硫唑嘌呤的作用与副作用（译文）

原文来自号称世界第一医学院的美国约翰霍普金森大学狼疮中心，译文由本人翻译，见下文
Azathioprine (Imuran)

Imuran is an anti-inflammatory immunosuppressive that can decrease joint damage and disability in people with lupus, rheumatoid arthritis, and other conditions. In addition, Imuran has proven to clearly improve lupus affecting the liver and kidneys. Imuran is “steroid-sparing,” which means that it may allow for a reduction of the amount of steroid being taken. Since the side effects of steroids generally increase with the dosage, this medication generally promotes a reduction in steroid side effects as well.

People with lupus have overactive immune systems. Imuran works by preventing some of the cells involved in this immune response (specifically, white blood cells [WBCs], or leukocytes) from spreading. Imuran is a “slow onset” drug, which means it may take 6-12 weeks for you to notice its effects. It usually comes in pill form and has fewer side effects than many other immunosuppressive medications. The most common and serious side effects involve the stomach and blood cells. Nausea and vomiting can occur, sometimes with stomach pain and diarrhea. Taking the medication with food may help to reduce these symptoms. Imuran can also decrease the number of certain cells in your blood. For this reason, blood tests should be done regularly to determine your white blood cell, platelet, and red blood cell count.

Less common side effects include liver test abnormalities, hepatitis (inflammation of the liver), pancreatitis (inflammation of the pancreas, a gland behind the stomach, that can cause abdominal pain), or an allergic reaction that can seem like the flu. During treatment, your doctor may perform tests for breakdown products (metabolites) of Imuran that can help monitor how your body is reacting to the drug.

Even though Imuran is effective in treating serious lupus symptoms, long term use of this medication does increase the risk of developing cancer. Your doctor can speak with you about this risk and any other concerns you may have. She/he will work with you to minimize the side effects of your medications while also maximizing the benefits.

In addition to having regular blood tests (CBCs), you should notify your doctor if you experience any of the following symptoms while taking Imuran: fever, a new rash, easy bruising or bleeding, or signs of infection. Be sure to speak with your doctor before taking getting any vaccines or having surgery. In addition, consult your doctor if you are pregnant, may become pregnant, or are breastfeeding, since Imuran can be harmful to your child.

Certain medications may interfere with Imuran, so be sure to notify your doctor of any other drugs you are taking. Medications that can interfere with Imuran include the gout medication allopurinol (Aloprim, Zyloprim), warfarin (Coumadin), some blood pressure medications including some ACE inhibitors (Accupril or Vasotec), olsalazine (Dipentum), mesalamine (Asacol, Pentasa), and sulfasalazine* (Azulfidine).



依木兰(硫唑嘌呤)

硫唑嘌呤是一种抗炎免疫抑制,可以减少患红斑狼疮、类风湿关节炎病人的关节损伤和残疾。此外,硫唑嘌呤显然已经被证明可以改善狼疮对肝脏和肾脏的影响。硫唑嘌呤是“steroid-sparing”,即激素的后备药，这意味着它可能允许减少类固醇的数量。因为类固醇的副作用通常随着剂量而增加,加服这种药物一般可以促进减少类固醇的副作用。

 患有红斑狼疮的病人其有一个活跃的免疫系统。硫唑嘌呤通过阻止一些细胞参与免疫反应(具体来说,白细胞(白细胞),或粒细胞)的蔓延起作用。硫唑嘌呤是一种“慢发作”的药物,这意味着它可能需要6 - 12周的时间你才能注意到它的作用。它通常是片剂，比其他许多免疫抑制药物的副作用更少。最常见和严重的副作用包括胃和血液细胞。可能出现恶心、呕吐,有时会伴随胃痛和腹泻。服用药物时和食物一起有助于减少这些症状。硫唑嘌呤也可以减少血液中的某些细胞的数量。出于这个原因,应该定期做血液检查确定你的白细胞,血小板和红细胞计数。 不常见的副作用包括肝脏测试异常、肝炎肝脏的炎症,胰腺炎(胰腺的炎症,背后的腺胃,可引起腹痛),或过敏反应,可以像流感。治疗期间,医生可能会检查测试硫唑嘌呤的代谢产物的分解产物,可以帮助监控你的身体对药物如何反应。 尽管硫唑嘌呤可以有效治疗严重的红斑狼疮症状,但长期使用这种药物会增加罹患癌症的风险。你的医生会和你谈论这种风险和其他任何可能发生的问题。她/他将与你共同努力,减少药物的副作用,同时最大化效益。 除了常规血液检查(cbc),你应该通知你的医生如果你服用硫唑嘌呤时出现有下列症状:发烧,皮疹,容易瘀伤或出血或感染的迹象。在接种疫苗和做手术之前需要咨询你的医生。另外,请咨询你的医生如果你怀孕了,或可能会怀孕,或者是母乳喂养,因为硫唑嘌呤可以对孩子有害。 另外某些药物会干扰硫唑嘌呤,所以一定要通知你的医生你服用的其他药物。有些药物会干扰硫唑嘌呤包括痛风药物别嘌呤醇(Aloprim Zyloprim)、华法林(香豆素),某些抗高血压药物包括一些ACE抑制剂(Accupril或Vasotec),olsalazine(Dipentum)mesalamine(Asacol Pentasa),和柳氮磺胺吡啶(Azulfidine)。