Drug interactions
Azathioprine + Fosinopril-hydrochlorothiazide
Severity: Major
Azathioprine and Fosinopril-hydrochlorothiazide: major interaction.
Last updated Sources: US FDA label
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 or neutropenia, particularly in patients with renal impairment. The risk is greatest early in therapy or with higher azathioprine doses.
What this interaction means in plain words
Azathioprine and Fosinopril-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; Fosinopril-hydrochlorothiazide belongs to Cardiovascular.
Why it happens
Proposed additive bone marrow suppression; ACE inhibitors may reduce erythropoietin and affect hematopoiesis.
What to do
Monitor complete blood counts regularly, including at the start of combined therapy. Reduce or stop azathioprine if cytopenias develop, or consider an alternative antihypertensive.
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?
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References
Other interactions of Fosinopril-hydrochlorothiazide
- Aliskiren + Fosinopril-hydrochlorothiazide Contraindicated
- Dofetilide + Fosinopril-hydrochlorothiazide Contraindicated
- Fosinopril-hydrochlorothiazide + Protein a column Contraindicated
- Fosinopril-hydrochlorothiazide + Sacubitril / valsartan Contraindicated
- Aldesleukin + Fosinopril-hydrochlorothiazide Major
- Amifostine + Fosinopril-hydrochlorothiazide Major
Other interactions of Azathioprine
- Adenovirus types 4 and 7 live + Azathioprine Contraindicated
- Azathioprine + Bcg vaccine live Contraindicated
- Azathioprine + Febuxostat Contraindicated
- Azathioprine + Influenza virus vaccine quadrivalent intranasal Contraindicated
- Azathioprine + Measles mumps and rubella vaccine Contraindicated
- Azathioprine + Measles mumps and rubella vaccine live Contraindicated
Frequently asked questions
Can I take Azathioprine with Fosinopril-hydrochlorothiazide?
MediHelp rates the interaction as major. Azathioprine and Fosinopril-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 or neutropenia, particularly in patients with renal impairment. The risk is greatest early in therapy or with higher azathioprine doses.
How serious is the interaction between Azathioprine and Fosinopril-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, including at the start of combined therapy. Reduce or stop azathioprine if cytopenias develop, or consider an alternative antihypertensive.
What other medicines interact with Fosinopril-hydrochlorothiazide?
MediHelp also lists interactions of Fosinopril-hydrochlorothiazide with, for example, Aliskiren, Dofetilide, Protein a column. The full list is on the Fosinopril-hydrochlorothiazide page.
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