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Asacol HD and Purinethol

Determining the interaction of Asacol HD and Purinethol and the possibility of their joint administration.

Check result:
Asacol HD <> Purinethol
Relevance: 10.05.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Using mercaptopurine together with mesalamine may increase the effects of mercaptopurine. Contact your doctor if you experience nausea, vomiting, stomach pain, diarrhea, bleeding, fever, chills, and other signs of infection. If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

MONITOR: Aminosalicylate derivatives (e.g., balsalazide, mesalamine, olsalazine, sulfasalazine) may potentiate the pharmacologic effects of purine antagonist antimetabolites (e.g., azathioprine, mercaptopurine, thioguanine). In vitro evidence indicates that aminosalicylate derivatives inhibit thiopurine methyltransferase (TPMT), the enzyme responsible for the metabolic clearance of cytotoxic thioguanine nucleotides that are formed from the antimetabolites in vivo. The interaction may be particularly severe in patients with low red blood cell TPMT activity. Even in the absence of an interaction, individuals with an inherited deficiency of TPMT are unusually sensitive to the myelosuppressive effects of purine antagonist antimetabolites and prone to developing rapid bone marrow suppression following the initiation of treatment with standard dosages. Between 0.3% to 1% of the population are TPMT-deficient and have low or no detectable TPMT activity (i.e. homozygous for low-activity alleles). Approximately 10% have intermediate TPMT activity (i.e. heterozygous for low-activity alleles), and they also tend to experience more bone marrow suppression than the majority of patients on usual dosages of the antimetabolites.

MANAGEMENT: Caution is advised if aminosalicylate derivatives must be used concomitantly with purine antagonist antimetabolites. Patients receiving the combination should be closely monitored for hematologic toxicity, and the antimetabolite dosage adjusted accordingly.

References
  • Lowry PW, Szumlanski CL, Weinshilboum RM, Sandborn WJ "Balsalazide and azathiprine or 6-mercaptopurine: evidence for a potentially serious drug interaction [letter; comment." Gastroenterology 116 (1999): 1505-6
  • "Product Information. Imuran (azathioprine)." Glaxo Wellcome, Research Triangle Park, NC.
  • "Product Information. Purinethol (mercaptopurine)." Glaxo Wellcome, Research Triangle Pk, NC.
  • Lewis LD, Benin A, Szumlanski CL, et al. "Olsalazine and 6-mercaptopurine-related bone marrow suppression: a possible drug-drug interaction." Clin Pharmacol Ther 62 (1997): 464-75
  • "Product Information. Tabloid (thioguanine)." Prasco Laboratories, Cincinnati, OH.
  • Lewis LD, Benin A, Szumlanski CL, Otterness DM, Lennard L, Weinshilboum RM, Nierenberg DW "Olsalazine and 6-mercaptopurine-related bone marrow suppression: A possible drug-drug interaction (Vol 62, pg 464, 1997)." Clin Pharmacol Ther 67 (2000): 431
  • Szumlanski CL, Weinshilboum RM "Sulphasalazine inhibition of thiopurine methyltransferase: possible mechanism for interaction with 6-mercaptopurine and azathioprine." Br J Clin Pharmacol 39 (1995): 456-9
  • Lowry PW, Franklin CL, Weaver AL, et al. "Leucopenia resulting from a drug interaction between azathioprine or 6-mercaptopurine and mesalamine, sulphasalazine, or balsalazide." Gut 49 (2001): 656-64
Asacol HD

Generic Name: mesalamine

Brand name: Apriso, Asacol HD, Delzicol, Lialda, Pentasa, Canasa, Canasa Pac, Rowasa, SfRowasa

Synonyms: n.a.

Purinethol

Generic Name: mercaptopurine

Brand name: Purinethol, Purixan

Synonyms: n.a.

In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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