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Chronic immunosuppression with imuran , a purine antimetabolite increases risk of malignancy in humans.

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IMURAN can cause fetal harm when administered to a pregnant womanIMURAN should not be given during pregnancy without careful weighing of risk versus benefitWhenever possibleuse of IMURAN in pregnant patients should be avoidedThis drug should not be used for treating rheumatoid arthritis in pregnant women12.

There has been a case report suggesting that haematological abnormalities may develop due to the concomitant administration of Imuran and captopril.

It has been suggested that the toxicity of Imuran may be enhanced in the presence of renal insufficiencybut controlled studies have not supported this suggestionNeverthelessit is recommended that the dosages used should be at the lower end of the normal range and that haematological response should be carefully monitoredDosage should be further reduced if haematological toxicity occurs.

When therapeutic response is evidentconsideration should be given to reducing the maintenance dosage to the lowest level compatible with the maintenance of that responseIf no improvement occurs in the patient’s condition within 3 monthsconsideration should be given to withdrawing Imuran.

Imuranin combination with corticosteroids and/or other immunosuppressive agents and proceduresis indicated to enhance the survival of organ transplantssuch as renal transplantscardiac transplantsand hepatic transplantsand to reduce the corticosteroid requirements of renal transplant recipients.

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