📋 Indications & Clinical Dosage
*Severe acute Crohns disease, Maintenance of remission of Crohns disease, Maintenance of remission of acute ulcerative colitis:*
Adult: 2-2.5 mg/kg daily, some patients may respond to lower doses.
*Rheumatoid arthritis, Severe systemic lupus erythematosus and other connective tissue disorders, Polymyositis:*
Adult: Initially up to 2.5 mg/kg daily in divided doses, adjusted according to response, rarely more than3 mg/kg daily; maintenance 1-3 mg/kg daily, discontinue if no improvement within 3 months.
*Autoimmune conditions:*
Adult: 1-3 mg/kg daily, adjusted according to response, Discontinue if no improvement within3 months.
*Suppression of transplant rejection:*
Adult: 1-2.5 mg/kg daily, adjusted according to response.
*Severe refractory eczema:*
Adult: 1-3 mg/kg daily (with normal or high TPMT activity), 0.5-1.5 mg/kg daily (with intermediate TPMT activity).
*Generalized myasthenia gravis:*
Adult: Initially 0.5-1 mg/kg daily, then increased to 2-2.5 mg/kg daily, dose is increased over 3-4 weeks.
⛔ Contraindications
Biliary stasis, toxic hepatitis, absent or very low thiopurine methyltransferase (TPMT) activity
⚠️ Precautions & Warnings
Monitor for toxic effects, perform regular blood counts, impaired renal function, infection, pregnancy, exposure to sunlight, reduce dose in elderly
🔄 Drug Interactions
Allopurinol, cytostatics, muscle relaxants.
⚠️ Adverse Reactions / Side Effects
Arthralgia, cholestatic jaundice, diarrhoea, dizziness, dose-related bone marrow suppression, fever, hair loss, herpes zoster infection, hypersensitivity reactions, hypotension,
interstitial nephritis, liver impairment, malaise, myalgia, nausea, neutropenia, rash, rigors, thrombocytopenia, vomiting. Rare: Hepatic veno-occlusive disease, lymphoma, pancreatitis, pneumonitis, red cell aplasia