Drug interactions
Azathioprine + Infliximab
Severity: Major
Azathioprine and Infliximab: major interaction.
Last updated Sources: UK SmPC
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
Combining a thiopurine with an anti-TNF antibody increases the degree of immunosuppression and raises the risk of serious and opportunistic infections. Hepatosplenic T-cell lymphoma has been reported, mainly in young males with inflammatory bowel disease receiving this combination.
What this interaction means in plain words
Azathioprine and Infliximab 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; Infliximab belongs to Musculoskeletal.
Why it happens
Additive pharmacodynamic immunosuppression through purine antimetabolite effects and TNF-alpha blockade.
What to do
Use the combination only when the benefit clearly justifies it, as in selected inflammatory bowel disease patients, and use the lowest effective doses. Monitor for infection, complete blood count and liver tests, and screen for latent tuberculosis and hepatitis B before treatment.
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 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
Other interactions of Infliximab
- Bcg vaccine live + Infliximab Contraindicated
- Infliximab + Influenza virus vaccine quadrivalent intranasal Contraindicated
- Infliximab + Measles mumps and rubella vaccine Contraindicated
- Infliximab + Measles mumps and rubella vaccine live Contraindicated
- Infliximab + Measles mumps rubella and varicella vaccine live Contraindicated
- Infliximab + Measles vaccine Contraindicated
Frequently asked questions
Can I take Azathioprine with Infliximab?
MediHelp rates the interaction as major. Azathioprine and Infliximab 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. Combining a thiopurine with an anti-TNF antibody increases the degree of immunosuppression and raises the risk of serious and opportunistic infections. Hepatosplenic T-cell lymphoma has been reported, mainly in young males with inflammatory bowel disease receiving this combination.
How serious is the interaction between Azathioprine and Infliximab?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use the combination only when the benefit clearly justifies it, as in selected inflammatory bowel disease patients, and use the lowest effective doses. Monitor for infection, complete blood count and liver tests, and screen for latent tuberculosis and hepatitis B before treatment.
What other medicines interact with Azathioprine?
MediHelp also lists interactions of Azathioprine with, for example, Adenovirus types 4 and 7 live, Bcg vaccine live, Febuxostat. The full list is on the Azathioprine page.
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