Talk:Azathioprine

What do we mean by Safe?
Stating a drug as being safe is an overly generalised and inappropriate comment. Indeed this drug may be associated with increased cancer risk and has been known to cause Hepatic VOD. It carries with it some risks vis-à-vis reproduction. I doubt if the normal reader would consider "safe" the appropriate word, certainly as a clinical scientist I do not. It would be more appropriate to view these issues in terms of cost to benefit analysis.

Given the use of this wording I doubt the objectiveness of the perspective of this article, thus I removed the word safe to allow the reader, given the side-effects listed and those mentioned here, to draw their own conclusions. SMSIRL 02:23, 12 May 2006 (UTC)

Mergefrom suggestion (Imuran)
My understanding is that in most cases stand-alone articles for brands of drugs for which there is a generic article aren't encouraged. My reading of the content of Imuran suggests there isn't much specifically about the brand vs. the substance in that stub-article. I'll leave it to a second- or third-opinion to actually enact or approve the merger. Regards, --User:Ceyockey ( talk to me ) 16:08, 3 December 2006 (UTC)

Side effects
"Side effects are uncommon, but include nausea, HA and rash."

What is HA? Harksaw 18:31, 1 October 2007 (UTC)

--- i was wondering the same thing - headache???? Woood 14:31, 2 October 2007 (UTC)
 * I'm guessing "HA" might mean uncontrollable laughter? — Preceding unsigned comment added by 50.47.16.42 (talk) 03:12, 25 March 2012 (UTC)

IBD
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2036.2008.03732.x large series in IBD. JFW | T@lk  13:41, 15 May 2008 (UTC)

Drug Interactions
Azathioprine appears to be a potent antagonist of warfarin and may be hazardous to patients with an underlying hypercoaguable state. --lbeben 01:48, 23 November 2008 (UTC) —Preceding unsigned comment added by Lbeben (talk • contribs)

Error in image
The image in the Azathioprine article says HC3 when it should say H3C. I don't know how to edit the image so could someone who know how to do that correct it? Thanks. HowardRubin (talk) 03:43, 7 September 2009 (UTC)

Use in cases of eczema / atopic dermatitis
This information might be added to this article.

In the spring of 2006 researchers reported on a study funded by the British Skin Foundation (Dr. Simon Meggitt, Royal Victoria infirmary & Prof. Nick Reynolds, Newcastle University) that azathioprine holds great promise for the treatment of moderate to severe eczema and atopic dermatitis. As a result of this study and other anecdotal evidence in the 40 year history of azathioprine use, the (British) National Eczema Society now lists azathioprine as a third-line treatment for severe to moderate cases of these skin diseases.

S. Meggitt, J. Gray, N. Reynolds Azathioprine dosed by thiopurine methyltransferase activity for moderate-to-severe atopic eczema: a double-blind, randomised controlled trial The Lancet, Volume 367, Issue 9513, Pages 839-846, 2006.

S. Brown, N.J. Reynolds Atopic and non-atopic eczema British Medical Journal, Issue 332, Pages 584-588, 2006.

--Symmerhill (a.k.a. Summerhill) (talk) 19:52, 27 October 2009 (UTC)

Pronunciation
How do you pronounce "Azathioprine"? is it AY-zuh-THIGH-oh-preen or uh-ZATH-ee-oh-preen or something else? nohat (talk) 21:47, 21 May 2010 (UTC)
 * I've added the pronunciation as per John C. Wells's Long Pronunciation Dictionary: AZ-uh-THIGH-oh-preen. +Angr 16:25, 23 May 2010 (UTC)
 * But on medline plus it's AY-za-THYE-oh-preen...--Jsjsjs1111 (talk) 08:03, 27 June 2012 (UTC)

why so many side effects?
It's unbalanced.--Jsjsjs1111 (talk) 01:32, 17 May 2012 (UTC)

GA
I'm thinking of working this into a GA during the holiday...any advice?--Jsjsjs1111 (talk) 14:35, 20 June 2012 (UTC)
 * We need page numbers for the AHFS in ref number one. I have filled in some data in the drug box and organized per WP:MEDMOS Doc James  (talk · contribs · email)(please leave replies on my talk page) 20:15, 22 June 2012 (UTC)
 * I only have the 2008 one...I'll use that one instead.--Jsjsjs1111 (talk) 20:46, 22 June 2012 (UTC)
 * Sure no worries. Is it similar to the online version? http://www.drugs.com/monograph/Azathioprine.html Doc James  (talk · contribs · email)(please leave replies on my talk page) 20:59, 22 June 2012 (UTC)
 * Yes it is similar. The problem is, the one I have in eletronic from is without any page numbers, but only with section name (92:44)--Jsjsjs1111 (talk) 21:23, 22 June 2012 (UTC)

Missing sections?
Could you have a look at the sections list at WP:MOSMED? The contraindications and pharmacokinetics sections seem to be missing, as well as information on chemical and physical properties (ideally including synthesis). I'll try to add something when time allows, but don't rely on me. Cheers, ἀνυπόδητος (talk) 08:58, 23 June 2012 (UTC)
 * For contraindications it's already included in Adverse effects section. I'm trying to look for chemical part.--Jsjsjs1111 (talk) 12:27, 23 June 2012 (UTC)
 * Synthesis added.--Jsjsjs1111 (talk) 15:20, 23 June 2012 (UTC)

File:AZA metabolism.svg
Vectorised File:AZA metabolism.svg and added structures. Could somebody tell me what 6-MMP is so that I can add it? And shouldn't the compound at the right be thioguanosine monophosphate? --ἀνυπόδητος (talk) 11:56, 23 June 2012 (UTC)
 * Thanks a lot! I've added what 6-MMP is.--Jsjsjs1111 (talk) 12:20, 23 June 2012 (UTC)
 * Thanks! I'll update the image, and also add a bit more on kinetics to the article. By the way, thanks for your work here and for your GA nomination. Hope the article makes it! --ἀνυπόδητος (talk) 13:48, 23 June 2012 (UTC)

Indications
At the moment there's a massive imbalance between "indications" and "adverse events". There are loads of articles that discuss clinical uses of azathioprine in particular disease states, such as IBD, SLE and such. At the very least I would recommend listing Cochrane reviews of its use.

There are professional recommendations for the regular monitoring of the blood count during treatment. These may need to be listed. JFW &#124; T@lk  23:25, 23 June 2012 (UTC)
 * Yes it's unbalanced, I'll try to fix that.--Jsjsjs1111 (talk) 05:02, 24 June 2012 (UTC)
 * Is it necessary to list out information about azathioprine used in all autoimmune diseases?--Jsjsjs1111 (talk) 07:10, 27 June 2012 (UTC)

Section "Kidney transplantations"
Thanks, ἀνυπόδητος (talk) 22:06, 27 June 2012 (UTC)
 * Can you tell whether radiotherapy for transplant rejection is really used in clinics, or was this just an experiment years ago?
 * "It is administered either at the time of antigenic stimulation or within the following two days." What does that mean? AZA has to be taken as long as the allograft lives, not just a day or two.
 * radiation is used, but not very often. The administration starts either at the time of antigenic stimulation or within the following two days. Thanks!--Jsjsjs1111 (talk) 23:16, 27 June 2012 (UTC)

More on pathway/mechanism
--ἀνυπόδητος (talk) 18:52, 30 August 2012 (UTC)
 * http://pathman.smpdb.ca/pathways/SMP00427/pathway?level=3
 * Strangely, this is the only source that claims AZA → 6-MP is enzymatic.
 * http://www.nature.com/nrc/journal/v8/n1/fig_tab/nrc2292_F2.html

major changes
Please follow MOS:MED when you change it, thanks.--Jsjsjs1111 (talk) 12:15, 9 September 2012 (UTC)

more on mechanism

 * --Jsjsjs1111 (talk) 12:49, 9 September 2012 (UTC)

External links modified
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Error in metab diagram under Pharmacology
There is an error in the metabolism diagram; the 5-carbon cycloalkanes should be riboses. Also, it may be helpful to include glutathione's role in the non-enzymatic reduction of AZA to 6-MP. ― Bio chemistry 🙴 ❤   03:16, 10 November 2017 (UTC)
 * Fixed. Thanks for catching this! --ἀνυπόδητος (talk) 09:22, 13 November 2017 (UTC)
 * You're welcome; thanks for fixing that!― Bio chemistry 🙴 ❤   18:37, 16 November 2017 (UTC)

now fixed 64.112.182.1 (talk) 16:06, 10 March 2021 (UTC)

The riboses in the metabolism diagram are depicted with only four carbons, but they are a five carbon sugar. Compare your structure of say TIMP with that of its wiki-page where it is drawn correctly. You are missing the extra "CH2" group before the 5' alcohol on *ALL* structures.64.112.182.1 (talk) 20:22, 9 February 2021 (UTC)
 * Thanks. Should be fixed now. --ἀνυπόδητος (talk) 16:51, 10 March 2021 (UTC)
 * EDIT: removed my original "not fixed" complaint above, looks good now! Thanks for the fix. 162.220.42.222 (talk) 18:39, 22 April 2021 (UTC)

eGPA?
Just saw Azathioprine used in the treatment of eosinophilic GPA |here. Should we mention this as one of the conditions the drug is used to treat? Myoglobin (talk) 00:39, 13 April 2018 (UTC)