Drug interactions
Azathioprine + Mycophenolate
Severity: Major
Azathioprine and Mycophenolate: major interaction.
Last updated Sources: Health Canada product monograph
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
Both drugs inhibit lymphocyte purine synthesis, so combining them gives duplicate immunosuppression with greater risk of infection, bone marrow suppression and malignancy. The combination is generally not recommended in routine practice.
What this interaction means in plain words
Azathioprine and Mycophenolate 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.
Why it happens
Additive antiproliferative effects on lymphocytes through overlapping inhibition of purine synthesis, with additive myelosuppression.
What to do
Avoid using both together; choose one agent. If combination is deliberately used, monitor blood counts frequently and watch for infection.
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
Frequently asked questions
Can I take Azathioprine with Mycophenolate?
MediHelp rates the interaction as major. Azathioprine and Mycophenolate 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. Both drugs inhibit lymphocyte purine synthesis, so combining them gives duplicate immunosuppression with greater risk of infection, bone marrow suppression and malignancy. The combination is generally not recommended in routine practice.
How serious is the interaction between Azathioprine and Mycophenolate?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid using both together; choose one agent. If combination is deliberately used, monitor blood counts frequently and watch for infection.
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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