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Azathioprine monitoring — GPhC CRA MCQ

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ModerateAdverse Drug ReactionsAzathioprine monitoringGPhC CRA

A 42-year-old man with Crohn's disease presents with a prescription for azathioprine 50 mg once daily. His TPMT (thiopurine methyltransferase) status is noted as normal activity. What monitoring is required before and during treatment?

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Correct answer: B — Full blood count should be checked weekly for the first four weeks and regularly thereafter, along with liver function tests

Azathioprine can cause bone marrow suppression (leucopenia, thrombocytopenia) and hepatotoxicity. Even with normal TPMT activity, the BNF recommends full blood count monitoring weekly for the first four weeks, then at least every three months during treatment. Liver function tests should also be monitored. TPMT testing helps identify patients at higher risk of myelosuppression but does not eliminate the need for ongoing monitoring.

Reference: BNF; NICE NG129 Crohn's Disease