Dosage |
2-2.5 mg/kg (1-1.5 mg/kg) |
Indications |
Maintenance, chronically active disease, steroid- refractory and steroid-dependency, fistulae, concommittant therapy with infliximab; |
Important side effects |
Pancreatitis, bone marrow supression, allergic reactions, drug heptatitis, nausea, malaise, bacterial and viral infections; in patients intolerant to azathioprine due to gastrointestinal symptoms, 6-mercaptopurine is suggested (not in side effects such as pancreatitis and bone marrow suppression) |
Monitoring |
Liver function, lipase and full blood count biweekly for the first three months, if normal then every three months throughout therapy |
Pregnancy |
Should be avoided, although available studies suggest a potential use especially in patients where maintaining remission is essential |
Comments |
Entire therapeutic efficacy is observed mostly after 2-4 mo; consider testing for thiopurine methyltransferase (TPMT) genotypes to identify patients with high-risk of bone marrow suppression; consider metabolite monitoring for adaequate dosing; ensure adequate birth control; allow 3 mo time before pregnancy or conceiving |