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Other brands with the same active ingredient
These brands contain the same active ingredient (Azathioprine). Strength and form may differ — confirm substitution with your doctor or pharmacist before switching.
ইঙ্গিত ও ব্যবহার
Imruza 50 এর জন্য নির্দেশিত:
ডোজ নির্দেশিকা
শুধুমাত্র নির্দেশিকা তথ্য
প্রদর্শিত ডোজগুলি সরকারি উৎসের সাধারণ নির্দেশিকা। ব্যক্তিগতকৃত ডোজের জন্য সর্বদা আপনার ডাক্তার বা ফার্মাসিস্টের পরামর্শ নিন।
Adults:
Transplants: Depending on the immunosuppressive regimen used, a dose of up to 5 mg/kg body weight per day may be given by mouth or intravenously on the first day of treatment. The maintenance dose should range from 1 to 4 mg/kg body weight per day and must be adjusted according to clinical need and how well the blood counts tolerate the drug. Evidence indicates that azathioprine treatment should be continued indefinitely, even if only low doses are needed, because of the risk of graft rejection. Other indications: In general, the starting dose is 1 to 3 mg/kg body weight per day, adjusted within these limits according to the clinical response (which may not be evident for weeks or months) and blood count tolerance. Once a therapeutic response is evident, reducing the maintenance dose to the lowest level that keeps that response should be considered. If the patient's condition has not improved within three months, withdrawing azathioprine should be considered. However, for patients with inflammatory bowel disease (IBD), a treatment duration of at least twelve months should be considered, and a response to treatment may not become clinically apparent until after three to four months. The maintenance dose needed may range from less than 1 mg/kg body weight per day to 3 mg/kg body weight per day, depending on the condition being treated and the individual patient's response, including blood count tolerance. Overweight children: Children considered overweight may need doses at the higher end of the range, so close monitoring of the response to treatment is recommended. Elderly: There is limited experience with giving azathioprine to elderly patients. Although the available data do not show that side effects are more common in elderly patients than in other patients treated with azathioprine, doses at the lower end of the range are recommended. Renal impairment: In patients with reduced kidney function, a dose reduction should be considered. Hepatic impairment: In patients with reduced liver function, a dose reduction should be considered.
পার্শ্বপ্রতিক্রিয়া
For Imruza there is no modern clinical documentation that can be used as support for determining the frequency of undesirable effects. Infections and infestations: Very common: viral, fungal and bacterial infections in transplant patients receiving Imruza in combination with other immunosuppressants. Neoplasms benign, malignant and unspecified (including cysts and polyps): Rare: neoplasms including lymphoproliferative disorders, skin cancers (melanomas and non-melanomas), sarcomas (Kaposi's and non-Kaposi's), uterine cervical cancer in situ, acute myeloid leukaemia and myelodysplasia. Blood and lymphatic system disorders: Very common: depression of bone marrow function; leucopenia. Common: thrombocytopenia. Immune system disorders: Uncommon: hypersensitivity reactions. Respiratory, thoracic and mediastinal disorders: Very rare. Gastrointestinal disorders: Common: nausea.
সতর্কতা ও নিষেধাজ্ঞা
Warnings & Precautions
Monitoring: There are potential hazards in the use of Imruza. It should be prescribed only if the patient can be adequately monitored for toxic effects throughout the duration of therapy. It is suggested that during the first 8 weeks of therapy, complete blood counts, including platelets, should be performed weekly or more frequently if high dosage is used or if severe renal and/or hepatic disorder is present. The blood count frequency may be reduced later in therapy, but it is suggested that complete blood counts are repeated monthly, or at least at intervals of not longer than 3 months. At the first signs of an abnormal fall in blood counts, treatment should be interrupted immediately as leucocytes and platelets may continue to fall after treatment is stopped. Patients receiving Imruza should be instructed to report immediately any evidence of infection, unexpected bruising or bleeding or other manifestations of bone marrow depression. Bone marrow suppression is reversible if Imruza is withdrawn early enough. There are individuals with an inherited deficiency of the enzyme thiopurine methyltransferase (TPMT) who may be unusually sensitive to the myelosuppressive effect of Imruza and prone to developing rapid bone marrow depression following the initiation of treatment with Imruza. This problem could be exacerbated by co-administration with drugs that inhibit TPMT, such as olsalazine, mesalazine or sulfasalazine. Also it has been reported that decreased TPMT activity increases the risk of secondary leukaemias and myelodysplasia in individuals receiving 6-mercaptopurine (the active metabolite of Imruza) in combination with other cytotoxics. Some laboratories offer testing for TPMT deficiency, although these tests have not been shown to identify all patients at risk of severe toxicity. Therefore close monitoring of blood counts is still necessary. The dosage of Imruza may need to be reduced when this agent is combined with other drugs whose primary or secondary toxicity is myelosuppression.Hepatotoxicity: Imruza is hepatotoxic and liver function tests should be routinely monitored during treatment.Renal and/or hepatic insufficiency: Caution is advised during the administration of Imruza in patients with renal impairment and/or hepatic impairment. Lesch-Nyhan syndrome: Mutagenicity: Chromosomal abnormalities have been demonstrated in both male and female patients treated with Imruza. Effects on fertility: Relief of chronic renal insufficiency by renal transplantation involving the administration of Imruza has been accompanied by increased fertility in both male and female transplant recipients.Carcinogenicity: Patients receiving immunosuppressive therapy, including Imruza are at an increased risk of developing lymphoproliferative disorders and other malignancies, notably skin cancers (melanoma and non-melanoma), sarcomas (Kaposi's and non-Kaposi's) and uterine cervical cancer in situ. The increased risk appears to be related to the degree and duration of immunosuppression. It has been reported that discontinuation of immunosuppression may provide partial regression of the lymphoproliferative disorder.A treatment regimen containing multiple immunosuppressants (including thiopurines) should therefore be used with caution as this could lead to lymphoproliferative disorders, some with reported fatalities. A combination of multiple immunosuppressants, given concomitantly increases the risk of Epstein-Barr virus (EBV)-associated lymphoproliferative disorders. Reports of hepatosplenic T-cell lymphoma have been received when Imruza is used alone or in combination with anti-TNF agents or other immunosuppressants. Although most reported cases occurred in the IBD population, there have also been cases reported outside of this population.Patients receiving multiple immunosuppressive agents may be at risk of over-immunosuppression, therefore such therapy should be maintained at the lowest effective level. Photosensitivity and risk of skin cancer: Exposure to sunlight and UV light should be limited, and patients should wear protective clothing and use a sunscreen with a high protection factor, to minimize the risk of skin cancer and photosensitivity Varicella Zoster Virus Infection: Infection with varicella zoster virus (VZV; chickenpox and herpes zoster) may become severe during the administration of immunosuppressants. Caution should be exercised.Progressive Multifocal Leukoencephalopathy (PML): PML, an opportunistic infection caused by the JC virus, has been reported in patients receiving Imruza with other immunosuppressive agents. Immunosuppressive therapy should be withheld at the first sign or symptoms suggestive of PML and appropriate evaluation undertaken to establish a diagnosis.Hepatitis B: Hepatitis B carriers (defined as patients positive for hepatitis B surface antigen [HBsAg] for more than six months), or patients with documented past. HBV infection, who receive immunosuppressive drugs are at risk of reactivation of HBV replication, with asymptomatic increases in serum HBV DNA and ALT levels. Local guidelines may be considered including prophylactic therapy with oral anti-HBV agents.Macrophage activation syndrome: Macrophage activation syndrome (MAS) is a known, life-threatening disorder that may develop in patients with autoimmune conditions, in particular with inflammatory bowel disease (IBD), and there could potentially be an increased susceptibility for developing the condition with the use of Imruza.
নিষেধাজ্ঞা
Do not use if you are allergic to azathioprine or to any other ingredient in this preparation. A known allergy to 6-mercaptopurine should alert the prescriber to a likely allergy to azathioprine.