{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT possible metabolizer and 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. NUDT15 status could not be determined based on genotyping performed. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}