Acarbose and Azathioprine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Azathioprine
Acarbose
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
An increased risk of hepatotoxicity
Interaction Deep Dive
The drug mercaptopurine carries a risk of liver toxicity, and this risk may rise when it is given alongside other agents capable of producing hepatotoxicity. Deaths linked to hepatic necrosis have been reported in connection with mercaptopurine use. Liver injury can develop at any dose, though it appears more often when the recommended dose is surpassed. During the initial phase of treatment, check serum transaminases, alkaline phosphatase, and bilirubin every week, then shift to monthly checks afterward. For patients taking mercaptopurine together with additional hepatotoxic medications or who already have known liver disease, perform liver testing at more frequent intervals. Should hepatotoxicity begin, discontinue mercaptopurine1.
Why it happens (mechanism)
Additive hepatotoxic effects
Common questions
Can I take Acarbose and Azathioprine together?
An increased risk of hepatotoxicity Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acarbose and Azathioprine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Acarbose or Azathioprine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: PURIXAN(R) oral suspension, mercaptopurine oral suspension. Rare Disease Therapeutics Inc (per FDA), Franklin, TN, 2024. DailyMed
Keep reading about Azathioprine
Keep reading about Acarbose
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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