Azathioprine; Mercaptopurine/Febuxostat Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Severe. These medicines may interact and cause very harmful effects and are usually not taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

Febuxostat may slow down how quickly your body processes azathioprine and mercaptopurine.

What might happen:

The amount of these medicines may increase and cause toxic effects such as fever, chills, easy bruising or bleeding, black or tarry stools, blood in urine, or mouth or lip sores.

What you should do about this interaction:

Let your healthcare professionals (e.g. doctor or pharmacist) know right away that you are taking these medicines together. Let your doctor know right away if you develop fever, chills, easy bruising or bleeding, black or tarry stools, blood in urine, or mouth or lip sores.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

  • 1.Uloric (febuxostat) US prescribing information. Takeda Pharmaceuticals America, Inc. February, 2018.
  • 2.Relling MV, Schwab M, Whirl-Carrillo M, Suarez-Kurtz G, Pui CH, Stein CM, Moyer AM, Evans WE, Klein TE, Antillon-Klussmann FG, Caudle KE, Kato M, Yeoh AEJ, Schmiegelow K, Yang JJ. Clinical Pharmacogenetics Implementation Consortium Guideline for Thiopurine Dosing Based on TPMT and NUDT15 Genotypes: 2018 Update. Clin Pharmacol Ther 2019 May;105(5):1095-1105.
  • 3.Logan JK, Wickramaratne Senarath Yapa S, Harinstein L, Saluja B, Munoz M, Sahajwalla C, Neuner R, Seymour S. Drug Interaction Between Febuxostat and Thiopurine Antimetabolites: A Review of the FDA Adverse Event Reporting System and Medical Literature. Pharmacotherapy 2020 Feb;40(2):125-132.
  • 4.Phansalkar S, Desai AA, Bell D, Yoshida E, Doole J, Czochanski M, Middleton B, Bates DW. High-priority drug-drug interactions for use in electronic health records. J Am Med Inform Assoc 2012 Sep-Oct; 19(5):735-43.

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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.