Imuran vs. Trexall

• Are Imuran and Trexall the Same Thing?
• What Are Possible Side Effects of Imuran?
• What Are Possible Side Effects of Trexall?
• What is Imuran?
• What is Trexall?
• What Drugs Interact with Imuran?
• What Drugs Interact with Trexall?
• How Should Imuran Be Taken?
• How Should Trexall Be Taken?

Imuran (azathioprine) and Trexall (methotrexate) are antimetabolites used to treat symptoms of rheumatoid arthritis.

Imuran is also used to prevent the body from rejecting a transplanted kidney.

Trexall is also used to treat some cancers and severe skin diseases such as severe psoriasis.

Side effects of Imuran and Trexall that are similar include upset stomach, nausea, or vomiting.

Side effects of Imuran that are different from Trexall include diarrhea, loss of appetite, hair loss, or skin rash.

Side effects of Trexall that are different from Imuran include inflammation of the mouth and lips, abdominal pain, dizziness, tired feeling, headache, bleeding gums, blurred vision, or leukopenia (low number of white cells in blood).

Both Imuran and Trexall may interact with sulfa drugs.

Imuran may also interact with allopurinol, mercaptopurine, methotrexate, blood thinners, cyclosporine, olsalazine, sulfasalazine, trimethoprim, or ACE inhibitors.

Trexall may also interact with azathioprine, chloramphenicol, hydroxychloroquine, retinol, tretinoin, isotretinoin, steroids, phenytoin, probenecid, tetracycline, theophylline, gold treatments, oral diabetes medications, penicillin antibiotics, medicines that reduce stomach acid, nonsteroidal anti-inflammatory drugs (NSAIDs), or salicylates such as aspirin and others.

Common side effects of Imuran include:

• upset stomach,
• nausea,
• vomiting,
• diarrhea,
• loss of appetite,
• hair loss, or
• skin rash.

Tell your doctor if you experience unlikely but serious side effects of Imuran including:

• muscle loss,
• hair loss,
• cold/numbness in the fingers,
• mouth sores,
• difficult/painful swallowing, or
• greasy stools.

Common side effects of Trexall include:

• inflammation of the mouth and lips,
• nausea,
• vomiting,
• upset stomach,
• abdominal pain,
• dizziness,
• tired feeling,
• headache,
• bleeding gums,
• blurred vision, and
• leukopenia (low number of white cells in blood).

Tell your doctor if you have serious side effects of Trexall including:

• dry cough,
• shortness of breath,
• diarrhea,
• white patches or sores inside your mouth or on your lips,
• blood in your urine or stools,
• urinating less than usual or not at all,
• fever,
• chills,
• body aches,
• flu symptoms,
• sore throat and headache with a severe blistering/peeling/red skin rash,
• pale skin,
• easy bruising or bleeding,
• weakness,
• stomach pain,
• loss of appetite,
• dark urine,
• clay-colored stools, or
• jaundice (yellowing of the skin or eyes).

Severe side effects occur more frequently in patients taking the high doses of Trexall.

Imuran (azathioprine) is an immunosuppressive antimetabolite used to prevent the body from rejecting a transplanted kidney. Imuran is also used to treat symptoms of rheumatoid arthritis. Imuran is available in generic form.

Trexall (methotrexate) is an antimetabolite drug that is used to treat some cancers, severe skin diseases such as severe psoriasis, and to treat forms of rheumatoid arthritis. Trexall is available in generic form as methotrexate.

Imuran may interact with diuretics (water pills), blood thinners, cyclosporine, insulin or oral diabetes medications, rifampin, azole antifungals, or seizure medications.

Imuran may also interact with antibiotics, anticholinesterase, isoniazid, bupropion, cholestyramine, cyclosporine, digitalis glycosides, estrogens (including oral contraceptives), barbiturates, ritonavir, indinavir, nonsteroidal anti-inflammatory drugs (NSAIDs), quetiapine, skin tests, thalidomide, and live or inactivated vaccines.

Following prolonged therapy, withdrawal of corticosteroids such as dexamethasone or trexall may result in symptoms of the corticosteroid withdrawal syndrome including muscle or joint pain and feeling unwell (malaise).

Trexall may interact with azathioprine, chloramphenicol, hydroxychloroquine, retinol, tretinoin, isotretinoin, steroids, sulfa drugs, phenytoin, probenecid, tetracycline, theophylline, gold treatments, oral diabetes medications, penicillin antibiotics, medicines that reduce stomach acid, nonsteroidal anti-inflammatory drugs (NSAIDs), or salicylates such as aspirin and others. Tell your doctor all medications and supplements you use. This drug should not be used in pregnant or breastfeeding women due to likely harm to the fetus or infant.

Trexall may interact with allopurinol, methotrexate, blood thinners, olsalazine, sulfasalazine, sulfamethoxasole, trimethoprim, or ACE inhibitors.

The dose of Imuran to prevent transplant rejection and minimize toxicity varies. The initial dose is usually 3 to 5 mg/kg daily, beginning at the time of transplant. It is usually given as a single daily dose on the day of, and in some cases 1 to 3 days before, transplantation. Maintenance levels of 1 to 3 mg/kg daily are usually possible. For rheumatoid arthritis, the initial dose is approx. 1.0 mg/kg (50 to 100 mg) given as a single dose or twice-daily. Maximum dose is 2.5 mg/kg per day.

Trexall is supplied in 5, 7.5, 10, and 15 mg tablets. The dose is designed for each patient's problem and can range from about 7.5 mg per week to 30 mg per day, depending on the disease process and the doctor's judgment. Trexall has been used in children with juvenile rheumatoid arthritis, but most doses were individualized.