Complications
Likelihood greater if treatment is longer and/or doses higher. Patients should be monitored for prevention by bone mineral densitometry of the lumbar spine and hip.
Calcium and vitamin D supplementation is recommended. Bisphosphonates may also be used.[1]
Glucose levels should be monitored. Diabetes is rare in patients with normal glucose tolerance before treatment; more common in patients with impaired glucose tolerance.
Alternate therapy regimen with azathioprine should be tried if possible. Corticosteroids should be kept at lowest dose possible. Diabetes treated appropriately.
Blood pressure should be monitored regularly and treated appropriately.
Dependent on the dose and duration of treatment. Dose should be adjusted if possible. Regular exercise can be advised.
More pronounced with daily dosing. Corticosteroids substituted with immunosuppressant if possible or alternate-day regimen tried.
Regular eye examinations are advised during treatment (once a year). Treated appropriately.
Rare adverse effect of azathioprine therapy. Monitored as appropriate.
Rare in patients who do not have associated hepatitis B and/or C infection and related mainly to the presence of cirrhosis. Develops in 1% to 9% of patients with autoimmune hepatitis and cirrhosis. Risk factors for hepatocellular carcinoma are cirrhosis ≥10 years, portal hypertension, continuous inflammation, and immunosuppressive therapy ≥3 years.[1] Patients with cirrhosis should be screened by hepatic ultrasound examination, with or without serum alpha‐fetoprotein level, every 6 months.[1][26]
Complications are treated and patient considered for transplantation.
Dependent on the dose and duration of treatment. Dose should be adjusted if possible. Treat symptomatically.
Rare adverse effect associated with corticosteroid use. Monitored as appropriate.
Occurs more often when corticosteroids are combined with non-steroidal anti-inflammatory drugs. Prednisolone should be taken with food to minimise the risk. Appropriate preventative therapy should be given when needed (e.g., proton-pump inhibitors).
Risk of infection is increased due to immunosuppressive therapy. Patients should be carefully monitored for possible infections and treated when they occur.
Regular monitoring of white blood cells (leukocytes) and erythrocytes is required.
Rare adverse effect of azathioprine therapy. Monitored as appropriate.
Rare adverse effect of azathioprine therapy. Monitored as appropriate.
Rare adverse effect of azathioprine therapy. Monitored as appropriate.
Rare adverse effect of azathioprine therapy. Monitored as appropriate.
Pregnant women or women trying to get pregnant should be warned of the risk to the baby. Monitored as appropriate.
One systematic review found no increase in the risk of low birth weight or birth defects in mothers taking azathioprine.[77]
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