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Imuran (azathioprine) Disease Interactions

There are 4 disease interactions with Imuran (azathioprine):

Major

Azathioprine (Includes Imuran) ↔ Bone Marrow Depression

Severe Potential Hazard, High plausibility

Applies to: Bone Marrow Depression/Low Blood Counts

Azathioprine may cause severe leukopenia, thrombocytopenia, macrocytic anemia, severe bone marrow depression and, rarely, pure red cell aplasia. Therapy with azathioprine should be administered cautiously in patients with bone marrow depression. Hematological toxicities are dose related. Caution and routine monitoring of blood counts and platelets is recommended. Patients should report any unusual bleeding or bruising.

References

  1. Snow JL, Gibson LE "A pharmacogenetic basis for the safe and effective use of azathioprine and other thiopurine drugs in dermatologic patients." J Am Acad Dermatol 32 (1995): 114-6
  2. Anstey A, Lennard L, Mayou SC, Kirby JD "Pancytopenia related to azathioprine-an enzyme deficiency caused by a common genetic polymorphism: a review." J R Soc Med 85 (1992): 752-6
  3. Singh G, Fries JF, Spitz P, Williams CA "Toxic effects of azathioprine in rheumatoid arthritis: a national post-marketing perspective." Arthritis Rheum 32 (1989): 837-43
View all 16 references
Major

Azathioprine (Includes Imuran) ↔ Infections

Severe Potential Hazard, Moderate plausibility

Applies to: Infection - Bacterial/Fungal/Protozoal/Viral

Serious infections, including reactivation of latent infections have been reported with the use of azathioprine. Cases of JC virus-associated infection resulting in progressive multifocal leukoencephalopathy (PML), sometimes fatal, have been reported in patients treated with immunosuppressants, including azathioprine. A diagnosis of PML should be considered in any patient presenting with new-onset neurological manifestations and a consultation with a neurologist is recommended. Consider reducing the amount of immunosuppression in patients who develop PML, and in transplant patients, consider the risk that the reduced immunosuppression represents to the graft.

Major

Azathioprine (Includes Imuran) ↔ Renal Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Azathioprine may accumulate in patients with impaired renal function. Therapy with azathioprine should be administered cautiously and may need dosage reduction in patients with impaired renal function.

References

  1. Odlind B, Hartvig P, Lindstrom B, Lonnerholm G, Grefberg N "Serum azathioprine and 6-mercaptopurine levels and immunosuppressive activity after azathioprine in uremic patients." Int J Immunopharmacol 8 (1986): 1-11
  2. Keystone EC, Schabas R "Hypotension with oliguria: a side-effect of azathioprine." Arthritis Rheum 24 (1981): 1453-4
  3. Schusziarra V, Ziekursch V, Schlamp R, Siemensen HC "Pharmacokinetics of azathioprine under haemodialysis." Int J Clin Pharmacol 14 (1976): 298-302
View all 11 references
Moderate

Azathioprine (Includes Imuran) ↔ Liver Disease

Moderate Potential Hazard, Moderate plausibility

Applies to: Liver Disease

Azathioprine is metabolically converted to the pharmacologically active 6-mercaptopurine (6-MP). Conversion to 6-MP and metabolism of 6-MP may be impaired in patients with liver disease. Therapy with azathioprine should be administered cautiously in patients with liver disease. Monitoring liver function is recommended in these patients.

References

  1. Farge D, Parfrey PS, Forbes RD, Dandavino R, Guttmann RD "Reduction of azathioprine in renal transplant patients with chronic hepatitis." Transplantation 41 (1986): 55-9
  2. Hohlfeld R, Michels M, Heininger K, Besinger U, Toyka KV "Azathioprine toxicity during long-term immunosuppression of generalized myasthenia gravis." Neurology 38 (1988): 258-61
  3. Read AE, Wiesner RH, LaBrecque DR, et al "Hepatic veno-occlusive disease associated with renal transplantation and azathioprine therapy." Ann Intern Med 104 (1986): 651-5
View all 16 references

Imuran (azathioprine) drug Interactions

There are 332 drug interactions with Imuran (azathioprine)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2017 Multum Information Services, Inc. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.

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