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Hello and welcome to JA. Dr Saleem here. Will be answering you shortly
Well the metallic taste is definitely due to metronidazole. Azathiopurine can cause bone marrow suppression and so low cell counts and thus easy bleed. Similarly steroids are irritant to stomach lining and can cause ulceration there. The commonest and most likely cause here would be gum bleed thats too small and only noticed when mixed with saliva in his case. As he has just started azathiopurine so gross decline in cell counts is also less likely this early. Nothing much of concern ,just keep an eye on saliva color and observe for any rash, bleed from nose, gums , in stool etc.
Monitor azathiopurine with periodic complete blood counts initially atleast fortnightly.
Take omeprazole or any other antacid to protect the stomach lining too.
Hope it answers your query.
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No not really its generally safe to take Ranitidine. Used with caution only when there is liver damage already due to some other cause.
Well its unlikely to be a result of that. Only if he gets breathless with coughing up of pinkish sputum is when you should seek professional help immediately .
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