WHAT IS IMURAN?

Imuran (Azathioprine) is an immunosuppressive medication. Use of immunosuppressive drugs in Myasthenia Gravis (MG) is based on the assumption that MG is an autoimmune disorder. With an autoimmune disorder, some of the body’s own antibodies attach to various cells belonging to the body. This causes damage to the cells and can result in disease.

The exact way that Imuran works in helping the Myasthenic is unknown. It is theorized, however, that Imuran suppresses the immune system, thereby causing a reduction of circulating antibodies. This results in fewer antibodies available to attack the acetylcholine receptors at the neuromuscular junction. Damaged receptors can then regenerate and be available again to function correctly in neuromuscular transmission. Hence, there is a return of motor function and strength.

WHY AM I TAKING IMURAN?

Imuran is one of many treatments your doctor may utilize to control your disease. Your doctor will use Imuran to reduce the number of harmful circulating antibodies in your system. Imuran is often used together with steroid therapy and plasmapheresis. However, it can also be used by itself in certain circumstances. Talk to your doctor to find out what he/she hopes Imuran will do for you.

WHAT IS IMURAN SUPPOSE TO DO?

If Imuran is working, after about 3-12 months you should notice a gradual improvement in how you feel. This can be measured clinically by:

• Decrease in the number and severity of symptoms
• Need for less Prednisone or acetylcholinesterase inhibitors (Mestinon, Mytelase)
• Need for less frequent plasmapheresis treatments
• Lower antibody titers

WHAT ARE POSSIBLE SIDE EFFECTS?

Check with your doctor immediately if any of the following side effects occur:

• Fever, chills, sore throat
• Muscle or joint pain
• Unusual tiredness or weakness
• Stomach pain with nausea and vomiting (severe)
• Yellowing of the eyes and skin
• Missed menstrual period
• Cough or shortness of breath
• Sores in the mouth or on the lips (cold sores)
• Blood in urine and /or painful urination

Other side effect may occur which usually do not require medical attention. They often go away after your body adjusts to the medication. These are:

• Loss of appetite
• Mild nausea, vomiting, GI upset
• Mild hair loss
• Darkening of the skin and fingernails

SPECIAL CONSIDERATIONS

• Imuran may cause some marrow suppression and elevation of liver enzymes. Therefore, you doctor will check your blood regularly to monitor for significant changes.
• You may have to stay on this medication indefinitely.
• The main clinical improvement occurs during the first year of therapy. Improvement is gradual, and it may take several months before you notice a major change. Even then some symptoms may still remain. Therefore, be patient.
  
• Doses vary from 100-200 mg. per day, which is taken in divided doses. Take your medication exactly as prescribed by your doctor. Never increase, decrease, or stop taking this medication without checking with your physician.
  
• Do not take Imuran if you are pregnant or intend to become pregnant while using it. This medication can cause birth defects if either the male or female is using it at the time of conception.
• If you miss a dose of Imuran and your schedule is ONCE A DAY, do not take the missed dose, and do not double the next dose. Instead, take your next regularly scheduled dose and check with your physician. If you are supposed to take Imuran SEVEAL TIMES A DAY, take the missed dose as soon as you remember it. If it is time for your next dose, take both doses together and resume your normal schedule. If you miss more than one dose, check with your physician.
• Store this medication away from heat and direct light.
  
• To prevent or lessen stomach upset:
• Eat small meals frequently throughout the day.
• Eat dry food such as toast and crackers.
• Avoid sweets and fried or fatty foods.
• Avoid liquids at mealtime.Store this medicine away form heat and direct light.
• Avoid immunizations without your doctor’s approval. Also take special precautions to avoid developing an infection. If you do become ill, contact your doctor immediately.
• Tell your physician if you are taking any other medications, especially allopurinol (Zyloprim).
• Your physician is prepared to discuss with you other possible infrequent complications such as infertility in women of childbearing age or increased incidence of certain types of malignancies.