Drug Interaction Report

Doxorubicin and Azathioprine: Interaction Details

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

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Azathioprine

Azasan Azasan® Imuran Imuran®
+

Doxorubicin

Adriamycin Adriamycin® Caelyx Doxil Rubex®
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 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 237 documented Doxorubicin interactions, 218 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
unspecified
Evidence
established
Severity
Major

What happens

An increased risk of hepatotoxicity

Interaction Deep Dive

Hepatic dysfunction developed in all 11 patients with refractory leukemia who received DOXOrubicin hydrochloride and 6-mercaptopurine concurrently (with and without vincristine and prednisone). Due to this increased risk of mercaptopurine-induced hepatotoxicity, caution should be exercised if DOXOrubicin is coadministered with mercaptopurine1. Although no formal drug interaction studies have been done with DOXOrubicin hydrochloride liposome injection, it may interact with drugs known to interact with the conventional formulation of DOXOrubicin 2.

Why it happens (mechanism)

Unknown

Literature reports

1 report — tap to read

a) Concurrent administration of DOXOrubicin and 6-mercaptopurine led to hepatoxicity, manifested by elevated total serum bilirubin, alkaline phosphatase, and AST, in all patients tested. Intravenous DOXOrubicin hydrochloride 50 mg/m(2) every 2 to 3 weeks per cycle was coadministered with 6-mercaptopurine 500 mg/m(2) IV daily for 5 days per cycle every 2 to 3 weeks, with and without vincristine and prednisone, in 11 patients with refractory leukemia 1.

Common questions

Can I take Doxorubicin and Azathioprine together?

An increased risk of hepatotoxicity Always confirm with your pharmacist or prescriber before making any change.

How serious is the Doxorubicin 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 "established". Well documented — supported by controlled studies or strong clinical data.

Questions for your pharmacist

  • Does my dose of Doxorubicin 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 (2)

  1. Product Information: doxorubicin HCl intravenous injection, doxorubicin HCl intravenous injection. Pfizer Labs (per FDA), New York, NY, 2013.
  2. Product Information: DOXIL(R) intravenous injection, doxorubicin HCl liposome intravenous injection. Janssen Products, LP (per FDA), Horsham, PA, 2012. DailyMed
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Azathioprine

Keep reading about Azathioprine

All Azathioprine interactions (219) Azathioprine drug information
Also serious with: Febuxostat Atovaquone Peginterferon Alfa-2A Injection Acarbose
Doxorubicin

Keep reading about Doxorubicin

All Doxorubicin interactions (237) Doxorubicin drug information
Also serious with: Tasonermin Smallpox Monkeypox Vaccine Mumps Virus Vaccine, Live Rubella Virus Vaccine, Live
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
Doxorubicin + Grapefruit St. John's Wort Acacia Rigidula Acerola Adrafinil African Wild Potato Alpha-lipoic Acid American Elder + 131 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.