{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT intermediate metabolizer and NUDT15 possible intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Initiate azathioprine at 20-50% of standard starting dose if the standard starting dose is ≥ 2 mg/kg/day. If starting dose is already below normal recommended starting dose (i.e., <2 mg/kg/day), dose reduction might not be recommended. During therapy, adjust the doses of azathioprine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing 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."}