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Azathioprine side effects: what 87,582 FDA adverse event reports show

Azathioprine · 1,310 reaction terms · 504,620 drug–reaction co-reports · data 2026-09-14
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Drug class

Purine Antimetabolite

FDA label (Established Pharmacologic Class) · compare the class

Who reports

87,582 reports · 87% serious · 8,696 with death outcome · 62% female

openFDA FAERS counts, all years, deduplication not applied

Used for

Azathioprine tablets are indicated as an adjunct for the prevention of rejection in renal homotransplantation. It is also indicated for the management of active rheumatoid arthritis to reduce signs and symptoms. Renal Homotransplantation: Azathioprine tablets are indicated as an adjunct for the prevention of rejection in renal homotransplantation.

FDA label, Indications and Usage

What it is

Azathioprine is a thiopurine that is 6-mercaptopurine in which the mercapto hydrogen is replaced by a 1-methyl-4-nitroimidazol-5-yl group. It is a prodrug for mercaptopurine and is used as an immunosuppressant, prescribed for the treatment of inflammatory conditions and after organ transplantation and also for...

PubChem CID 2265 (ChEBI)

Boxed warning

- MALIGNANCY Chronic immunosuppression with azathioprine, a purine antimetabolite increases risk of malignancy in humans. Reports of malignancy include post-transplant lymphoma and hepatosplenic T-cell lymphoma (HSTCL) in patients with inflammatory bowel disease.

FDA label
How to read this page. FAERS is a spontaneous-reporting system: counts are not incidence rates and a signal is not proof of causation. Each reaction below is run through an automated screen — is the term in the FDA label (known), in the indications (the disease being treated), an administrative/coding term, or none of these (unlabeled)? That screen is mechanical text matching, not a causality assessment. The 30 hand-written Bradford Hill assessments are on the causality assessment page. Not medical advice.

Causality screen of the 40 strongest signals

Labeled — boxed warning 1Labeled adverse reaction 1Labeled (related wording) 1Likely indication confounding 3Reporting / coding artifact 1Lab value / disease marker 9Not in label — unassessed 24
What the badges mean

Strongest disproportionality signals

Flagged terms (PRR ≥ 2, χ² ≥ 4, n ≥ 10), ranked by PRR; infinite PRRs (no comparator reports) excluded. The EBGM column is a second, shrinkage-based estimate (MGPS) with its 5th percentile EB05 and the BCPNN IC025; a pair flagged by PRR alone is marked PRR-only and should be read as fragile. The strata column recomputes the PRR on serious reports only and flags pairs whose reports are unusually skewed by sex or come mostly from consumers rather than clinicians. 1,270 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.

Show:
ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Synovial fluid analysis792,654.9
1,225.7–5,750.7ROR 2,657.3 · χ² 16,843 / p <1e-300
206.2 EB05 170.8 · IC025 +6.2
3/3 methods agree
Reporting / coding artifactserious n=79 · ♀ 100% (drug 62%) · 100% cliniciannot reported in cached trials
Grip strength119254.5
196.4–329.8ROR 254.8 · χ² 14,311 / p <1e-300
120.4 EB05 103.3 · IC025 +6.0
3/3 methods agree
Not in label — unassessedserious n=119 · ♀ 100% (drug 62%) · 100% cliniciannot reported in cached trials
Hepatosplenic t-cell lymphoma155171.2
139.2–210.5ROR 171.5 · χ² 15,081 / p <1e-300
98.3 EB05 86.0 · IC025 +6.0
3/3 methods agree
Labeled — boxed warning
exact term
serious n=155 · ♀ 31% (drug 62%) · 100% cliniciannot reported in cached trials
Pulmonary vasculitis212160.9
135.1–191.6ROR 161.3 · χ² 19,909 / p <1e-300
95.1 EB05 84.9 · IC025 +6.1
3/3 methods agree
Not in label — unassessedserious n=212 · ♀ 0% (drug 62%)not reported in cached trials
Lupus vulgaris437139.3
123.8–156.8ROR 140.0 · χ² 37,602 / p <1e-300
87.5 EB05 80.9 · IC025 +6.2
3/3 methods agree
Not in label — unassessedserious n=437 · ♀ 100% (drug 62%) · 95% cliniciannot reported in cached trials
Blood iron abnormal359138.4
121.5–157.7ROR 139.0 · χ² 30,753 / p <1e-300
87.1 EB05 79.8 · IC025 +6.1
3/3 methods agree
Lab value / disease markerserious n=357 · ♀ 100% (drug 62%)not reported in cached trials
Anti-cyclic citrullinated peptide antibody235130.4
111.2–152.9ROR 130.7 · χ² 19,330 / p <1e-300
83.7 EB05 75.1 · IC025 +5.9
3/3 methods agree
Lab value / disease markerserious n=235 · ♀ 100% (drug 62%) · 100% cliniciannot reported in cached trials
Total lung capacity abnormal129122.9
99.3–152.0ROR 123.0 · χ² 10,163 / p <1e-300
80.1 EB05 69.2 · IC025 +5.7
3/3 methods agree
Not in label — unassessedserious n=128 · ♀ 0% (drug 62%)not reported in cached trials
Retinitis49199.8
89.8–110.9ROR 100.4 · χ² 33,660 / p <1e-300
70.2 EB05 65.1 · IC025 +5.9
3/3 methods agree
Not in label — unassessedserious n=491 · ♀ 100% (drug 62%) · 94% cliniciannot reported in cached trials
Sle arthritis8499.8
77.3–128.8ROR 99.9 · χ² 5,699 / p <1e-300
69.3 EB05 57.7 · IC025 +5.3
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious n=84 · ♀ 100% (drug 62%) · 100% clinicianNCT00094458: 1/163 (0.6%) control (serious AE)
Ileocaecal resection9393.1
73.2–118.4ROR 93.2 · χ² 6,005 / p <1e-300
66.1 EB05 55.6 · IC025 +5.3
3/3 methods agree
Not in label — unassessedserious n=93 · 100% cliniciannot reported in cached trials
Capillaritis7389.4
68.3–117.1ROR 89.5 · χ² 4,561 / p <1e-300
64.0 EB05 52.6 · IC025 +5.1
3/3 methods agree
Not in label — unassessedserious n=73 · ♀ 0% (drug 62%) · 100% cliniciannot reported in cached trials
Elbow deformity8880.9
63.5–103.0ROR 80.9 · χ² 5,106 / p <1e-300
59.7 EB05 49.9 · IC025 +5.1
3/3 methods agree
Not in label — unassessedserious n=88 · ♀ 100% (drug 62%)not reported in cached trials
Coombs positive haemolytic anaemia10872.6
58.5–90.1ROR 72.7 · χ² 5,772 / p <1e-300
55.2 EB05 47.0 · IC025 +5.2
3/3 methods agree
Not in label — unassessedserious n=108 · ♀ 0% (drug 62%) · 100% cliniciannot reported in cached trials
Bone erosion81471.4
66.0–77.2ROR 72.0 · χ² 43,286 / p <1e-300
54.9 EB05 51.8 · IC025 +5.6
3/3 methods agree
Not in label — unassessedserious n=814 · ♀ 92% (drug 62%)not reported in cached trials
Overlap syndrome15267.6
56.4–80.9ROR 67.7 · χ² 7,695 / p <1e-300
52.4 EB05 45.8 · IC025 +5.2
3/3 methods agree
Not in label — unassessedserious n=152 · ♀ 100% (drug 62%)not reported in cached trials
Seronegative arthritis24767.5
58.6–77.7ROR 67.7 · χ² 12,521 / p <1e-300
52.5 EB05 47.2 · IC025 +5.4
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=247 · ♀ 100% (drug 62%) · 100% cliniciannot reported in cached trials
Cholestasis of pregnancy10067.0
53.7–83.7ROR 67.1 · χ² 5,010 / p <1e-300
51.9 EB05 43.9 · IC025 +5.1
3/3 methods agree
Labeled adverse reaction
exact term
serious n=99 · ♀ 100% (drug 62%) · 100% cliniciannot reported in cached trials
Granuloma skin18166.8
56.7–78.8ROR 67.0 · χ² 9,091 / p <1e-300
52.0 EB05 45.9 · IC025 +5.3
3/3 methods agree
Not in label — unassessedserious n=180 · ♀ 100% (drug 62%)not reported in cached trials
Spirometry abnormal12564.6
53.0–78.8ROR 64.7 · χ² 6,093 / p <1e-300
50.5 EB05 43.5 · IC025 +5.1
3/3 methods agree
Lab value / disease markerserious n=125 · ♀ 0% (drug 62%)not reported in cached trials
Deep vein thrombosis postoperative41363.8
57.2–71.1ROR 64.1 · χ² 20,034 / p <1e-300
50.3 EB05 46.3 · IC025 +5.4
3/3 methods agree
Not in label — unassessedserious n=413 · ♀ 100% (drug 62%) · 94% cliniciannot reported in cached trials
Facet joint syndrome64461.4
56.3–66.9ROR 61.8 · χ² 30,294 / p <1e-300
48.8 EB05 45.7 · IC025 +5.4
3/3 methods agree
Not in label — unassessedserious n=644 · ♀ 100% (drug 62%) · 96% cliniciannot reported in cached trials
Adjustment disorder with depressed mood40459.9
53.7–66.8ROR 60.2 · χ² 18,610 / p <1e-300
47.9 EB05 44.1 · IC025 +5.3
3/3 methods agree
Not in label — unassessedserious n=404 · ♀ 100% (drug 62%) · 96% cliniciannot reported in cached trials
Nodular regenerative hyperplasia14259.7
49.6–71.7ROR 59.7 · χ² 6,486 / p <1e-300
47.5 EB05 41.3 · IC025 +5.1
3/3 methods agree
Not in label — unassessedserious n=142 · ♀ 0% (drug 62%) · 100% cliniciannot reported in cached trials
Rheumatic fever87159.5
55.3–64.1ROR 60.1 · χ² 39,971 / p <1e-300
47.7 EB05 45.1 · IC025 +5.4
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=871 · ♀ 100% (drug 62%) · 94% cliniciannot reported in cached trials
Dislocation of vertebra42155.8
50.2–62.0ROR 56.1 · χ² 18,270 / p <1e-300
45.2 EB05 41.7 · IC025 +5.3
3/3 methods agree
Not in label — unassessedserious n=421 · ♀ 100% (drug 62%) · 95% cliniciannot reported in cached trials
Mite allergy12055.4
45.4–67.5ROR 55.4 · χ² 5,141 / p <1e-300
44.7 EB05 38.4 · IC025 +4.9
3/3 methods agree
Not in label — unassessedserious n=120 · ♀ 0% (drug 62%)not reported in cached trials
Antineutrophil cytoplasmic antibody positive12850.9
42.1–61.7ROR 51.0 · χ² 5,111 / p <1e-300
41.8 EB05 36.1 · IC025 +4.9
3/3 methods agree
Lab value / disease markerserious n=128 · ♀ 0% (drug 62%)not reported in cached trials
Clear cell renal cell carcinoma11146.2
37.7–56.6ROR 46.3 · χ² 4,066 / p <1e-300
38.6 EB05 32.9 · IC025 +4.7
3/3 methods agree
Not in label — unassessedserious n=111not reported in cached trials
Eosinophilic granulomatosis with polyangiitis32445.7
40.6–51.4ROR 45.8 · χ² 11,818 / p <1e-300
38.3 EB05 34.9 · IC025 +5.0
3/3 methods agree
Not in label — unassessedserious n=323 · ♀ 20% (drug 62%)not reported in cached trials
X-ray abnormal28244.8
39.5–50.9ROR 45.0 · χ² 10,113 / p <1e-300
37.7 EB05 34.2 · IC025 +5.0
3/3 methods agree
Lab value / disease markerserious n=282 · ♀ 100% (drug 62%)not reported in cached trials
Tenosynovitis stenosans8844.6
35.5–56.0ROR 44.7 · χ² 3,117 / p <1e-300
37.4 EB05 31.3 · IC025 +4.6
3/3 methods agree
Not in label — unassessedserious n=88 · ♀ 100% (drug 62%) · 100% cliniciannot reported in cached trials
Terminal ileitis9444.1
35.4–55.0ROR 44.2 · χ² 3,301 / p <1e-300
37.1 EB05 31.2 · IC025 +4.6
3/3 methods agree
Not in label — unassessedserious n=94not reported in cached trials
Ileal stenosis27243.1
37.9–49.1ROR 43.3 · χ² 9,428 / p <1e-300
36.5 EB05 33.0 · IC025 +4.9
3/3 methods agree
Not in label — unassessedserious n=272NCT00094458: 1/17 (5.9%) on Azathioprine (serious AE)
Anti-cyclic citrullinated peptide antibody positive1,03740.8
38.2–43.6ROR 41.3 · χ² 34,294 / p <1e-300
34.9 EB05 33.2 · IC025 +5.0
3/3 methods agree
Lab value / disease markerserious PRR 23.3 · ♀ 100% (drug 62%) · 94% cliniciannot reported in cached trials
Swollen joint count increased44840.1
36.2–44.3ROR 40.3 · χ² 14,547 / p <1e-300
34.3 EB05 31.7 · IC025 +4.9
3/3 methods agree
Lab value / disease markerserious n=448 · ♀ 100% (drug 62%) · 95% cliniciannot reported in cached trials
Mycotic allergy12140.0
33.0–48.5ROR 40.1 · χ² 3,902 / p <1e-300
34.2 EB05 29.4 · IC025 +4.6
3/3 methods agree
Not in label — unassessedserious n=121 · ♀ 0% (drug 62%)not reported in cached trials
C-reactive protein abnormal91139.6
36.9–42.5ROR 40.0 · χ² 29,308 / p <1e-300
34.0 EB05 32.2 · IC025 +5.0
3/3 methods agree
Lab value / disease markerserious n=910 · ♀ 93% (drug 62%)NCT00094458: 1/18 (5.6%) control
Rheumatoid factor positive79037.9
35.2–40.8ROR 38.2 · χ² 24,412 / p <1e-300
32.7 EB05 30.9 · IC025 +4.9
3/3 methods agree
Lab value / disease markerserious n=790 · ♀ 100% (drug 62%) · 93% cliniciannot reported in cached trials

Trial evidence (ClinicalTrials.gov)

✓ Trial adverse-event data found on ClinicalTrials.gov

Largest completed trials with posted results that list Azathioprine as a study intervention. The right-hand column of the signal table shows whether each FAERS term was also recorded in these trials, with a real denominator (3 of 40 signal terms matched).

Caveats: trial populations, doses and follow-up differ from the reporting population; AE terms are sponsor-coded and matched here by wording; absence from a trial list means the term was not reported above the sponsor's frequency threshold, not that it cannot occur.

Most frequently reported reactions

By raw co-report count, regardless of disproportionality. Common terms here are often the illness itself or generic outcomes.

ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Off label use (used outside approved label)13,3043.7
3.7–3.8ROR 4.2 · χ² 27,071 / p <1e-300
3.7 EB05 3.6 · IC025 +1.8
3/3 methods agree
Reporting / coding artifactserious PRR 4.3not reported in cached trials
Drug ineffective (drug did not work)13,0082.4
2.3–2.4ROR 2.6 · χ² 10,982 / p <1e-300
2.4 EB05 2.3 · IC025 +1.2
3/3 methods agree
Reporting / coding artifactserious PRR 4.0not reported in cached trials
Condition aggravated6,5525.3
5.2–5.4ROR 5.6 · χ² 22,608 / p <1e-300
5.2 EB05 5.1 · IC025 +2.3
3/3 methods agree
Reporting / coding artifactserious PRR 5.1not reported in cached trials
Arthralgia (joint pain)5,8663.4
3.3–3.5ROR 3.6 · χ² 10,120 / p <1e-300
3.4 EB05 3.3 · IC025 +1.7
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 3.8NCT00094458: 1/163 (0.6%) control (serious AE)
Diarrhoea (diarrhea)5,4842.1
2.0–2.1ROR 2.1 · χ² 3,016 / p <1e-300
2.0 EB05 2.0 · IC025 +1.0Labeled adverse reaction
exact term
serious PRR 2.1NCT00094458: 1/163 (0.6%) control (serious AE)
Nausea5,2241.6
1.5–1.6ROR 1.6 · χ² 1,177 / p 3e-258
1.6 EB05 1.5 · IC025 +0.6Labeled adverse reaction
exact term
serious PRR 1.8NCT00094458: 1/17 (5.9%) on Azathioprine; 46/161 (28.6%) control
Fatigue (tiredness)5,1371.6
1.5–1.6ROR 1.6 · χ² 1,150 / p 2e-252
1.6 EB05 1.5 · IC025 +0.6Not in label — unassessedserious PRR 1.7NCT00094458: 6/17 (35.3%) on Azathioprine; 22/161 (13.7%) control
Headache4,4201.7
1.6–1.7ROR 1.7 · χ² 1,288 / p 2e-282
1.7 EB05 1.6 · IC025 +0.7Not in label — unassessedserious PRR 2.0NCT00094458: 1/17 (5.9%) on Azathioprine; 19/161 (11.8%) control
Pain4,2281.6
1.6–1.7ROR 1.7 · χ² 1,106 / p 9e-243
1.6 EB05 1.6 · IC025 +0.7Labeled adverse reaction
exact term
serious PRR 1.6NCT00094458: 4/179 (2.2%) on Azathioprine; 1/161 (0.6%) control (serious AE)
Abdominal pain3,8254.0
3.9–4.1ROR 4.1 · χ² 8,514 / p <1e-300
3.9 EB05 3.8 · IC025 +1.9
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 3.2NCT00094458: 4/179 (2.2%) on Azathioprine; 1/161 (0.6%) control (serious AE)
Dyspnoea (shortness of breath)3,7641.6
1.5–1.6ROR 1.6 · χ² 857 / p 9e-189
1.6 EB05 1.6 · IC025 +0.6Not in label — unassessedserious PRR 1.4NCT00094458: 1/17 (5.9%) on Azathioprine; 2/161 (1.2%) control
Malaise (feeling unwell)3,7232.0
2.0–2.1ROR 2.1 · χ² 1,988 / p <1e-300
2.0 EB05 2.0 · IC025 +1.0Labeled adverse reaction
exact term
serious PRR 2.1NCT00094458: 1/8 (12.5%) on Azathioprine; 1/161 (0.6%) control
Drug intolerance3,6989.5
9.2–9.8ROR 9.9 · χ² 27,252 / p <1e-300
9.2 EB05 8.9 · IC025 +3.1
3/3 methods agree
Reporting / coding artifactserious PRR 9.6 · ♀ 83% (drug 62%)not reported in cached trials

Unlabeled candidate signals

These flagged terms were not found in the FDA label text and do not match an artifact pattern. They are the pairs that would merit a structured assessment (temporality, dose-response, biological plausibility, consistency across databases, trial or cohort evidence). The screen has not done that; string-matching misses label wording, and a strong PRR can still be stimulated reporting, co-medication, or the disease itself.

✓ A hand-written Bradford Hill causality assessment exists for this drug: Azathioprine ↔ Bone-marrow suppression (pancytopenia).

Want to assess one of these properly? The runbook describes the Bradford Hill / trial-evidence workflow used on the assessment page, and handoff_top1000_signals.csv lists the strongest unassessed pairs across all drugs.

Common questions

What are the most reported side effects of Azathioprine?

In FDA FAERS, the most frequently co-reported reaction terms for Azathioprine are arthralgia, diarrhoea, nausea, fatigue, headache, pain. These are report counts, not rates: FAERS has no denominator, reporting is voluntary and uneven, and a term can be reported because of the illness being treated rather than the drug.

Does Azathioprine have an FDA boxed warning?

Yes. The current FDA label carries a boxed warning: - MALIGNANCY Chronic immunosuppression with azathioprine, a purine antimetabolite increases risk of malignancy in humans. Reports of malignancy include post-transplant lymphoma and hepatosplenic T-cell lymphoma (HSTCL) in patients with inflammatory bowel disease.

Do FAERS signals prove that Azathioprine causes these side effects?

No. A disproportionality signal (PRR, ROR) means a reaction is reported more often with this drug than with others in the database. That can reflect a real effect, but also the disease being treated, stimulated reporting after news or litigation, co-medications, or how reports are coded. Causality needs temporality, dose-response, biological plausibility, consistency across data sources and, ideally, trial or cohort evidence. This page screens each term against the FDA label and ClinicalTrials.gov results; it does not establish causation.

Sources & methods

Page generated 2026-10-08. Label and PubChem text are retrieved automatically and may lag the current label; always check the current prescribing information. OpenPV is a beta research tool of the Open Source Medicine Foundation.