Azathioprine: Adverse Reactions and Hematological Monitoring in Long-Term Immunosuppressant Therapy

Middle-aged Hispanic doctor in his medical office, reviewing hematological data on a computer. Dressed in a white coat and glasses, symbolizing careful attention in managing azathioprine therapy and monitoring for myelosuppression and hepatic toxicity.

Azathioprine is a widely used immunosuppressant in the treatment of autoimmune diseases and in the prevention of transplant rejection. However, its long-term use requires meticulous attention due to its potential adverse reactions, particularly concerning myelosuppression and hepatic toxicity. This article explores the complications associated with azathioprine and emphasizes the importance of hematological monitoring in prolonged therapies.

Adverse Reactions and Monitoring

As an antimetabolite, azathioprine can induce myelosuppression, leading to an increased risk of infections and other hematological complications. Studies have shown that genotyping enzymes such as thiopurine methyltransferase (TPMT) and NUDT15 is crucial for predicting hematological toxicity in patients treated with azathioprine. Identifying polymorphisms in these genes allows for dose adjustments and minimizes adverse effects.

Furthermore, regular hematological monitoring is essential to detect changes in hematological indices, such as white blood cell count and mean corpuscular volume, which may indicate toxicity. The monitoring of active metabolites can also be beneficial for adjusting therapy and enhancing treatment safety.

Conclusions

The use of azathioprine in long-term therapies necessitates constant vigilance to prevent and manage its adverse reactions. Hematological monitoring and genotyping are valuable tools for optimizing therapy and minimizing the risks of myelosuppression and hepatic toxicity. Implementing these strategies can significantly improve the safety and efficacy of azathioprine treatment.

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Created 6/1/2025