

It is also advisable to have the annual winter flu vaccine. You will need to have the inactivated (dead) form of the vaccine via your GP.

Azathioprine and 6-Mercaptopurine can make skin more sensitive when exposed to the sun so a high level protection sun screen should be used.