Azathioprine Therapy Guidance

Key Drug Interactions and Contraindications

The British Association of Dermatologists recommends avoiding Allopurinol due to severe myelosuppression, requiring a 65-75% dose reduction if combination is necessary 4, 5, 6
The British Association of Dermatologists advises against combining azathioprine with Sulfasalazine, as it inhibits TPMT activity and potentiates toxicity 4, 5
The British Association of Dermatologists notes that Warfarin may impair anticoagulant effect 4, 5
The British Association of Dermatologists warns of increased risk of serious hematological toxicity when azathioprine is combined with myelosuppressive drugs like penicillamine or co-trimoxazole 4, 5
The British Association of Dermatologists cautions that ACE inhibitors may induce severe leucopenia 4, 5
The British Association of Dermatologists states that live vaccines are contraindicated 4, 5
The British Association of Dermatologists lists hypersensitivity to azathioprine or 6-mercaptopurine as an absolute contraindication 2, 3
The British Association of Dermatologists considers very low or absent TPMT activity an absolute contraindication 1, 7, 8, 9, 10
The British Association of Dermatologists notes severe infections as an absolute contraindication 2, 3
The British Association of Dermatologists states that severely impaired hepatic or bone marrow function is an absolute contraindication 2, 3
The British Association of Dermatologists lists pancreatitis as an absolute contraindication 2, 3

The British Association of Dermatologists recommends baseline liver function tests before starting azathioprine therapy 2, 3, 11
The British Association of Dermatologists advises weekly liver function tests for the first 4 weeks of azathioprine therapy 11
The British Association of Dermatologists suggests monthly monitoring until maintenance dose is achieved 11
The British Association of Dermatologists recommends every 3 months monitoring once a stable dose is achieved 2, 11
Patients should seek urgent medical attention for signs of liver impairment, including jaundice, as recommended by the British Association of Dermatologists 1, 5

The British Association of Dermatologists recommends that patients on azathioprine report immediately any unexplained bruising or bleeding 1
The British Association of Dermatologists advises patients to report sore throat or signs of infection immediately 1
The British Association of Dermatologists recommends immediate reporting of high fever 5
The British Association of Dermatologists suggests that patients report jaundice immediately 11
The British Association of Dermatologists warns patients to seek immediate medical attention for sudden onset abdominal pain, possible pancreatitis 4