Drug & supplement interaction

Ostarine + Azathioprine

Azathioprine brand names: Imuran, Azamune.

Moderate Interaction
Medically reviewed by · Updated September 2026
The bottom line Moderate

Ostarine has a moderate interaction with Azathioprine. Theoretically, concomitant use with hepatotoxic drugs might increase the risk of adverse hepatotoxic effects.

Read the full interaction report
SeverityModerate
LikelihoodPossible
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Ostarine and Azathioprine

Here is the interaction we found between these two, with the evidence behind it.

Moderate

HEPATOTOXIC DRUGS

Why this applies to Azathioprine

Azathioprine falls under HEPATOTOXIC DRUGS — the group Ostarine interacts with.

Theoretically, concomitant use with hepatotoxic drugs might increase the risk of adverse hepatotoxic effects.
Some clinical research shows that ostarine can increase alanine aminotransferase, a marker of liver damage, in some patients. Additionally, the U.S. Food and Drug Administration warns that supplements containing SARMs, such as ostarine, have been associated with reports of liver toxicity and there are at least two reports of drug-induced liver injury attributed to the use of ostarine.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the concern with pairing these two: azathioprine can already stress the liver, and your doctor likely checks your liver enzymes (like ALT) while you're on it. Ostarine, a SARM that isn't FDA-approved, has its own track record of liver trouble. There are real-world reports of liver injury tied to it, plus lab signs of rising ALT in some users. Stack two things that can each irritate the liver, and you may raise your odds of liver inflammation.

To be fair, this specific interaction is theoretical, based on how each acts rather than direct studies of the two together. Still, watch for yellowing skin or eyes, dark urine, belly pain, or unusual tiredness. Honestly, Ostarine isn't recommended at all, so please talk with your pharmacist or doctor before mixing it with azathioprine.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Warning Letter: Ironmag Labs 10/23/17. FDA Inspections, Compliance, Enforcement, and Criminal Investigations, October 23, 2017. https://www.fda.gov/iceci/enforcementactions/warningletters/2017/ucm582464.htm Accessed: November 1, 2017
  2. Warning Letter: Panther Sports Nutrition 10/23/17. FDA Inspections, Compliance, Enforcement, and Criminal Investigations, October 23, 2017. https://www.fda.gov/iceci/enforcementactions/warningletters/2017/ucm581630.htm. Accessed: November 1, 2017
  3. Warning Letter: Infantry Labs LLC 10/23/17. FDA Inspections, Compliance, Enforcement, and Criminal Investigations, October 23, 2017. https://www.fda.gov/iceci/enforcementactions/warningletters/2017/ucm582685.htm. Accessed: November 1, 2017
  4. Dobs AS, Boccia RV, Croot CC, et al. Effects of enobosarm on muscle wasting and physical function in patients with cancer: a double-blind, randomised controlled phase 2 trial. Lancet Oncol 2013;14(4):335-45. PubMed
  5. Dalton JT, Barnette KG, Bohl CE, et al. The selective androgen receptor modulator GTx-024 (enobosarm) improves lean body mass and physical function in healthy elderly men and postmenopausal women: results of a double-blind, placebo-controlled phase II tri
  6. Bedi H, Hammond C, Sanders D, Yang HM, Yoshida EM. Drug-induced liver injury from enobosarm (ostarine), a selective androgen receptor modulator. ACG Case Rep J 2021;8(1):e00518. PubMed
  7. Weinblatt D, Roy S. Drug-Induced Liver Injury Secondary to Enobosarm: A Selective Androgen Receptor Modulator. J Med Cases 2022;13(5):244-248. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Ostarine Also Interacts With Other Medications

Ostarine has 439 moderate, 171 minor known drug interactions in our database — the Azathioprine one above is one of them. If you take anything else, check it against the full list below.

Moderate 439 Minor 171 No known interaction 2,220 (incl. Azathioprine)
Taking anything else?

Check Another of Your Medications Against Ostarine

Covers the 2,830 medications we’ve checked against Ostarine. Pick one to open its full report.

Everything else you take

See Every Supplement That Interacts With Azathioprine

This page covers Ostarine only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Azathioprine page lists 106 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Beer (major), Siberian Cocklebur (major), Wine (major) and Active Hexose Correlated Compound (ahcc) (moderate).

By severity: 4 major · 92 moderate · 10 minor.

From our pharmacist’s overview on the Azathioprine page

“Azathioprine (Imuran) quiets an overactive immune system, which is why people take it after a transplant or for autoimmune disease, and it is also why I read this interaction list with real caution. Fully half of the 106 supplements on file, 53 of them, appear because they stimulate immunity and could blunt the very effect you depend on.”

Reviewed by 2 · Jul 18, 2026

Open the Azathioprine interaction page

One more smart check

Taking Ostarine as Part of a Dietary Supplement Product? Check It for Interactions

We hold 33 real supplement products containing Ostarine, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Ostarine. Your product may carry other ingredients that interact with Azathioprine too, on top of Ostarine — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Ostarine and Azathioprine Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Ostarine
Steady interest

#1,271 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Azathioprine
Top 25%

#612 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Ostarine

What is Ostarine?

  • Muscle building
  • Athletic performance
  • Fat loss / body recomposition
  • Bodybuilding cycles

Ostarine (also called MK-2866 or enobosarm) is an experimental, unapproved drug known as a SARM (selective androgen receptor modulator), not a true dietary supplement. It is not approved by the FDA, is banned in sports, and has been linked to liver injury and other serious harms, so it is not recommended for general use.

Read the full Ostarine monograph & all interactions
Medication

About Azathioprine

What Is Azathioprine Used For?

Brand names: Imuran, Azamune

Azathioprine is used alongside other medications to help prevent the body from rejecting a kidney transplant (renal homotransplantation). It is also used to treat active rheumatoid arthritis — reducing signs and symptoms in adults who have not responded well enough to other treatments.

Other pain relievers such as aspirin, NSAIDs, or low-dose steroids may be continued alongside azathioprine for rheumatoid arthritis. Combining azathioprine with disease-modifying antirheumatic drugs (DMARDs) has not been well studied and is not recommended.

See full Azathioprine drug information
Keep checking

Other Drugs & Ostarine

Browse every other medication we’ve checked against Ostarine — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
439Moderate
171Minor
2,219No known interaction
439 Moderate 171 Minor 2,219 No interaction
Moderate

439 interactions

Showing 60 of 439 moderate interactions — see all 439 on the Ostarine page.

Minor

171 interactions

Showing 60 of 171 minor interactions — see all 171 on the Ostarine page.

No interaction 2,219 drugs checked — show the list

We also checked Ostarine against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,219 medications checked with no known interaction — see the full Ostarine list.

See the full Ostarine interactions page
See every supplement checked against Azathioprine, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Ostarine monograph › Uses, safety, and every drug interaction in one place Azathioprine supplement interactions › Every supplement checked against Azathioprine, ranked by severity Azathioprine drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Ostarine and Azathioprine Together: Common Questions

Can you take Ostarine with Azathioprine?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Ostarine and Azathioprine interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Azathioprine and Ostarine?

Our pharmacists answer your medication & supplement questions — free.

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.