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Before starting the administration of immunosuppressantsthe prescriber should check to see if the patient has a history of VZVSerologic testing may be useful in determining previous exposurePatients who have no history of exposure should avoid contact with individuals with chickenpox or herpes zosterIf the patient is exposed to VZVspecial care must be taken to avoid patients developing chickenpox or herpes zosterand passive immunisation with varicella-zoster immunoglobulinVZIGmay be considered.

IMURAN is teratogenic in rabbits and mice when given in doses equivalent to the human dose5 mg/kg dailyAbnormalities included skeletal malformations and visceral anomalies11.

The mechanisms whereby azathioprine affects autoimmune diseases are not knownAzathioprine is immunosuppressivedelayed hypersensitivity and cellular cytotoxicity tests being suppressed to a greater degree than are antibody responsesIn the rat model of adjuvant arthritisazathioprine has been shown to inhibit the lymph node hyperplasiawhich precedes the onset of the signs of the diseaseBoth the immunosuppressive and therapeutic effects in animal models are dose-relatedAzathioprine is considered a slow-acting drug and effects may persist after the drug has been discontinued.

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