Imuran Dosage/Direction for Use

Adults and Children: In Transplants: In renal transplantation the dose of Imuran required to prevent rejection and minimize toxicity will vary with individual patients; this necessitates careful management. Initial dose is usually 3 to 5 mg/kg daily, beginning at the time of transplant. Imuran is usually given as a single daily dose on the day of, and in a minority of cases to three days before transplantation. Imuran is often initiated with the intravenous administration of the sodium salt, with the subsequent use of film-coated tablets (at the same dose level) after the post-operative period. Intravenous administration of the sodium salt is indicated only in patients unable to tolerate oral medications. Dose reduction to maintenance levels of 1 to 3 mg/kg daily is usually possible. The dose of Imuran should not be increased to toxic levels because of threatened rejection. Discontinuation may be necessary for severe haematologic or other toxicity, even if rejection of the hemograft may be a consequence of drug withdrawal.
Therapy with Imuran should be maintained indefinitely unless positive contra-indications should arise. Sometimes only a very low dose is necessary if therapy is discontinued even after a period of years, there is a high risk of graft rejection within a few weeks. In other conditions, the dosage and duration of treatment may vary according to the condition, its severity and the clinical response obtained.
A therapeutic response may not be evident a few days or even weeks after initiation of therapy. If no improvement occurs in the patient's condition within three months, consideration should be given to withdrawing Imuran.
For the treatment of most conditions the starting dose is 2 to 2.5 mg/kg orally which should be reduced if haematological or other complications occur.
In chronic active hepatitis the dose is 1 to 1.5 mg/kg/day orally. In rheumatoid arthritis lower doses can be effective.