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Drug Interactions between mercaptopurine and Xeljanz Oral Solution

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

mercaptopurine tofacitinib

Applies to: mercaptopurine and Xeljanz Oral Solution (tofacitinib)

GENERALLY AVOID: Coadministration of tofacitinib with biologic DMARDs or potent immunosuppressants (e.g., azathioprine, 6-mercaptopurine, cyclosporine, and tacrolimus) may potentiate the risk of infections as well as lymphoma and other malignancies. Serious and sometimes fatal infections due to bacterial, mycobacterial, invasive fungal, viral, or other opportunistic pathogens have been reported in patients receiving tofacitinib, most of whom were taking concomitant immunosuppressants such as methotrexate or corticosteroids. Lymphoma and other malignancies, including melanoma and non-melanoma skin cancers, have also been observed with tofacitinib use. Epstein Barr virus-associated posttransplant lymphoproliferative disorder has been observed at an increased rate in renal transplant patients treated with tofacitinib and concomitant immunosuppressive agents (basiliximab, high-dose corticosteroids, and mycophenolic acid) relative to cyclosporine plus the same induction regimen (2.3% vs. 0%). Data on the use of tofacitinib with all biologic DMARDs and/or immunosuppressants are not available.

MANAGEMENT: Concomitant use of tofacitinib with biologic DMARDs or potent immunosuppressants should generally be avoided. If coadministration is necessary, patients should be closely monitored for the development of signs and symptoms of infection during and after treatment, including the possible development of tuberculosis in patients who tested negative for latent tuberculosis infection prior to initiating therapy. If a serious infection, an opportunistic infection, or sepsis develops, tofacitinib should be interrupted until the infection is controlled.

References

  1. (2021) "Product Information. Xeljanz (tOFACitinib)." Pfizer Australia Pty Ltd, pfpxeljt11021
  2. (2022) "Product Information. Xeljanz (tofacitinib)." Pfizer Ltd, XJ 5mg 26_0 GB

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Drug and food interactions

Moderate

mercaptopurine food

Applies to: mercaptopurine

ADJUST DOSING INTERVAL: Limited data suggest that food may decrease the oral bioavailability of 6-mercaptopurine (6-MP). In one study, the pharmacokinetics of 6-MP were studied on two separate occasions in seven patients. A single dose of 6-MP was administered after an overnight fast on one occasion and 15 minutes after a standard breakfast on the other. The authors reported that peak plasma levels of 6-MP were lower and took longer to reach following administration in the fed state. In addition, plasma levels were undetectable (less than 20 ng/mL) in two patients.

MANAGEMENT: Until more information is available regarding the effect of food on 6-MP absorption, it may be advisable to take 6-MP on an empty stomach 1 hour before or 2 hours after a meal.

References

  1. Schmidt LE, Dalhoff K (2002) "Food-drug interactions." Drugs, 62, p. 1481-502

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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 interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.