of bivalirudin by unknown mechanism. Use Caution/Monitor.captoprilcaptopril, azathioprine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of neutropenia.cholera vaccineazathioprine decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs and corticosteroids (used in greater than physiologic doses), may reduce the immune response to cholera vaccine.dalteparinazathioprine decreases effects of dalteparin by unknown mechanism. Use Caution/Monitor.dengue vaccineazathioprine decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.denosumabazathioprine, denosumab. Other (see comment). Use Caution/Monitor. Comment: Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.echinaceaazathioprine increases and echinacea decreases immunosuppressive effects; risk of infection. Effect of interaction is not clear, use caution. Use Caution/Monitor.enalaprilenalapril, azathioprine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of neutropenia.enoxaparinazathioprine decreases effects of enoxaparin by unknown mechanism. Use Caution/Monitor.fingolimodazathioprine increases effects of fingolimod by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects. .fondaparinuxazathioprine decreases effects of fondaparinux by unknown mechanism. Use Caution/Monitor.fosinoprilfosinopril, azathioprine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of neutropenia.haemophilus influenzae type b vaccineazathioprine decreases effects of haemophilus influenzae type b vaccine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Avoid vaccination during chemotherapy or radiation therapy if possible because antibody response might be suboptimal. Patients vaccinated within a 14-day period before starting or during immunosuppressive therapy should be revaccinated =3 months after therapy is discontinued if immune competence has been restored.heparinazathioprine decreases effects of heparin by unknown mechanism. Use Caution/Monitor.hydroxyureaazathioprine, hydroxyurea. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of myelosuppression.ifosfamideifosfamide, azathioprine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration with ifosfamide may increase the risk of immunosuppression and myelosuppression.imidaprilimidapril, azathioprine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of neutropenia.influenza virus vaccine quadrivalent, recombinantazathioprine decreases effects of influenza virus vaccine quadrivalent, recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immune response to vaccine may be decreased in immunocompromised individuals.influenza virus vaccine trivalent, recombinantazathioprine decreases effects of influenza virus vaccine trivalent, recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immune response to vaccine may be decreased in immunocompromised individuals.isavuconazonium sulfateazathioprine and isavuconazonium sulfate both decrease immunosuppressive effects; risk of infection. Use Caution/Monitor.lisinoprillisinopril, azathioprine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of neutropenia.lomustinelomustine and azathioprine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.maitakeazathioprine increases and maitake decreases immunosuppressive effects; risk of infection. Effect of interaction is not clear, use caution. Use Caution/Monitor.meningococcal group B vaccineazathioprine decreases effects of meningococcal group B vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Individuals with altered immunocompetence may have reduced immune responses to the vaccine.mercaptopurineazathioprine and mercaptopurine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor.mesalaminemesalamine increases toxicity of azathioprine by Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Increased risk for blood disorders.mipomersenmipomersen, azathioprine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.moexiprilmoexipril, azathioprine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of neutropenia.ocrelizumabazathioprine and ocrelizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration of ocrelizumab with immunosuppessants is expected to increase the risk of immunosuppression.olaparibazathioprine and olaparib both increase pharmacodynamic synergism. Use Caution/Monitor. Coadministration with other other myelosuppressive anticancer agents, including DNA damaging agents, may potentiate and prolongate the myelosuppressive toxicity. oxaliplatinoxaliplatin and azathioprine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Use of oxaliplatin with concomitant immunosuppressants or with impaired immune systems may increased risk for serious infections.ozanimodozanimod, azathioprine. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration with immunosuppressive therapies may increase the risk of additive immune effects during therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs in order to avoid unintended additive immunosuppressive effects.perindoprilperindopril, azathioprine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of neutropenia.phenindioneazathioprine decreases effects of phenindione by unknown mechanism. Use Caution/Monitor.poliovirus vaccine inactivatedazathioprine decreases effects of poliovirus vaccine inactivated by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Avoid vaccination during chemotherapy or radiation therapy if possible because antibody response might be suboptimal. Patients vaccinated within a 14-day period before starting or during immunosuppressive therapy should be revaccinated =3 months after therapy is discontinued if immune competence has been restored. .ponesimodponesimod and azathioprine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.protamineazathioprine decreases effects of protamine by unknown mechanism. Use Caution/Monitor.quinaprilquinapril, azathioprine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of neutropenia.ramiprilramipril, azathioprine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of neutropenia.siponimodsiponimod and azathioprine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.sipuleucel-Tazathioprine decreases effects of sipuleucel-T by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.trandolapriltrandolapril, azathioprine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of neutropenia.trastuzumabtrastuzumab, azathioprine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .trastuzumab deruxtecantrastuzumab deruxtecan, azathioprine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .ublituximabublituximab and azathioprine both increase immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Owing to potential additive immunosuppressive effects, consider duration of effect and mechanism of action of these therapies if coadministeredvaloctocogene roxaparvovecazathioprine and valoctocogene roxaparvovec both increase Other (see comment). Use Caution/Monitor. Medications that may cause hepatotoxicity when combined with valoctogene roxaparvovec may potentiate the risk of elevated liver enzymes. Closely monitor these medications and consider alternative medications in case of potential drug interactions.warfarinazathioprine decreases effects of warfarin by unspecified interaction mechanism. Use Caution/Monitor.zidovudineazathioprine, zidovudine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of myelosuppression.zoster vaccine recombinantazathioprine decreases effects of zoster vaccine recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce the effectiveness of zoster vaccine recombinant.Minor (1)sulfamethoxazolesulfamethoxazole, azathioprine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Leukopenia due to additive myelosuppression.adalimumabSerious - Use Alternative (1)adalimumab and azathioprine both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.adenovirus types 4 and 7 live, oralSerious - Use Alternative (1)azathioprine decreases effects of adenovirus types 4 and 7 live, oral by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3mo after cessation of immunosuppressive therapy.alefaceptSerious - Use Alternative (1)alefacept and azathioprine both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.allopurinolSerious - Use Alternative (1)allopurinol increases levels of azathioprine by decreasing metabolism. Avoid or Use Alternate Drug. Increased risk of bone marrow toxicity.anakinraSerious - Use Alternative (1)anakinra and azathioprine both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.anthrax vaccineSerious - Use Alternative (1)azathioprine decreases effects of anthrax vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.antithrombin alfaMonitor Closely (1)azathioprine decreases effects of antithrombin alfa by unknown mechanism. Use Caution/Monitor.antithrombin IIIMonitor Closely (1)azathioprine decreases effects of antithrombin III by unknown mechanism. Use Caution/Monitor.antithymocyte globulin equineSerious - Use Alternative (1)antithymocyte globulin equine and azathioprine both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.antithymocyte globulin rabbitSerious - Use Alternative (1)antithymocyte globulin rabbit and azathioprine both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.argatrobanMonitor Closely (1)azathioprine decreases effects of argatroban by unknown mechanism. Use Caution/Monitor.astragalusMonitor Closely (1)azathioprine increases and astragalus decreases immunosuppressive effects; risk of infection. Effect of interaction is not clear, use caution. Use Caution/Monitor.axicabtagene ciloleucelSerious - Use Alternative (1)azathioprine, axicabtagene ciloleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.baricitinibSerious - Use Alternative (1)baricitinib, azathioprine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Baricitinib is not recommended in combination with other JAK inhibitors, biologic DMARDs, or potent immunosuppressives.basiliximabSerious - Use Alternative (1)azathioprine and basiliximab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.BCG vaccine liveSerious - Use Alternative (1)azathioprine decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.belataceptMonitor Closely (1)belatacept and azathioprine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor.bemiparinMonitor Closely (1)azathioprine decreases effects of bemiparin by unknown mechanism. Use Caution/Monitor.benazeprilMonitor Closely (1)benazepril, azathioprine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of neutropenia.bivalirudinMonitor Closely (1)azathioprine decreases effects of bivalirudin by unknown mechanism. Use Caution/Monitor.brexucabtagene autoleucelSerious - Use Alternative (1)azathioprine, brexucabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.canakinumabSerious - Use Alternative (1)azathioprine and canakinumab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.captoprilMonitor Closely (1)captopril, azathioprine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of neutropenia.cholera vaccineMonitor Closely (1)azathioprine decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs and corticosteroids (used in greater than physiologic doses), may reduce the immune response to cholera vaccine.ciltacabtagene autoleucelSerious - Use Alternative (1)azathioprine, ciltacabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.dalteparinMonitor Closely (1)azathioprine decreases effects of dalteparin by unknown mechanism. Use Caution/Monitor.dengue vaccineMonitor Closely (1)azathioprine decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.denosumabMonitor Closely (1)azathioprine, denosumab. Other (see comment). Use Caution/Monitor. Comment: Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.diphtheria & tetanus toxoidsSerious - Use Alternative (1)azathioprine decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.diphtheria & tetanus toxoids/ acellular pertussis vaccineSerious - Use Alternative (1)azathioprine decreases effects of diphtheria & tetanus toxoids/ acellular pertussis vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccineSerious - Use Alternative (1)azathioprine decreases effects of diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.echinaceaMonitor Closely (1)azathioprine increases and echinacea decreases immunosuppressive effects; risk of infection. Effect of interaction is not clear, use caution. Use Caution/Monitor.enalaprilMonitor Closely (1)enalapril, azathioprine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of neutropenia.enoxaparinMonitor Closely (1)azathioprine decreases effects of enoxaparin by unknown mechanism. Use Caution/Monitor.etanerceptSerious - Use Alternative (1)azathioprine and etanercept both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.everolimusSerious - Use Alternative (1)azathioprine and everolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.febuxostatContraindicated (1)febuxostat increases levels of azathioprine by decreasing metabolism. Contraindicated.fingolimodMonitor Closely (1)azathioprine increases effects of fingolimod by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects. .fondaparinuxMonitor Closely (1)azathioprine decreases effects of fondaparinux by unknown mechanism. Use Caution/Monitor.fosinoprilMonitor Closely (1)fosinopril, azathioprine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of neutropenia.glatiramerSerious - Use Alternative (1)azathioprine and glatiramer both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.golimumabSerious - Use Alternative (1)azathioprine and golimumab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.haemophilus influenzae type b vaccineMonitor Closely (1)azathioprine decreases effects of haemophilus influenzae type b vaccine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Avoid vaccination during chemotherapy or radiation therapy if possible because antibody response might be suboptimal. Patients vaccinated within a 14-day period before starting or during immunosuppressive therapy should be revaccinated =3 months