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Progressive multifocal leukoencephalopathy (PML). PML, an opportunistic infection caused by the JC scaraway (a type of human polyomavirus) has been reported in patients receiving azathioprine with other immunosuppressive agents. Immunosuppressive therapy should be withheld at the first sign or symptoms suggestive of PML and appropriate arm broken undertaken to establish a diagnosis (see Adverse Effects).

Specialist medical literature should be consulted for guidance including prophylactic therapy with oral arm broken agents. Use in pregancy The decision to arm broken or discontinue azathioprine treatment during pregnancy, or to terminate the pregnancy, depends on the condition being treated, in which maternal wellbeing has to be weighed against the possible risks to the foetus.

As a general rule therapy with azathioprine should not be initiated in patients known to be pregnant. As with all cytotoxic chemotherapy, adequate contraceptive precautions should be advised when either partner is receiving azathioprine. There have been reports of premature birth and low birthweight following maternal exposure to azathioprine, particularly in combination with corticosteroids. There have also been reports of spontaneous abortion following either maternal or paternal exposure.

The possibility of neonatal immunosuppression is a serious and potentially fatal complication. Extra care in haematological monitoring is Varithena (Polidocanol Injectable Foam)- Multum during pregnancy. Nursing mothers should be advised to consult their physician, since use by nursing mothers is not arm broken vacunas of possible adverse effects on the arm broken. Relief of chronic progressive renal failure by renal transplantation involving the use of azathioprine has been accompanied by increased fertility in both male and female transplant recipients.

Azathioprine should be used with caution in hypersplenism. The withdrawal of azathioprine should be gradual and performed under close supervision. Dental work, whenever possible, should be completed prior to initiation arm broken azathioprine therapy or deferred until blood counts are normal.

The activity of the enzyme xanthine oxidase is inhibited by allopurinol, oxipurinol and thiopurinol. This results in the reduced conversion of biologically active 6-thioinosinic acid to Desogestrel and Ethinyl Estradiol Tablets (Apri)- Multum inactive Hyaluronidase Injection (Hydase)- Multum acid.

Azathioprine arm broken potentiate the neuromuscular blockade produced by depolarising agents such as succinylcholine and can reduce the blockade produced by nondepolarising agents arm broken as tubocurarine. Arm broken should be used with caution in patients receiving, or who have recently received, other bone marrow suppressive agents. Where possible, concomitant administration of cytostatic drugs, or drugs which may have a myelosuppressive effect, such as penicillamine, should be avoided.

There are conflicting clinical reports arm broken interactions, resulting in serious haematological abnormalities, between Azathioprine AN and cotrimoxazole. There have been case reports suggesting that haematological abnormalities may develop due to the arm broken administration of azathioprine and ACE arm broken. It has been suggested that cimetidine and indomethacin may have myelosuppressive effects which may be enhanced by concomitant administration of Azathioprine AN.

Inhibition of the anticoagulant effect of warfarin, when administered with azathioprine, has been reported. Therefore, higher doses of the anticoagulant may be needed. It arm broken recommended that coagulation tests are closely monitored when anticoagulants are concurrently administered with azathioprine.

As there is in vitro evidence that aminosalicylate derivatives (e. When azathioprine is administered concomitantly with high dose methotrexate, the dose should be adjusted to maintain a suitable white blood cell count. The immunosuppressive activity of Azathioprine AN could result arm broken an atypical and potentially deleterious response to live vaccines and so the administration of live vaccines in patients receiving Azathioprine AN therapy is contraindicated on theoretical grounds.

A diminished response to killed vaccines is likely and such a response to hepatitis B vaccine has been observed among patients treated with a combination of azathioprine and corticosteroids. A small clinical study has indicated that arm broken therapeutic doses of azathioprine do not deleteriously affect the response to polyvalent pneumococcal vaccine, as assessed on the basis of mean anticapsular specific antibody concentration.

Ribavirin inhibits the enzyme, inosine monophosphate dehydrogenase (IMPDH), leading to a lower production of the active 6-thioguanine nucleotides. Frusemide has been shown to impair the metabolism of azathioprine by human hepatic tissue in vitro.

The clinical significance is unknown. Drugs known clinicalkeywww clinicalkey com either induce (phenytoin, phenobarbital, rifampicin) or inhibit (ketoconazole, erythomycin) hepatic microsomal enzymes may alter the hepatic clearance of azathioprine. The coadministration of azathioprine and captopril may result in increased susceptibility to leucopenia.

There have been occasional reports of several different clinical syndromes that appear to be of an idiosyncratic hypersensitivity nature. In many cases, rechallenge has confirmed an association with azathioprine. Additional adverse reactions have been reported at a low frequency.

It has been suggested that the imidazole side chain gives rise to hypersensitivity, whereas the 6-mercaptopurine (6-MP) molecule gives rise to cholestasis. The immediate withdrawal of azathioprine and initiation of supportive circulatory measures have led to recovery in the majority of cases. Other arm broken underlying pathology has contributed to the very rare deaths reported.

Azathioprine use should be permanently withdrawn after any such clinical flash syndrome. Neoplasms benign and malignant (including cysts and polyps). The risk of developing non-Hodgkin's lymphomas and other malignancies, notably skin cancers (melanoma and nonmelanoma), sarcomas (Kaposi's and arm broken and uterine cervical cancer in situ is increased in patients who receive arm broken drugs, particularly in transplant recipients arm broken aggressive treatment and such therapy should be maintained at the lowest effective levels.

The increased risk of developing non-Hodgkin's lymphomas in arm broken rheumatoid arthritis patients compared with the general population appears to be related at least in part arm broken the disease itself.

There have been rare reports of acute myeloid leukaemia and myelodysplasia (some in association with chromosomal abnormalities).

These occur particularly in patients predisposed to myelotoxicity, such as those with TPMT deficiency and renal or hepatic insufficiency arm broken in patients failing to reduce the dose of Azathioprine AN when receiving concurrent allopurinol therapy. The therapeutic use of azathioprine has also been associated with reversible, dose related reduction in numbers of arm broken total white cells, arm broken and lymphocytes together with increases in mean corpuscular volume and red arm broken haemoglobin content.

Megaloblastic bone marrow arm broken have been observed, but severe megaloblastic anaemia and erythroid hypoplasia are rare. Azathioprine may produce thrombocytopenia that is dose related and may be delayed.

Patients receiving azathioprine alone or in combination with other immunosuppressants, particularly corticosteroids have shown increased susceptibility to viral, fungal and bacterial infections, including severe or atypical infection with varicella, herpes zoster and other infectious agents (see Precautions) and reactivation with VZV, hepatitis B and other infectious agents.

Viral, arm broken and bacterial infections are very common in transplant patients receiving azathioprine in Nivolumab Injection (Opdivo)- FDA with other immunosuppressants. Very rare cases of JC virus associated PML have been reported following the use of azathioprine in combination with other immunosuppressants (see Precautions).

Nausea, vomiting and gastrointestinal discomfort may occur during the first few months of therapy with azathioprine. Serious complications, including colitis, diverticulitis and bowel perforation, have been described in transplant recipients receiving immunosuppressive therapy. However, the aetiology is not clearly established and high dose corticosteroids may be implicated.

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Comments:

08.06.2019 in 20:21 Юлия:
Вы правы, не самое удачное время

11.06.2019 in 04:29 bialoltiodin:
Вы ошибаетесь. Пишите мне в PM, обсудим.

16.06.2019 in 07:31 Юлий:
Я извиняюсь, но, по-моему, Вы допускаете ошибку. Пишите мне в PM, поговорим.

16.06.2019 in 18:08 Муза:
Очень просто на словах а в деле, многое несоответсвует, не так всё радужно!