Mercaptopurine with Alfalfa Interaction Details
Brand Names Associated with Mercaptopurine
- 6-MP
- Mercaptopurine
- Purinethol®
- Purixan®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 29, 2023
Interaction Effect
Reduced immunosuppressive drug effectiveness and acute transplant rejection
Interaction Summary
In a case report, alfalfa appeared to antagonize post-transplant immunosuppression when given concomitantly with azathioprine and cyclosporine. The patient presented with severe, acute rejection of a previously stable (16 years) transplanted kidney approximately 6 weeks after beginning a regimen of alfalfa and black cohosh. Cyclosporine serum concentrations remained unchanged throughout the clinical course.
Severity
Major
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Alfalfa should not be used concurrently with azathioprine. Advise patients taking azathioprine for transplant maintenance to avoid alfalfa, including herbal teas and combination supplement products containing alfalfa. If patients are found to be taking alfalfa and azathioprine, discontinue alfalfa and evaluate the patient for signs and symptoms of transplant rejection.
Mechanism Of Interaction
T-cell activation by L-canavanine, a constituent of alfalfa, leading to immunostimulation
Literature Reports
A) Acute organ rejection occurred in a renal transplant recipient after she ingested alfalfa and black cohosh supplements concurrently with her immunosuppressants. The patient had been effectively immunosuppressed for 16 years with a stable regimen of azathioprine 50 milligrams (mg) daily and cyclosporine 75 milligrams twice daily; baseline serum creatinine concentration was 1.1 to 1.4 mg/deciliter (dL). Approximately 4 weeks after beginning a dietary supplement regimen of alfalfa and black cohosh (to manage symptoms of menopause), serum creatinine concentration increased to 1.9 mg/dL, subsequently escalating to 2.9 mg/dL 2 weeks later. A biopsy of the transplanted kidney revealed severe, acute rejection, requiring management with anti-T-cell immunoglobulin and steroids. Cyclosporine serum concentrations were unchanged throughout the clinical course .
Mercaptopurine Overview
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Mercaptopurine is used alone or with other chemotherapy drugs to treat acute lymphocytic leukemia (ALL; also called acute lymphoblastic leukemia and acute lymphatic leukemia; a type of cancer that begins in the white blood cells). Mercaptopurine is in a class of medications called purine antagonists. It works by stopping the growth of cancer cells.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.