Cladribine and Mercaptopurine interaction

Cladribine and Mercaptopurine: both prescribing labels flag this combination with the strongest language, such as a contraindication, a boxed warning, or an instruction to avoid it.

Major

Do not combine without a prescriber's guidance. The label language below is the strongest FDA uses.

What the FDA labels say

From the Cladribine (Mavenclad) label · effective 2026-05-27

Major

Prevention or Management Concomitant use with myelosuppressive or other immunosuppressive drugs is not recommended.

Drug interactionsby drug classView label on DailyMed

From the Mercaptopurine label · effective 2026-01-30

Moderate

A treatment regimen containing multiple immunosuppressants (including thiopurines) should therefore be used with caution as this could lead to lymphoproliferative disorders, some with reported fatalities.

Warnings and precautionsby drug classView label on DailyMed
Moderate

A combination of multiple immunosuppressants, given concomitantly increases the risk of Epstein-Barr virus (EBV)-associated lymphoproliferative disorders.

Warnings and precautionsby drug classView label on DailyMed

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Not medical advice. Interaction Checker quotes FDA label text and NIH fact sheets. Whether an interaction matters for you depends on doses, timing, kidney and liver function, and other conditions. Confirm with a pharmacist or prescriber.