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Unexplained infections, ulceration of the throat, bruising and bleeding are the main signs of overdosage with Imuran and result from bone marrow depression, which may be maximal after 9 to 14 days. These signs are more likely to be manifested following chronic overdosage, rather than after a single acute overdose. There has been a report of a patient who ingested a single overdose of 7.5 g of Imuran. The immediate toxic effects of this overdose were nausea, vomiting and diarrhoea, followed by mild leucopenia and mild abnormalities in liver function. Recovery was uneventful.
There is no specific antidote. Blood counts should be closely monitored and general supportive measures, together with appropriate blood transfusion, instituted if necessary. Active measures (such as the use of activated charcoal) may not be effective in the event of azathioprine overdose unless the procedure can be undertaken within 60 minutes of ingestion.
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