Imuran Tablets 25mg

Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.

• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor, nurse or pharmacist.
• This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor, nurse or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

What is in this leaflet:

1. What Imuran is and what it is used for
2. What you need to know before you take Imuran
3. How to take Imuran
4. Possible side effects
5. How to store Imuran
6. Contents of the pack and other information

Do not take Imuran if:

• you are allergic (hypersensitive) to azathioprine, mercaptopurine or any of the other ingredients of Imuran (listed in section 6).

Do not take Imuran if any of the above apply to you. If you are not sure, talk to your doctor, nurse or pharmacist before taking Imuran.

Warnings and precautions

Talk to your doctor, nurse or pharmacist before taking Imuran if:

• you have liver or kidney disease
• you have ‘Lesch-Nyhan Syndrome’. This is a rare condition that runs in families caused by a lack of something called HPRT or ‘hypoxanthine- guanine-phosphoribosyltransferase’
• you have a condition where your body produces too little of something called TPMT or ‘thiopurine methyltransferase’
• you have ever suffered from chickenpox or shingles.

NUDT15-gene mutation

If you have an inherited mutation in the NUDT15-gene (a gene which is involved in the break-down of Imuran in the body), you have a higher risk of infections and hair loss and your doctor may in this case give you a lower dose.

If you are not sure if any of the above apply to you, talk to your doctor, nurse or pharmacist before taking Imuran.

Talk to your doctor, pharmacist or nurse before taking Imuran

If you are receiving immunosuppressive therapy, taking Imuran could put you at greater risk of:

• tumours, including skin cancer. Therefore, when taking Imuran, avoid excessive exposure to sunlight, wear protective clothing and use protective sunscreen with a high protection factor.
• lymphoproliferative disorders
  • treatment with Imuran increases your risk of getting a type of cancer called lymphoproliferative disorder. With treatment regimen containing multiple immunosuppressants (including thiopurines), this may lead to death.
  • A combination of multiple immunosuppressants, given concomitantly increases the risk of disorders of the lymph system due to a viral infection (Epstein-Barr virus (EBV)-associated lymphoproliferative disorders).

Taking Imuran could put you at greater risk of:

• developing a serious condition called Macrophage Activation Syndrome (excessive activation of white blood cells associated with inflammation), which usually occurs in people who have certain types of arthritis

Other medicines and Imuran

Please tell your doctor, nurse or pharmacist if you are taking or have recently taken any other medicines. This includes medicines obtained without a prescription, including herbal medicines. This is because Imuran can affect the way some medicines work.

Also some other medicines can affect the way Imuran works.

In particular, tell your doctor, nurse or pharmacist if you are taking any of the following medicines:

• allopurinol - used for gout
• tubocurarine or succinylcholine – used during operations
• warfarin - used for blood clots
• penicillamine - used for rheumatoid arthritis
• co-trimoxazole - used for infections
• captopril - used for high blood pressure or heart problems
• cimetidine - used for stomach ulcers and indigestion
• indomethacin - used for pain and inflammation
• furosemide - used for high blood pressure and heart problems
• olsalazine or mesalazine - used for a bowel problem called ulcerative colitis
• sulfasalzine or balsalazide - used for rheumatoid arthritis or ulcerative colitis.

If you are not sure if any of the above apply to you, talk to your doctor, nurse or pharmacist before taking Imuran.

Having vaccines while you are taking Imuran

If you are going to have a vaccination speak to your doctor or nurse before you have it. This is because vaccines may not work properly while you are taking Imuran.

Tests you may have while taking Imuran

Your doctor may ask you to have a blood test while you are taking Imuran. This is to check your blood cell count. .Your doctor may change your dose of Imuran after the test.

Pregnancy, breast-feeding and fertility

• Do not take Imuran if you are a man trying to have a baby. This is because it may affect the baby.
• Do not take Imuran if you are a women who is pregnant or think you might become pregnant. This is because it may affect the baby.
• Do not take Imuran if you are breast-feeding. This is because small amounts may pass into the mother’s milk. Ask your doctor, midwife or pharmacist for advice before taking any medicine, if you are pregnant or breast-feeding.

Imuran and the sun

While taking Imuran you may be more likely to develop some types of cancers such as skin cancer. Some people also become sensitive to sunlight which can cause skin discolouration or a rash. Take care to avoid too much sun, cover up and use sunscreen.

Chickenpox /Shingles infection

Infection with chickenpox or shingles can become severe in patients taking immunosuppressive medicine. Therefore you should avoid contact with anyone suffering from chickenpox or shingles.

To stop your body rejecting an organ transplant

On the first day

• the usual dose is up to 5 mg per kg of body weight.

For the rest of your treatment

• you will take between 1 and 4 mg per kg of body weight each day.

For other conditions

At the start of your treatment

• you will take 1 to 3 mg per kg of body weight each day
• your doctor may reduce your dose later.

If you take more Imuran than you should

If you take more Imuran than you should, talk to your doctor or go to a hospital straight away. Take the medicine pack with you.

If you forget to take Imuran

• If you forget to take Imuran, tell your doctor.
• Do not take a double dose to make up for a forgotten dose.

Stop taking Imuran and see a doctor straight away, if you notice any of the following serious side effects, you may need urgent medical treatment:

• allergic reaction, the signs may include:
  • general tiredness, dizziness, feeling sick (nausea), being sick (vomiting) or diarrhoea
  • high temperature (fever), shivering or chills
  • redness of the skin or a skin rash
  • pain in the muscles or joints
  • changes in the amount and colour of the urine (kidney problems)
  • dizziness, confusion, feeling light headed or weak, caused by low blood pressure
• you bruise more easily or notice any unusual bleeding
• you have a high temperature (fever) or other signs of an infection
• you feel extremely tired
• you notice lumps anywhere on your body
• you notice any changes to your skin, for example blisters or peeling
• your health suddenly gets worse
• you come into contact with anyone who is suffering from chickenpox or shingles.

If you notice any of the above, stop taking Imuran and see a doctor straight away.

Other side effects include:

Very common (affects more than 1 in 10 people)

• infections caused by a virus, fungus or bacteria
• reduction in your bone marrow function, which may make you feel unwell or show up in your blood tests
• low white blood cell level in your blood tests, which may cause an infection.

Common (affects less than 1 in 10 people)

• low blood platelet level, which may cause you to bruise or bleed easily.

Uncommon (affects less than 1 in 100 people)

• low red blood cell level, which may cause you to be tired, get headaches, be short of breath when exercising, feel dizzy and look pale
• inflammation of the pancreas, which may cause you severe upper stomach pain, with feeling sick (nausea) and being sick (vomiting)
• liver problems, which may cause pale stools, dark urine, itchiness and yellowing of your skin and eyes.

Rare (affects less than 1 in 1,000 people)

• problems with your blood and bone marrow which may cause weakness, tiredness, paleness, headaches, sore tongue, breathlessness, bruising or infections
• problems with your bowel leading to diarrhoea, abdominal pain, constipation, feeling sick (nausea) and being sick (vomiting)
• hair loss which may get better even though you continue to take Imuran
• severe liver damage which can be life threatening
• various types of cancers including blood, lymph and skin cancers
• sensitivity to sunlight which can cause skin discolouration or a rash.

Very rare (affects less than 1 in 10,000 people)

• inflammation of your lungs causing breathlessness, cough and a fever.

Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store

By reporting side effects you can help provide more information on the safety of this medicine.

What Imuran contains

• The active substance is azathioprine.
• The other ingredients are lactose, pregelatinised starch, maize starch, stearic acid, magnesium stearate, methylhydroxypropyl cellulose, and propylene glycol 400.
• There is no colouring in the yellow tablets.
• The colouring in the orange tablets contains titanium dioxide (E171), iron oxide yellow (E172) and iron oxide red (E172).

What Imuran looks like and contents of the pack

• Imuran tablets are covered by a thin coating and come in two strengths and colours;
  Orange, round, biconvex, film-coated tablets, unscored, branded `IM 2' and containing 25 mg Azathioprine BP in each tablet.
  Yellow, round, biconvex, film-coated tablets, scored, branded ‘IM 5’ and containing 50 mg Azathioprine BP in each tablet.

Imuran tablets come in packs of 28, 30, 56, 60 and 100 tablets.

The 50 mg tablets are also available in packs of 1000 tablets.

Not all pack sizes may be marketed.

Marketing Authorisation Holder and Manufacturer

Marketing Authorisation Holder:

Imuran 25 mg

PL 39699/0004

Imuran 50 mg

PL 39699/0005

Manufacturer: