Drug interactions
Infliximab + Mercaptopurine
Severity: Major
Infliximab and Mercaptopurine: 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
Combining infliximab with a thiopurine increases the risk of serious infections and may increase the risk of lymphoma. Hepatosplenic T-cell lymphoma has been reported rarely, mainly in young males with inflammatory bowel disease. The combination is nonetheless used because it can improve efficacy and reduce anti-drug antibodies.
What this interaction means in plain words
Infliximab and Mercaptopurine 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.
Infliximab belongs to Musculoskeletal; Mercaptopurine belongs to Oncology.
Why it happens
Additive immunosuppression from TNF-alpha blockade and thiopurine-mediated lymphocyte suppression.
What to do
Monitor for infection, blood counts and liver tests, and screen for tuberculosis and hepatitis B before starting. Reassess the need for continued combination therapy periodically, especially in young males.
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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Other interactions of Mercaptopurine
- Adenovirus types 4 and 7 live + Mercaptopurine Contraindicated
- Azathioprine + Mercaptopurine Contraindicated
- Bcg vaccine live + Mercaptopurine Contraindicated
- Febuxostat + Mercaptopurine Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Mercaptopurine Contraindicated
- Mercaptopurine + Smallpox 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 Infliximab with Mercaptopurine?
MediHelp rates the interaction as major. Infliximab and Mercaptopurine 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 infliximab with a thiopurine increases the risk of serious infections and may increase the risk of lymphoma. Hepatosplenic T-cell lymphoma has been reported rarely, mainly in young males with inflammatory bowel disease. The combination is nonetheless used because it can improve efficacy and reduce anti-drug antibodies.
How serious is the interaction between Infliximab and Mercaptopurine?
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 for infection, blood counts and liver tests, and screen for tuberculosis and hepatitis B before starting. Reassess the need for continued combination therapy periodically, especially in young males.
What other medicines interact with Mercaptopurine?
MediHelp also lists interactions of Mercaptopurine with, for example, Adenovirus types 4 and 7 live, Azathioprine, Bcg vaccine live. The full list is on the Mercaptopurine page.
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