Drug Interaction Report

Azathioprine and Typhoid Vaccine, Live: Interaction Details

A pharmacist-reviewed analysis of the Azathioprine and Typhoid Vaccine, Live interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Azathioprine

Azasan Azasan® Imuran Imuran®
+

Typhoid Vaccine, Live

Vivotif
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Jul 11, 2026
Editorial policy · Data sources
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Interaction severity
Major
Potentially serious — often needs a change or close monitoring.
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.

Of 219 documented Azathioprine interactions, 213 are rated major — including this one.
Worried about symptoms right now? Contact your pharmacist or prescriber, or call Poison Control at 1-800-222-1222 (US). Call 911 for an emergency.
Onset
delayed
Evidence
established
Severity
Major

What happens

An increased risk of infection by the live vaccine

Interaction Deep Dive

Transplant patients receiving azathioprine have subnormal responses to vaccines1. Low-dose azathioprine therapy (less than 3 mg/kg/day) is not considered sufficiently immunosuppressive and is not a contraindication for administration of the varicella virus vaccine 3. However, vaccination with a live vaccine in a patient immunocompromised by a chemotherapeutic agent has resulted in severe and fatal infections 45. One patient experienced disseminated vaccinia infection after receiving a smallpox vaccine while on concomitant methotrexate therapy 6. Live virus and bacterial vaccines should not be administered to a patient receiving an immunosuppressive chemotherapeutic agent. At least three months should elapse between the discontinuation of chemotherapy and vaccination with a live vaccine 2.

Why it happens (mechanism)

Subnormal response to vaccine due to suppressed immune system

Common questions

Can I take Azathioprine and Typhoid Vaccine, Live together?

An increased risk of infection by the live vaccine Always confirm with your pharmacist or prescriber before making any change.

How serious is the Azathioprine and Typhoid Vaccine, Live interaction?

It is rated major. Potentially serious — often needs a change or close monitoring.

How quickly could this interaction happen?

The documented onset is "delayed". Effects tend to build up gradually over days to weeks.

How strong is the evidence for this interaction?

The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.

Questions for your pharmacist

  • Does my dose of Azathioprine or Typhoid Vaccine, Live 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 (6)

  1. Product Information: IMURAN(R) oral tablets, azathioprine oral tablets. Prometheus Laboratories Inc. (per FDA), San Diego, CA, 2014. DailyMed
  2. Centers for Disease Control and Prevention: General Recommendations on Immunization. MMWR 2011; 60(2):3-.
  3. Harpaz R, Ortega-Sanchez IR, & Seward JF: Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2008; 57(RR-5):1-30.
  4. MMWR: General recommendations on immunization. MMWR 1989; 38:205-214, 219-227.
  5. Rosenbaum EH, Cohen RA, & Glatstein HR: Vaccination of a patient receiving immunosuppressive therapy for lymphosarcoma. JAMA 1966; 198:737-740. DOI
  6. Allison J: Methotrexate and small pox vaccination (letter). Lancet 1968; 2:1250.
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Azathioprine

Keep reading about Azathioprine

All Azathioprine interactions (219) Azathioprine drug information
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Typhoid Vaccine, Live

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All Typhoid Vaccine, Live interactions (73)
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Beyond drug–drug

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:

Azathioprine + Activated Charcoal Beer Siberian Cocklebur Wine Active Hexose Correlated Compound (ahcc) Alfalfa American Ginseng Andrographis + 98 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

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This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.