Sulphasalazine inhibition of thiopurine methyltransferase: possible mechanism for interaction with 6-mercaptopurine and azathioprine

Br J Clin Pharmacol. 1995 Apr;39(4):456-9. doi: 10.1111/j.1365-2125.1995.tb04478.x.


Thiopurine drugs are used in the treatment of inflammatory bowel disease--as are sulphasalazine and its metabolite 5-aminosalicylic acid (ASA). S-Methylation catalyzed by thiopurine methyltransferase (TPMT) is a major pathway in the metabolism of thiopurines. The hypothesis was tested that TPMT might be inhibited by sulphasalazine or isomers of ASA. Sulphasalazine as well as 3-, 4- and 5-ASA inhibited recombinant human TPMT, with IC50 values of 78, 99, 2600 and 1240 microM, respectively. Kinetic studies demonstrated that the inhibition of TPMT by sulphasalazine and ASA isomers was non-competitive with regard to the thiopurine substrate, 6-MP, and was uncompetitive with regard to the methyl donor for the reaction, S-adenosyl-L-methionine. Our observations raise the possibility of a clinically significant drug-drug interaction in patients treated simultaneously with sulphasalazine and thiopurine drugs.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aminosalicylic Acids / pharmacology
  • Anti-Inflammatory Agents, Non-Steroidal / pharmacology
  • Azathioprine / pharmacokinetics*
  • Binding, Competitive
  • Drug Interactions
  • Gallic Acid / analogs & derivatives
  • Gallic Acid / pharmacology
  • Humans
  • Kinetics
  • Mercaptopurine / pharmacokinetics*
  • Mesalamine
  • Methylation
  • Methyltransferases / antagonists & inhibitors*
  • Pyridines
  • Recombinant Proteins / antagonists & inhibitors
  • Substrate Specificity
  • Sulfapyridine / pharmacology
  • Sulfasalazine / pharmacology*


  • Aminosalicylic Acids
  • Anti-Inflammatory Agents, Non-Steroidal
  • Pyridines
  • Recombinant Proteins
  • 3,4-dimethoxy-5-hydroxybenzoic acid
  • Sulfasalazine
  • Mesalamine
  • Gallic Acid
  • Mercaptopurine
  • Methyltransferases
  • thiopurine methyltransferase
  • Azathioprine
  • pyridine
  • Sulfapyridine