Supplements and Azathioprine.
Azathioprine, sold under the brand name Imuran, is a thiopurine immunosuppressant.
Azathioprine is a thiopurine immunosuppressant. It is used in inflammatory bowel disease, autoimmune hepatitis, and some leukaemias. UK prescribing centres on azathioprine and mercaptopurine. The class requires TPMT (thiopurine methyltransferase) genotype or activity testing before starting in most UK centres, because low TPMT activity drives severe myelosuppression at standard doses. The supplement surface includes the interaction with allopurinol. Allopurinol can be given alongside but requires substantial thiopurine dose reduction. It also includes any supplement with significant bone marrow effect. Folate supplementation is sometimes added given the antimetabolite mechanism. The herpes virus and JC virus reactivation signal matters for any patient on sustained thiopurine therapy. Immune-stimulating supplements warrant care during active treatment. Liver function monitoring is routine.
Below are the 3 documented pairs we have explicitly assessed against Azathioprine in the Distil database: 3 amber. The pairs cluster around 1 mechanism: Immunosuppression caution. Every call is cited to either a clinical reference (PMID) or the British National Formulary. Anything not on this list is either still to be assessed or beyond our database scope. The checker beneath surfaces assessments by supplement, and the missing-item form at the bottom of the page routes any uncatalogued supplement into our next curation pass.
Documented interactions
Last reviewed 15 June 2026. Each interaction below lists the evidence its assessment drew on: some rest on studies of the exact pair, others on mechanism evidence, where a citation may support one part of the reasoning rather than the exact combination. The evidence line on each entry says which.
Immunosuppression caution
Amber Does Akkermansia muciniphila (pasteurised) interact with ?
If you take a medicine that suppresses your immune system, check with your specialist before starting any probiotic. The pasteurised (non-living) form used here lowers the usual concern, but immune data are incomplete, so a quick word with your team is the safe route.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Bifidobacterium longum 1714 interact with ?
If you take azathioprine, it is sensible to check with your specialist before starting this strain: azathioprine dampens the immune system, often for an autoimmune condition or after a transplant, and in people whose defences are significantly weakened there have been rare cases of a probiotic organism getting into the bloodstream and causing an infection. Avoid any probiotic, including this strain, if you are seriously unwell in hospital or have a central line or drip. Bifidobacterium longum 1714 is a live bacterium, and the evidence that probiotics are safe for most people comes from studies of people who were not significantly immunosuppressed, so on azathioprine let your specialist's advice decide.
Evidence: Supported by human study data.
Amber Does Probiotics interact with ?
If you take azathioprine, it is sensible to check with your specialist before starting a probiotic: azathioprine dampens the immune system, often for an autoimmune condition or after a transplant, and in people whose defences are significantly weakened there have been rare cases of the probiotic organism getting into the bloodstream and causing an infection. Avoid any probiotic if you are seriously unwell in hospital or have a central line or drip. Probiotics are live bacteria or yeast, and the evidence that they are safe for most people comes from studies of people who were not significantly immunosuppressed, so on azathioprine let your specialist's advice decide.
Evidence: Supported by human study data.
What this list does not say. Pairs not flagged here are not implicitly safe. They are either not yet in our database, or fall outside our inclusion scope (food-supplement interactions only; for drug-drug interactions, the BNF is authoritative). Use the checker below to surface any supplement, and submit a missing item if you take something we have not catalogued.
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How we grade severity, choose what's in scope, and what we exclude.
Every call on this page is reasoned. We publish the full rubric for severity tiers, the medication inclusion logic, the evidence grades we accept, and what we deliberately leave out. About three thousand words. Worth reading once if you use this tool more than occasionally.
Read the full methodologyA full supplement review, built around you, not a generic stack.
The free checker answers one interaction question at a time. A Distil report reviews the bigger picture: your goals, diet, medications, current supplements and any blood results you provide, then shows what appears worth keeping, changing, adding or leaving out.
- what your diet already covers, so you are not adding a capsule for something food is already handling
- which evidence-graded compounds are worth considering for your goals, and which were considered but left out
- what to keep, change or stop from what you already take, plus the order to introduce anything new
- how your medications and complete supplement stack fit together, with daily timing and a clear point for reassessment
The interaction check is one section of the full report. You also get the reasoning behind each recommendation and the evidence references used.
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