{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (20%-50% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.4 – 1.5 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}