Comparative Pharmacology
Head-to-head clinical analysis: AZATHIOPRINE versus IMURAN.
Peer-Reviewed Evidence
Head-to-head clinical analysis: AZATHIOPRINE versus IMURAN.
AZATHIOPRINE vs IMURAN
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Azathioprine is a purine analog that inhibits purine nucleotide synthesis, thereby suppressing DNA replication and cell proliferation. It is converted to 6-mercaptopurine, which acts as a purine antagonist, inhibiting de novo purine synthesis and interfering with RNA and DNA synthesis, particularly in rapidly dividing cells such as T-lymphocytes.
Imuran (azathioprine) is a purine antimetabolite that inhibits DNA synthesis by interfering with purine metabolism. It is converted in vivo to 6-mercaptopurine (6-MP), which is further metabolized to thioinosinic acid and thioguanine nucleotides. These metabolites inhibit de novo purine synthesis and incorporation of purines into nucleic acids, thereby suppressing T-cell proliferation and antibody production.
1.5 to 2.5 mg/kg orally once daily; typical adult dose 50-150 mg/day orally. Intravenous dose is 3-5 mg/kg/day as a slow infusion over 30-60 minutes.
Initially 3-5 mg/kg/day orally once daily; maintenance dose 1-3 mg/kg/day orally once daily. IV dose equivalent to oral.
None Documented
None Documented
Clinical Note
moderateAzathioprine + Digoxin
"Azathioprine may decrease the cardiotoxic activities of Digoxin."
Clinical Note
moderateAzathioprine + Digitoxin
"Azathioprine may decrease the cardiotoxic activities of Digitoxin."
Clinical Note
moderateAzathioprine + Deslanoside
"Azathioprine may decrease the cardiotoxic activities of Deslanoside."
Clinical Note
moderateAzathioprine + Acetyldigitoxin
"Azathioprine may decrease the cardiotoxic activities of Acetyldigitoxin."
Terminal elimination half-life of azathioprine is approximately 2–5 hours; its active metabolite 6-mercaptopurine has a half-life of 1–2 hours, but 6-thioguanine nucleotides accumulate in red blood cells with a half-life of several days, correlating with myelosuppression.
Azathioprine: 0.16–0.75 h; 6-mercaptopurine: 1.5–4.7 h (terminal). Extended up to 5 h in renal impairment. Context: short half-life allows daily dosing; clinical effect persists due to active metabolites.
Renal (approximately 2% as unchanged drug, 30% as 6-thiouric acid and other metabolites); biliary/fecal (minor, <10% as metabolites).
Primarily renal excretion of inactive metabolites; 50% as 6-thiouric acid and other metabolites; <2% unchanged. Minor biliary/fecal elimination (<10% total).
Category D/X
Category C
Immunosuppressant
Immunosuppressant