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Azathioprine Side Effects

Well I tried the Azathioprine (Imuran in Canada) and after being only on 50mg a day for about three weeks I started getting really nauseated after taking my dose for about an hour or so after. I was sick to the point of not being able to move off the couch and I worried it was just a combo of all the pills that I was taking at once. So I decided to take the Azathioprine by itself only to realize it was the culprit. I phoned my doctor and they took me off it immediately and made me go for blood work the next day, which worried me as they side effects can be harmful to your liver and to your bone marrow (so my doc told me) I have yet to hear about my results but I’m sure it will be fine as I was not on the full dose. I just thought I would put my experience out there for anyone else who has had strange side effects from Azathioprine.



46 thoughts on “Azathioprine Side Effects”

    1. i have uc/crohns i was put on 50mg azathionprine i was told it would take 9 days to enter my syntom but within hour and a half of taking my first my dose i was violent sick flu syntom accured and had very bad headache and dizzie spells all in all felt like crap my body was totaly intolarent to this meddication so to anyone reading this beware of taking this meddication

      1. I started on 25mg dose for 2 weeks, then they moved it to 50mg for 2 weeks and the plan is to be on 75mg longterm and wean off the Pred. However, like you, once I started taking the 25mg (and it only got worse on the 50mg) I felt so sick. I am healthy (except the UC) and never really have flu or colds and am only sick if I have drunk. I felt so sick and every time I take it I feel sick too for a few hours after. I just resign myself to the sofa or the bed and pray it goes away quick.

        I have an appointment with the doc in a couple of weeks and will bring it up to him then.

  1. That’s strange that some meds do things to some people and not others. My docs response was that some of his patients get sick from it. Besides I’m pretty much in remission and slowly getting off the prednisone as well so I will be happy to just be on Asacol which give me no side effects!

    1. i just started on the aza 50 mg ive been on the asacole for a year and its not helping my chrons disease when i took my first aza pile so far no side afect with my case the DR dont want me on the predazone so i hope this will work

  2. I am on triple the amount you are on, I’m on 150 mg a day and I get quiet nauseated i have to get bloods taken every monday to check for neutropenia as that is a common side effect and risk.

  3. Well I am going to try another 6-MP and see if it works but if it makes me sick my doc told me to stop taking it as well! *shrugs* It really gets frustrating as I am on the cusp of remission but just can’t seem to get over that last little bump! Wish me luck! lol

  4. I was on Imuran for 2 weeks at a dose of 175mg. I had to get off after that becuase of extreme nausea and vomitting. Each night precisily 5 hours after I took the medicine I would be throwing up. I had to eventually go to the ER and they found that the Imuran had given me pancreaitis as well.

    This drug did not work for me. The doctor has recently prescribed me Remicade. I am unsure if I will go along with it..
    BECA– USE…

    I am currently on the SCD diet, 3rd week and I am starting to feel so much better, formed BM approx 3 times a day versus the D I was experiencing 10+ times a day.

    Wish me luck!

  5. I was on aziotheoprine 3 pills a day for several months 4 to be exact,started feeling better but getting very sore joints.I also started getting tender skin and what appeared to be a invisible rash.I have been off for a little over a week and starting to loose the joint pain,still experiencing rash like symptons at this time.I started my first dose of methotrexate and have been ok accept experiencing stomache pain after dinner time that i have never experienced before.Any comments or similar experiences anyone.I dont now if it is due to coming off imuran or the new metotrexate???

    1. Hey Kevin, when you say the invisible rash, are you talking about something that was really itchy, but nobody could see it type of thing? Or was your skin redish?
      The reason I ask is because I also developed some rash like stuff after trying Humira for my UC, but it was definitely visible, quite red and the doctors ended up saying it was Psoriasis. But at the same time, I had all kinds of joint pains that started up. In speaking with a ton of others on this site and on the facebook page, it seems quite clear to me now that a whole bunch of people with UC get joint pains from time to time. But not nearly as many talk about rash like stuff. I hope you can shake off the stomach pain with your new medications. I guess what I am trying to say is it seems that some of the symptoms like joint pains at least might be more related to the disease itself. I still get them from time to time and I have been off all medications for about 14 months now. do you notice the joint stuff more when you are in a bad flare or is it indifferent to how the traditional UC symtoms are for you?

      1. i was told by my DR that haveing UC or Chrons just the disease it self can cause itiching i get it alot on myarms,legs and my hands he has me on Hydroxzine HCL 25 mg3 times a day if needed for itching it seams to work but some times it makes me sleepy

  6. I was on azathioprine and methotrexate together. I was ill after half an hour of taking the azathioprine, stomach pain, vomitting, shaking, freezing etc. I was taken off it immediately and replaced it with prednizone.I now take methotrexate(retinal vasculitis), prednizone, eltroxin(thyroid),concor (heart),atacand (heart). I have never been ill till 3 years ago when diagnosed with retinal vasculitis and it has snowballed from there. Its frustrating, as there is no cure!!!!!!

  7. With Rheumatoid Arthritis I was prescribed Azathioprine and after a month had excrutiating back pain which eventually was diagnosed as pancreatitis. Was admitted to hospital for 3 weeks where after lots of tests and scans it was discovered that the Azathioprine had damaged my pancreas and caused the stomache and bowels to become inflammed. Now, 3 years later I have to take creon before meals as I can’t digest food properly. Also I am diabetic. The nausea is controlled with cyclazine. My bowels are still affected and am having more scans and tests to find out how inflammed they are. It is unbelievable how one little tablet can cause so many problems. Unfortunately now I do can’t take any anti inflammitory drugs or any medication to help with the arthritis apart from pain killers and the odd steroid therapy.
    I am awaiting 2 hip replacements and another knee replacement plus both thumb joints are being replaced too. Shoulders have been operated on twice, elbow and hand. The list is never ending. Only POSITIVE thing is that the surgeons CAN do something to ease the pain. I am a very strong person and get on with my life. Though, I do wish that I was never prescribed Azathioprine.

  8. I am on this medication for Non Alcoholic Cirrhosis caused by Autoimmune Hepatitis. I have been on it for several months and keep feeling worse and worse. I have started getting nauseated (I take the medication with food), bruising getting worse, my hair is falling out, am VERY tired, having diarrhea and my joints and muscles ache to the point that I cry. I work at a job where I stand a minimum of 7.5 hours a day, sometimes longer, and am miserable. I go to see the doctor this week. The joint/muscle aches are new and because I have liver damage, I can only take one pain med and it doesn’t touch the pain I have. The alternative to taking this med is dying of liver failure…not much choice here.

    1. Louise,
      My husband (59) also has cirrhosis (non alcoholic) caused by autoimune hep and is taking Azathioprine. He was on steroids for a year along with the AZA and now has a strange outbreak of bleeding blisters on his hands. He suffered a sudden attack of diverticulitis and was on cipro and another antibiotic when he suddenly got a bladder infection. Both issues abated but he sometimes sees blood in urine and thinks he is dying for sure. He also now has joint pain starting in his hands which is quite painful We are hopin he will eventually be able to come off thsie med. Wish things were different!
      Feel free to reply

  9. I have been on azathioprine for a little over a year now after having an ilectomy and cecectomy for Chrones disease. I went from 50 mg to 200mg bc the levels were not high enough in my blood tests. The only thing I noticed is that it makes me tired and I did have an “invisible” rash one day where I itched everywhere. I took an oatmeal bath, used cotizone cream and Benadryl and it didn’t go away for 3 days. I haven’t had any other problems, the prednisone I was on for 3 months after made me gain a lot of weight and my face broke out. I haven’t really had any problems but the pancreatitis is scaring me reading these posts. How common is it to develope this from the medicine??!!

  10. I’ve taken azathioprine for about 18 months now, i take 150mg a day. I was weaned from cyclosporin onto these and have had no side effects from them (unlike the cylosporin which the side effects were awful) i have however had a few nasty flare ups since being onit so its obviously not 100% effective for me but I haven’t had any problems with side effects at all.

  11. I was on 50mg Aziathioprine, it took massive effect I was also on Ciclosporin an Mesalzine, aziathrioprine in 3 weeks time the doctor put my dose up of aziathioprine to 150mg. Within a week I was having high temperature and feeling very ill. I suddenly passed out one morning and went in to hospital to find out my white blood cells where very low and they started treating me an took me off all medication. So the doctor told me I’m still a bit aneamic. Be careful with Aziathioprine, especially on a high dose

  12. My rheumatologist is planning to start me on Imuran for Behcet’s, which is causing Ischemic Colitis (I have been having flares every time I go down to 40 mg. of Prednisone). I am nervous after having read about Imuran’s side effects- I already suffer greatly from joint pains and extreme fatigue. (Currently, my alternative is Remicade and I am not too psyched about that either, but I just want to be careful.)
    My doctor was even initially hesitant to begin Imuran, since my TPMT levels were quite low (16). It seems like people that are going to have major reactions have them almost right away, while those for whom it works great aren’t noticing effects for some time. I am afraid I won’t know the difference between a life-threatening side effect and a major flare…
    Did anyone notice a correlation between their TPMT levels and negative experiences with Azathioprine?

  13. Hi,

    Does anyone out there have any experience with or know more about azathioprine and the risk of lymphoma?

    I was diagnosed with severe UC seven years ago. I lost so much blood that I had to be hospitalized for a week and given a blood transfusion. At first, my doctor prescribed Prednisone and Asacol–then I became dependent on Prednisone to the point that I would go into a flare as soon as I started tapering off of it. About five years ago, I started taking azathioprine. I’ve experienced some wicked nausea, but overall the drug has been mostly effective for me. However, I am VERY concerned about the risk of hepatosplenic T-cell lymphoma (HSTCL), a rare type of T-cell lymphoma, that seems to happen particularly in IBD patients who take azathioprine and is very aggressive (er, fatal). As of January 2012, I’d been flare free for 18 months, so my doctor agreed that it’d be a good time to try coming off the azathioprine. Two months later, I’m in a severe flare and am even considering taking extended leave from work to cope with the flare (very unlike me).

    I’m 34, have a great family and really f’ing want to enjoy life. Part of me wonders if I should just stay on azathioprine so that I can enjoy my life, even if it may be shorter.

    Does anyone out there have any experience with or know more about azathioprine and the risk of lymphoma? I follow (my version of) the SCD and a strict gluten-free diet. I do yoga. I have pretty relentess anxiety, but do a fairly good job of managing it when not in a flare. In my natural state, I’m a tree-hugging, natural foodie. I hate taking medicines. But, I can’t seem to live without them. Help!

    1. Hi Allie,
      I too am worried about the side effects of being on AZA, especially at 34 which I consider to be a potentially long time to be on such a drug, but I have to be honest that having had two flare ups requiring 3 week stints in hospital, that I was lucky enough to tolerate 200mg of AZA which for the last two and a half years has kept me [essentially] remission free and without issue.

      I have had to monitor bloods of course, and this has required some tweaking to meds and otherwise I can only report the growth of moles (!) which apparently is fairly common for AZA patients.

      I have now been off AZA for 3 weeks and yes it is like having the stabilisers off but I am basically “listening” to my body a lot more now and not quite as care free as I was. I would definitely go back on it if I start slipping, but I think as most [that can tolerate it] would say, you need to take the chance, because unchecked flares are pretty horrible. I suppose in way we’re lucky that we have it as an option to improve our situation (?).

      Ultimately you need to find what works for you, but for me I am happy to try balancing between using it when I need it and trying to limit the drugs that I take.

    2. I have a 14.5 year old Border Collie. Five years ago, in 2009, she came down with Auto Immunue Hemolytic Anemia. She was treated with a combination of Prednisone and Azathioprine. She survived after being at near death and made a full recovery. We’ve had a great 5 years. Three months ago she was diagnosed with Lymphoma. We are treating homeopathically with essiac tea and other items.

    1. im 14 and im on 100mg and since being on it im alot more short tempered and get frustrated easily. I am a teenager but since starting the tablets there has been a change in my mood

      1. Hi lauren,
        My daughter is 13 and was diagnosed 9 months ago. She has been on Asacol HD, but is having stomache aches frequently and Dr is thinking of going on Imuran. Can you tell me what you started out taking, how long you’ve been taking med, and any affects you’ve had?

    2. my doctor just up my dose to 100 mg yesterday,plus prednizone,today i am extreemly dizzy,my heart is beating really hard and yes my moods are very unpredictable

  14. Was diagnosed with UC about 10 years ago now been on combinations of 6mp, steroids and sulphersalazine EC tabs. Nothing so far has had a lasting effect. Changed doctors two -three months ago and he swapped out the steroids and 6mp for azathioprine with the sulphersalazine. I thought what have I got to loose and I have actually developed a taste for hospital food.

    Made the swap over a month. First of all it was brilliant for the first time since I first got sick I could look forward and I had hope. The aza gave me a rash that i could cope with and i was a little achy in my legs but the flu had hit everyone so i figured that was why i was sore. But then the pain just kept getting worse. Then about a week ago I started to ache all threw my bones, my hands are so sore in the mornings that the other day I had to get in the shower partly dressed as I was to sore to undress fully. I’ve been off it 3 days now and the pain is manageable and mostly in morning. Absolutely devastated, my bones are aching I had to leave work today because i couldnt cope i could feel a flare up beginning and I just couldn’t cope emotionally.I have no idea when it’s going to subside enough for me to use a keyboard, never been so happy to have a smart phone as I am now otherwise I would just be scared by myself, not that I’m happy that orhers have had similar experiences but glad I’m not alone.

    I’m back on the steroids with the sulphersalazine

    1. Experience and suggestions for dealing with post reaction body pain

      Had UC / Crohns for 14 years. Started Azathioprine 2 weeks ago. After a week, increased to 100mg/day. Next day the worst flew I have ever experienced started. Day 2 body pains started. Stopped drug. Three days later, flu is 90% is better but the body pains are still brutal.

      Any suggestions appreciated.


  15. In reply to the increased anger / frustration issue addressed by Lauren and Marla.

    Myself the side effects have been more physical (achy rashy). But that being said when I asked my partner if he thought that I had become more short tempered he replied that I was more emotional, and I know for myself that lately I seem to have no patience for pettiness, I assumed that this was due to my own frustrations with trying to get my body not to turn on me, while having to listen to girls at work argue about someone using thier pen. But it may have been a side effect of the azathioprine, or I may just be feeling a bit fed up. I have found that ignoring the things that trigger my negative feelings where I can (things that are out of my control or that are really if no consequence) has certainly helped.

  16. Has anyone found any success with the use of Medical Marijuana (or street marijuana if not available as legal medicine) (no legal/moral judgements here)?

    I have found it really helps. They will never do studies on this stuff because it is a plant and no big pharmaceutical companies can make money from it if everyone grows the plant in their homes! Yes, there are side effects (the high, the brain stuff, if smoked then the lung issues) but overall in my non-medical and subjective judgement, the side effects are a lot less than Prednisolone, Azathioprine (cancer-causing) and all the other ones. Yes, we may need these too to deal with the immune issue, but in terms of the accompanying symptoms (the insomnia, the pain, the gut, the bleeding…) marijuana really seems to help. A couple of tokes in the evening (and depending on your schedule and life, maybe a couple in the morning) can help.

    I am interested in people’s responses.

    1. I was diognosed with uc 4 years ago following the birth of my first child. I have been given every medication under the sun, dependent on steroids taking 100mg aza but still flaring daily really is a debilitating illness it’s hard not to get down. Doing much research I found that smoking can improve symptoms so I thought may as well give it a go I came off all drugs 6months ago and started to smoke 3-5 cigs a day oh can’t believe the difference not had a single flare since the day I started feel amazing I now have my life back and can enjoy my children. Yes maybe it might knock a few years off at the end but I’m enjoying the time I have the side effects are prob less than being on aza long term but this is the only thing that’s ever worked for me so I’m happy :) so maybe it’s not the cannabis but the nicotine your bennifitting from?

  17. Was diagnosed with UC in may of 2012. I had symptoms of UC about a year before i was actually diagnosed. When first diagnoised was started out on 4.8 g of asacol as well as canasa and rawasa enemas. That combination worked tremedously for about 2 months and then everything stated going downhill. I was then put on steroids along with the previoulsy mentioned medication for about a month with no changes. I was in the hospital soon after that because flare was very bad (doctor said its the worse he had ever seen). i was having like 17 BM’s/day all with blood, horrible. They gave me IV steroids (60 MG/day) along with the asacol and steroid ememas. I noticed some change but not the desired effect that I or my doctors were looking for. I was released from the hospital because the BM’s slowed down to about 10/day and inflamation levels in my blood work decreased. I started taking 50mg of imuran for about a week with no significant impact so the doctor bumped me up to 200mg/day. I have been on 200mg for a week now and my symptoms have gotten better. I only have 6 BM’s a day, way better. The only real negative effects of the imuran that I have is that i notice that my heart pounds and i have pain in the upper right quadrant of the abdomen right under rib cage. Got first blood work done today, waiting for results. Hopefully everything looks good because the imuran seems to be working. Current medications currently on (20 mg steroids-taper, asacol 4.8 grams/day, 200mg imuran, prilosec 2pills/day). I am 38

  18. I have been on 150mg of Imuran for 10 years. I have Crohns. I am finally well enough to taper down, and I have successfully gotten down to 100mg. I was taking it in the morning and felt so nauseated, the nausea went on for 8 years, I just thought it was normal. My GI doc told me to take it at night before bed. I just have a light snack, and take it and go right to bed. Now I don’t get naseated, unless I take it and don’t go to bed. It seems to help. I was having joint pain for years, and they never could figure it out, my doc thought it was related to my Crohns. Now that I am in remission, they have decided it’s not my Crohns. But, since I have been tapering down on the Imuran, my joint pain is better. So, I think the joint pain is caused by the Imuran, even though it is not listed as a side effect.

  19. jeez,it scares me to take AZA after reading all these comments.i just took it for 4 days and i have back pain but im not sure because of the medicine or because i keep looking at laptop thus bending my back…

  20. I have DLS and show alot of the symptoms right now for SLE, going threw testing for this. I am on Azathioprine 50 2 x’s a day. The first night I took it, I was up vomiting all night. The second time I took it I was nauseaed but fine. I am on 6 other oral medications and have been on them for a while. None of them have done this to me. Two days after I started this medications, I got a left ear ache, then left muscle upper arm pain and left neck pain. The next morning I got pain in my left I and started to see this dark spot and light obstructing my vision. Then lightening in my eye. I went into the eye doctor, My retina is bleeding in 4 different area’s and there is fluid leaking as well in the back of my eye. My optic nerve is also enlarging in both eyes and pressure is building up behind both eyes. Plus,my left eye showed some type of blockage behind it.

    I don’t have high blood pressure and I don’t have diebete’s. This all happened on a Monday, by Wed. I was in the ER with a trmendous headache only on the left side of my head, blurred vision, pain in my ear, jaw, neck left arm, tingling in my hand, my dr said it was signs of a stroke. The CT, showed nothing. No bleeding in the head, no blockage or lessions, thank god, just the trigger of a really bad migraine in the wrapped optical nerves from all the pressure of what is happening to my left eye.

    Today is Thursday, and it has started all over again in my left eye. I am baffled. I am tired of fighting with dr’s on what is happening to me as well. FML!

  21. I have had ulcerative colitis since 2000 and was initially treated with a selection of non steroid anti inflammatorys and aza but after 9 months of this was even worse. I then went into hospital and was treated for a week on Aza and IV NSADS but still didn’t improve. I was told treatment wasn’t working and I would have to have a total bowel removal. I was devestated. I was offered one last shot, cyclosporin. I took it and had it in IV. After months of bleeding, urgency, incontinence, and essentially living hell within hours of going on cyclosporin I started to settle. I really couldn’t believe the transformation and how quickly it worked. The next day I was much more settled and out of hospital a week later. Sent home on oral cyclosporin and AZA. Gradually reduced the Cyc but stayed on the AZA. Been on AZA ever since 13 years. 200mgs per day. Initially for the first 6 months or so I had aches and pains mainly from joints but this eventually subsided. My skin is drier and I believe this to be a side effect of the AZA. The other big thing for me is photosensitivity. I have no resistance to the sun whatsoever. Even with factor 50 I still burn. I have recently reduced my dose on a trial basis to 100 mg. I have been told that AZA takes 3 months to get into and out of the system. Been on 100 mg now for 4 months with no adverse effects. Am going to try and drop it even further with a view of getting off it completely. Am going to seek advice from consultant who has said if I reduce just monitor carefully. As for the sickness reported by other people I can honestly say I have never felt sick on AZA at all. Having said this I really don’t want to stay on it any longer, but I also don’t want go go back to what I was like before. I will add that over the last 18 months I have changed my diet considerably and have cut out sugary, fatty, and processed foods. I truly believe that this has had positive results on my UC even though my consultant has said it’s nothing to do with what you eat! Hope this helps.

  22. My consultant has suggested starting me on Azathioprine as I keep having flare ups on my present medication Salazoprin which I have been on for 13 years now. After reading on the negative comments about Aza I am extremely nervous. Is there anybody who actually gets on with this medication?

    1. Yes I have been taking Imuran for 8 years now
      I did experience all the side effects… specialist said it is very effective its just getting past the body getting used to it

      It literally rook a whole year!

      But not pain or flare up…..nothing
      a happy normal life…..on a nasty drug that is very effective

      I think if your doctor does not specialise in the field or just deal with this type of patient every single day……and hear all the effects they don”t know its normal and does calm down

  23. My husband has struggled to get his symptoms under control for the last five years on and off;- he has been through a lot, not unusual for a patient with this condition. He is currently on mercaptopurine which is doing the job it’s supposed to and keeping him from relapsing; however he collapsed last week at work whilst sitting in a meeting-he had eaten, drank etc. His work colleagues thought he had, had a stoke. Paramedics at the scene put it down to a normal fainting episode? I am suspect that it may be to do with the medication? He also has blood in his urine-tested under control conditions with clinistix- so I am concerned that his consultant finds it incidental when it clearly says on the mercaptopurine side affects listed that these symptoms should at least warrant further investigation.
    He is exceptionally tired and at times finding his memory is not what it should be-
    Has anyone else had similar issues around this drug? It’s so difficult to know what to do, I know this medication comes with it’s compromises but I just don’t want to watch the man I love struggle on like this. Dose anyone know of consultants who treat this disease without the harsh cytotoxics? surely there must be another way?

  24. When I started taking Imuran I did experience all the symptoms mentioned here like nausea, headaches, dizziness ect…..The specialist I was seeing said it is because it takes time for the body to get used to it……I even experienced the hair loss

    I have been in remission from Crohns and Colitis for 8 years

    My hair grew back
    no more nausea

    just the body getting used to taking it

    with monthly monitoring of my blood

  25. Have just started on imuran 2 weeks ago for Crohn’s disease. I also do remicade treatments every 8 weeks. I’ve noticed since I started taking the imuran that my lower back just kills me and of course I’m back to having diarrhea. Does any one else experience this?

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