Drug General Information (ID: DDIPVNSJXE)
Drug Name			Cyclophosphamide		Drug Info		Azathioprine		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antineoplastics				Immunosuppressive Agents
Structure

Mechanism of Cyclophosphamide-Azathioprine Interaction (Severity Level: Moderate)
Additive myelosuppressive effects Click to Show/Hide Mechanism Graph
Drug Name		Cyclophosphamide				Azathioprine
Mechanism 1		Myelosuppressive effects				Myelosuppressive effects
Key Mechanism Factor 1
		Factor Name		Myelosuppressive effects
		Factor Description		Myelosuppression, also known as bone marrow suppression, is a decrease in bone marrow activity that leads to a decrease in the production of blood cells. Some blood cell disorders include: erythrocytopenia (anemia), leukopenia (neutropenia), and thrombocytopenia (thrombocytopenia).
Mechanism Description		Additive myelosuppressive effects by the combination of Cyclophosphamide and Azathioprine
Increased risk of hepatotoxicity Click to Show/Hide Mechanism Graph
Drug Name		Cyclophosphamide				Azathioprine
Mechanism 2		Hepatotoxicity				Hepatotoxicity
Key Mechanism Factor 2
		Factor Name		Hepatotoxicity
		Factor Description		Combination of drugs that can induce hepatotoxicity may increase the risk of liver injury. Symptoms vary depending on the level of exposure and the total extent of liver damage, and may cause few symptoms if the damage is mild, and eventually lead to liver failure in patients with severe damage.
Mechanism Description		Increased risk of hepatotoxicity by the combination of Cyclophosphamide and Azathioprine

Recommended Action
Management		If concomitant therapy is needed patients should be monitored for signs and symptoms of hepatotoxicity and myelotoxicity. Patients should be advised to promptly notify their physician if they experience fever, chills, sore throat, mouth sores, unusual fatigue, bleeding, bruising, abdominal pain, darkened urine, or pale stools.

References
1	Shaunak S, Munro JM, Weinbren K, Walport MJ, Cox TM "Cyclophosphamide-induced liver necrosis: a possible interaction with azathioprine." Q J Med 67 (1988): 309-17. [PMID: 3060893]