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TPMT TESTING CANNOT SUBSTITUTE FOR COMPLETE BLOOD COUNTCBCMONITORING IN PATIENTS RECEIVING IMURANTPMT genotyping or phenotyping can be used to identify patients with absent or reduced TPMT activityPatients with low or absent TPMT activity are at an increased risk of developing severelife-threatening myelotoxicity from IMURAN if conventional doses are givenPhysicians may consider alternative therapies for patients who have low or absent TPMT activityhomozygous for non-functional allelesIMURAN should be administered with caution to patients having one non-functional alleleheterozygouswho are at risk for reduced TPMT activity that may lead to toxicity if conventional doses are givenDosage reduction is recommended in patients with reduced TPMT activityEarly drug discontinuation may be considered in patients with abnormal CBC results that do not respond to dose reduction.

In generalstarting dosage is from 1 to 3 mg/kg bodyweight/dayand should be adjustedwithin these limitsdepending on the clinical responsewhich may not be evident for weeks or monthsand haematological tolerance.

Using Imuran for a long time may increase your risk of skin cancer and lymphomaLymphoma is a cancer that affects your immune cells.

Information is available on the risk of malignancy with the use of IMURAN in rheumatoid arthritissee ADVERSE REACTIONSIt has not been possible to define the precise risk of malignancy due to IMURANThe data suggest the risk may be elevated in patients with rheumatoid arthritisthough lower than for renal transplant patientsHoweveracute myelogenous leukemia as well as solid tumors have been reported in patients with rheumatoid arthritis who have received IMURAN.

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