Living with Lupus

Azathioprine (Imuran) as a Lupus Treatment

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What Is Imuran?

Azathioprine, sold under the brand name Imuran, is an immunosuppressant. Immunosuppressants are a class of medications that decrease the activity of the body’s immune system. Azathioprine is used with other medications to prevent transplant rejection in people who received kidney transplants. It is also used to treat severe rheumatoid arthritis when other medications and treatments have not helped.

Although it is not approved for lupus, it is commonly used as a treatment for systemic lupus erythematosus and lupus nephritis. In a small survey of our LupusCorner community, about 5% of people had been prescribed Imuran in order to treat their lupus. In fact, the survey showed that more people had tried Imuran than Benylsta, the most recent drug approved for lupus.

How Does It Work?

Azathioprine is a prodrug. These substances are inactive by themselves However, the body can turn them into active ingredients. The body converts Imuran into the two active components:

  1. 6-mercaptopurine
  2. 6-thioinosinic acid

These components reduce the function of the body’s immune system by interfering with cell growth and division, known as DNA synthesis. Although the immune system is important for fighting infections, immune system cells sometimes mistakenly attack the body’s own tissues. This is the defining feature of autoimmune diseases including:

  • lupus
  • IBD
  • rheumatoid arthritis (RA)


Used with prednisone, Azathioprine can reduce the amount steroids used to manage the disease. Several studies have shown Azathioprine to improve disease activity in severe lupus nephritis. A small study published in 1971 showed improved disease outcomes for SLE patients taking Azathioprine along with prednisone compared to patients taking prednisone by itself.

As you know, each person’s experience with lupus is unique. Also, azathioprine is not an option for everyone. You should discuss with your doctor which medications may be a good treatment option for you.

Safety / Side Effects

Few treatments are without risk. However, the most common side effects of azathioprine are gastrointestinal, such as nausea, vomiting and diarrhea.


Some side effects can be serious. If you experience any of the following symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately.

  • rash
  • fever
  • weakness
  • muscle pain

This medication may cause other side effects. Call your doctor if you have any unusual problems while you are taking azathioprine.






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