Drug interactions
Azathioprine + Rabies vaccine
Severity: Major
Azathioprine and Rabies vaccine: 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
Azathioprine may impair the antibody response to rabies vaccine, which is important because rabies is nearly always fatal once symptoms appear. The vaccine is inactivated and safe to give.
What this interaction means in plain words
Azathioprine and Rabies vaccine 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
Azathioprine impairs lymphocyte proliferation and humoral responses to vaccination.
What to do
Give the vaccine, and for post-exposure prophylaxis combine with rabies immunoglobulin as indicated. Check rabies neutralizing antibody titres after vaccination.
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
- Azathioprine 25mg Film-Coated Tablets - SmPC sections 4.3/4.5 (class statement: killed vaccines; "A diminished response to killed vaccines is likely and such a response to hepatitis B vaccine has been observed among patients treated with a combination of aza") — electronic medicines compendium (UK SmPC)
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 Rabies vaccine?
MediHelp rates the interaction as major. Azathioprine and Rabies vaccine 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 may impair the antibody response to rabies vaccine, which is important because rabies is nearly always fatal once symptoms appear. The vaccine is inactivated and safe to give.
How serious is the interaction between Azathioprine and Rabies vaccine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Give the vaccine, and for post-exposure prophylaxis combine with rabies immunoglobulin as indicated. Check rabies neutralizing antibody titres after vaccination.
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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