Shared care policies are developed when sophisticated or complex treatments that were initiated in secondary care are then prescribed by a GP. They set out the process that needs to be followed for the GP to take on prescribing responsibility. The term 'Effective Shared Care Agreement' (ESCA) is now being used. ESCAs should be patient specific and encompass all aspects relevant to that particular patient.
Clinical responsibility should be considered for transfer to primary care only where it is agreed that the patient's clinical condition is stable or predictable.
Shared Care Policy And Prescribing Information For Oral AZATHIOPRINE [RENAL Patients](Adults Only)
Applies to: NHS Grampian / Version 3 /
Prepared by / Authorised for issue by / Document no:
NHSG/RenalSCP/Azath/MGPG713
Author(s) as job title(s) / Medicines Guidelines
and Policies Group / Effective date: January 2015
Brian Porteous / Caroline Hind / Review Date: January 2017 or sooner if recommendations change
Supersedes: Version 2, 2006
Please keep this document in the patients notes
PATIENT NAME
CHI NUMBER
ADDRESS
DATE OF BIRTH
Insert patient sticker here / HOSPITAL
TELEPHONE NO
CONSULTANT (print name)
SIGNATURE / WARD
DATE
THERAPEUTIC INDICATION FOR THIS PATIENT:
(To be completed by consultant)
DOSAGE/FREQUENCY OF ADMINISTRATION:
SAFE PRACTICE IS THAT THE CLINICIAN WHO ORDERS THE TEST MUST ACT ON THE RESULT
CARE WHICH IS THE RESPONSIBILITY OF THE HOSPITAL CONSULTANT
1.Baseline:
Full Blood Count (FBC)
Liver Function Tests (LFT), U&Es and creatinine.
2.Copy of results to be sent to GP.
3.Initiation of therapy and recommendations for dose increments.
This will be controlled by the Renal Unit.
4.The Renal Unit has primary responsibility for monitoring clinical response to treatment according to the schedule below.
- FBC and LFTs (inc. ALT and Alk Phos) weekly for six weeks and then fortnightly until dose stable for six weeks. Thereafter, monthly.
- U&Es and creatinine every six months.
- Patients should be asked about the presence of sore throat, abnormal bruising or bleeding at each visit.
GENERAL PRACTITIONER (GP)
1.Prescribing of medication under guidance of consultant.
2.To preserve vital venous access, monitoring will be done by the renal service at ARI unless otherwise notified.
3.The GP should be aware that the drug can cause bone marrow suppression, leucopenia, increased risk of malignancy – lymphomas and skin cancer.
- Patients should be asked about the presence of sore throat, abnormal bruising or bleeding at each visit.
NOTE: In addition to absolute value for haematological indices a rapid fall or a consistent downward trend in any value should prompt caution and extra vigilance.
When writing laboratory request forms always include details of the patient’s medication
NOTE: If something unexpected occurs contact Renal Unit/On Call Registrar or Consultant.
Shared Care Policy and Prescribing information for General Practitioners
AZATHIOPRINE (Renal patients, adults only continued)
Abnormal Monitoring Results / Action To Be Taken
- WBC <4 X 109/L
- Platelets <150x109/L
- >2-fold rise in ALT or Alk Phos.
- MCV>105fl
- Abnormal bruising, sore throat, rash, oral ulceration
- Unexplained fever
- Malignancies
For specific product information please consult the current summary of product characteristics ( and the BNF( )
Other information
- Live vaccines should be avoided in patients taking azathioprine.
- A single dose of pneumococcal polysaccharide vaccine and annual influenza vaccine should be given.
- Varicella Zoster Immunoglobulin should be given to non-immune individuals if exposed to shingles or chickenpox.
- There are a number of drug interactions that must be considered when a new drug is prescribed. Please refer to Summary of Product Characteristics, BNF, or contact Medicines Information
- Do not prescribe with allopurinol (unless discussed/advised by a renal consultant).
- Inhibition of the anticoagulant effect of warfarin, when administered with azathioprine has been reported. Monitor concurrent use.
- Increased risk of haematological toxicity with co-trimoxazole and trimethoprim.
- To minimise the risk of skin cancer, exposure to sunlight and Ultra Violet light should be limited by wearing protective clothing and using sunscreen with a high protection factor.
Discuss with consultant. Azathioprine should not be given to patients who are pregnant or likely to become pregnant without careful assessment of risk versus benefit. Transplant patients and those with SLE should not stop azathioprine on becoming pregnant.
Breast-feeding
Not recommended. Discuss with Aberdeen Maternity Hospital.
Responsibilities of GPs
A GP should:
- Contact a consultant or registrar in the Renal Unit in the event of a drug reaction or monitoring abnormality or anything you are unhappy about.
- Only continue to prescribe azathioprine if it is being satisfactorily monitored.
- Be alert for any of the known adverse reactions.
Reference
DH Shared Care Guidelines -
Grampian Medicines Management Website, Shared Care Policies webpage -
UNCONTROLLED WHEN PRINTEDReview Date: January 2017 (sooner if recommendations change)NHSG/RenalSCP/Azath/MGPG713- 1 -
Shared Care Policy and Prescribing Information for Azathioprine [Renal Patients] (Adults only)- Version 3, January 2017