Skip to content
MediHelp
MediHelp Drug reference

Drug interactions

Azathioprine + Enalapril-hydrochlorothiazide

Severity: Major

Azathioprine and Enalapril-hydrochlorothiazide: major interaction.

Last updated

For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.

Summary

ACE inhibitors given with azathioprine have been associated with anemia and leukopenia, particularly in renal impairment or transplant recipients. The effect can be significant and may require dose reduction or discontinuation of one drug.

What this interaction means in plain words

Azathioprine and Enalapril-hydrochlorothiazide can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.

Azathioprine belongs to Gastrointestinal Tract; Enalapril-hydrochlorothiazide belongs to Cardiovascular.

Evidence level: Moderate

Why it happens

ACE inhibitors may reduce erythropoietin and bone marrow response, adding to azathioprine myelosuppression; mechanism not fully established.

What to do

Monitor complete blood counts regularly, especially during initiation. Reduce or stop azathioprine if cytopenias develop.

What to ask your pharmacist

  • Does the benefit of taking both outweigh the risk in my case?
  • Do I need any blood test, ECG or other check while on both?
  • What early warning signs should I watch for, and what should I do if they appear?

Bring a full list of your medicines, including over-the-counter products, supplements and herbal remedies, to every pharmacy visit.

Pro+ members

Unlock the full page

Create an account and start a Pro+ trial to unlock the full management advice for Azathioprine and Enalapril-hydrochlorothiazide, the additional notes, the evidence detail and the whole-prescription interaction checker.

  • Full clinical management advice
  • Additional notes
  • Evidence detail
  • Interaction checker for a whole prescription
Create free account Sign in

Try Pro+ free for 14 days on the web. No card needed.

Frequently asked questions

Can I take Azathioprine with Enalapril-hydrochlorothiazide?

MediHelp rates the interaction as major. Azathioprine and Enalapril-hydrochlorothiazide can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. ACE inhibitors given with azathioprine have been associated with anemia and leukopenia, particularly in renal impairment or transplant recipients. The effect can be significant and may require dose reduction or discontinuation of one drug.

How serious is the interaction between Azathioprine and Enalapril-hydrochlorothiazide?

MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor complete blood counts regularly, especially during initiation. Reduce or stop azathioprine if cytopenias develop.

What other medicines interact with Enalapril-hydrochlorothiazide?

MediHelp also lists interactions of Enalapril-hydrochlorothiazide with, for example, Aliskiren, Dofetilide, Protein a column. The full list is on the Enalapril-hydrochlorothiazide page.

Full monographs, dosing and an interaction checker in the MediHelp app

Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.

Download on theApp Store Get it onGoogle Play

Browse A–Z · Drug interactions

Get the app Sign in