Do you feel comfortable using azathioprine for dermatomyositis in patients with cirrhosis?

Azathioprine can cause liver damage, albeit this is a rare complication and usually asymptomatic. Therefore, I would probably avoid it in cases of liver cirrhosis and try other medications, like mycophenolate, IVIG, tofactinib. In either case, I would consult at the same time with the patient's hepa...

Great question! AZA hepatic toxicity is thought to be multifactorial but may be partially related to secondary glutathione reduction leading to mitochondrial damage. Glutathione levels are often already decreased in patients with notable hepatic dysfunction, which may theoretically increase the risk...