{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT intermediate metabolizer and NUDT15 normal metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Initiate azathioprine at 30-80% of standard starting dose if the standard starting dose is > 2 mg/kg/day. If starting dose is already below standard recommended starting dose (i.e., <2 mg/kg/day), dose reduction might not be recommended. During therapy, adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing azathioprine over other agents. Please consult a clinical pharmacist for more information."}