Drug search by name

Imuran and Zyloprim

Determining the interaction of Imuran and Zyloprim and the possibility of their joint administration.

Check result:

Imuran <> Zyloprim

Relevance: 24.11.2022 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 allopurinol together with azaTHIOprine can increase the effects of azaTHIOprine. This can cause fever, chills, sore throat, body aches, weakness, muscle pain, easy bruising or bleeding, mouth sores, pale stools, darkened urine, or severe nausea, vomiting, and diarrhea. If your doctor prescribes these medications together, you may need a dose adjustment or special tests to safely take 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:

ADJUST DOSE: Allopurinol may potentiate the pharmacologic effects of orally administered thiopurines. Severe bone marrow suppression and other toxicity have been associated with concomitant use of allopurinol and mercaptopurine (6-MP) or azathioprine, the latter of which is metabolized to 6-MP in vivo. The mechanism is thought to be allopurinol inhibition of 6-MP first-pass metabolism via hepatic or intestinal xanthine oxidase, the enzyme that catalyzes the inactivation of 6-MP. In one study, allopurinol pretreatment resulted in a nearly 500% increase in peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of oral 6-MP. No effect was observed on the pharmacokinetics of intravenous 6-MP. In a retrospective study of 24 heart and/or lung transplant patients receiving azathioprine, investigators found that 46% became leukopenic, 30% moderately anemic, and 22% thrombocytopenic within 3 months after starting allopurinol despite general compliance with thiopurine dosage reduction guidelines. Thus, decreasing the dosage by two-thirds or greater as often recommended does not abolish the risk of myelotoxicity.

MANAGEMENT: Caution is advised if allopurinol must be used concomitantly with oral thiopurines. Most authorities recommend that thiopurine dosage be reduced to approximately 1/4 to 1/3 the usual dosage, and the patient closely monitored for hematologic and other toxicity. Subsequent doses should be adjusted based on therapeutic response and appearance of adverse effects. Patients should be advised to consult their physician if they develop signs and symptoms suggestive of thiopurine toxicity such as fever, chills, sore throat, fatigue, lethargy, pallor, anorexia, jaundice, dark urine, nausea, vomiting, signs of local infection, and unusual bleeding or bruising.

References

Zimm S, Ettinger LJ, Holcenberg JS, Kamen BA, Vietti TJ, Belasco J, Cogliano-Shutta N, Balis F, Lavi LE, Collins JM, et al "Phase I and clinical pharmacological study of mercaptopurine administered as a prolonged intravenous infusion." Cancer Res 45 (1985): 1869-73
Brooks RJ, Dorr RT, Durie BG "Interaction of allopurinol with 6-mercaptopurine and azathioprine." Biomed 36 (1982): 217-22
"Product Information. Purinethol (mercaptopurine)." Glaxo Wellcome, Research Triangle Pk, NC.
"Product Information. Imuran (azathioprine)." Glaxo Wellcome, Research Triangle Park, NC.
Kennedy DT, Hayney MS, Lake KD "Azathioprine and allopurinol: the price of an avoidable drug interaction." Ann Pharmacother 30 (1996): 951-4
Venkat Raman G, Sharman Vl, Lee HA "Azathioprine and allopurinol: a potentially dangerous combination." J Intern Med 228 (1990): 69-71
Cox GJ, Robertson DB "Toxic erythema of palms and soles associated with high-dose mercaptopurine chemotherapy." Arch Dermatol 122 (1986): 1413-4
Zazgornik J, Kopsa H, Schmidt P, Kuschan K, Deutsch E "Increased danger of bone marrow damage in simultaneous azathioprine-allopurinol therapy." Int J Clin Pharmacol Ther Toxicol 19 (1981): 96-7
Coffey JJ, White CA, Lesk AB, Rogers WI, Serpick AA "Effect of allopurinol on the pharmacokinetics of 6-mercaptopurine (NSC 755) in cancer patients." Cancer Res 32 (1972): 1283-9
Haagsma CJ "Clinically important drug interactions with disease-modifying antirheumatic drugs." Drugs Aging 13 (1998): 281-9
Boyd IW "Allopurinol-azathioprine interaction." J Intern Med 229 (1991): 386
Gearry RB, Day AS, Barclay ML, Leong RW, Sparrow MP "Azathioprine and allopurinol: A two-edged interaction." J Gastroenterol Hepatol 25 (2010): 653-5
Krowka MJ, Breuer RI, Kehoe TJ "Azathioprine-associated pulmonary dysfunction." Chest 83 (1983): 696-8
Cummins D, Sekar M, Halil O, Banner N "Myelosuppression associated with azathioprine-allopurinol interaction after heart and lung transplantation." Transplantation 61 (1996): 1661-2
Berns A, Rubenfeld S, Rymzo WT "Hazard of combining allopurinol and thiopruine." N Engl J Med 286 (1972): 730-1
Kelley WN "Current therapy of gout and hyperuricemia." Hosp Pract 11 (1976): 69-76
Zimm S, Collins JM, O'Neill D, Chabner BA, Poplack DG "Inhibition of first-pass metabolism in cancer chemotherapy: interaction of 6-mercaptopurine and allopurinol." Clin Pharmacol Ther 34 (1983): 810-7

Imuran

Generic Name: azathioprine

Brand name: Azasan, Imuran

Synonyms: n.a.

What is Imuran?

Zyloprim

Generic Name: allopurinol

Brand name: Zyloprim, Lopurin, Aloprim

Synonyms: n.a.

What is Zyloprim?

+ Add a drug Remove all

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.

The list of popular interactions