Mercaptopurine with Lisinopril Interaction Details
Brand Names Associated with Mercaptopurine
- 6-MP
- Mercaptopurine
- Purinethol®
- Purixan®
Brand Names Associated with Lisinopril
- Lisinopril
- Prinivil®
- Qbrelis®
- Zestoretic® (containing Hydrochlorothiazide, Lisinopril)
- Zestril®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 29, 2023
Interaction Effect
Myelosuppression
Interaction Summary
The use of angiotensin converting enzyme inhibitors in patients receiving azathioprine has been reported to result in anemia or leukopenia.
Severity
Major
Onset
Delayed
Evidence
Theoretical
How To Manage Interaction
Avoid combination therapy with azathioprine and angiotensin converting enzyme inhibitors. If these drugs must be administered concomitantly, monitor patients for myelosuppression, especially anemia and leukopenia.
Mechanism Of Interaction
Unknown
Literature Reports
A) Eleven renal transplant patients who had been converted from cyclosporine and prednisone to azathioprine and prednisone and were concurrently taking either captopril or enalapril developed severe anemia . When two of these patients were converted back to cyclosporine, their anemia rapidly resolved. In order to study the effect of concurrent use of azathioprine and either enalapril or captopril, two groups of 10 azathioprine-treated patients who did (group A) or did not (group B) take an ACE inhibitor were compared to determine hematological parameters. In group A, 8 patients received enalapril and 2 received captopril. Hematocrit (32.9 +/- 6.3% vs 41.0 +/- 5%), hemoglobin (11.5 +/- 2 g/dL vs 13.9 +/- 1.6 g/dL), and haptoglobin (115.7 +/- 65.4 vs 210.4 +/- 114.4 mg/dL) values of group A were significantly lower than those of group B. Hematological parameters and renal function were compared in group A for the periods 3 to 6 months before and 3 to 6 months after institution of ACE inhibitor therapy. There was a significant decrease in hematocrit (mean 41.5% vs 36%) and hemoglobin (mean 14.1% vs 11.3%) 3 to 6 months after starting ACE inhibitor therapy. Other hematological parameters and renal function remained stable. Concurrent use of azathioprine and either enalapril or captopril should be avoided.
B) A 37-year-old renal transplant patient developed anemia while being treated with azathioprine and enalapril, despite also receiving recombinant human erythropoietin (rHuEpo) . Three months post-transplant, enalapril 10 mg daily was added to the patient's regimen, which included cyclosporine, azathioprine, mizoribine, and prednisolone. Normocytic normochromic anemia gradually appeared, and 6000 International Units per week of rHuEpo was administered intravenously when the hematocrit (Hct) dropped from 38.7% to 21%. In spite of the rHuEpo dose being increased to 9000 International Units, the anemia continued to worsen. The patient had no evidence of decreasing renal function, leukopenia, or thrombocytopenia. When the Hct dropped to 16.5%, the enalapril was discontinued. The Hct gradually recovered to 32.2%, even though the rHuEpo administration had been stopped.
C) A 17-year-old female with malignant nephrosclerosis was being successfully treated with captopril 50 mg daily and furosemide 500 mg daily for seven months. White cell counts were within the normal range. The patient then received a renal transplant, and 20 days after the addition of azathioprine 150 mg daily to the captopril therapy, the white cell count fell to 1700/mcgL. Azathioprine was stopped and the white count returned to normal (4600/mcgL) within eight days. When azathioprine was reintroduced because of suspected rejection, the white count again fell to 2300/mcgL over 16 days. Captopril therapy was discontinued and blood pressure was controlled by other antihypertensive medications. The patient's white count returned to normal within five days (4700/mcgL), despite continuing azathioprine therapy .
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.
Lisinopril Overview
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Lisinopril is used alone or in combination with other medications to treat high blood pressure in adults and children 6 years of age and older. It is used in combination with other medications to treat heart failure. Lisinopril is also used to improve survival after a heart attack. Lisinopril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors. It works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly and the heart can pump blood more efficiently.
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High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys, and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.
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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.