Mercaptopurine

Mercaptopurine is used in the treatment of blood cancer. It shows its working by decreasing the number of red blood cells, which is produced by the body. Mercaptopurine can be taken with or without food or you can have it one hour before or 2 hours after the meal. Your doctor will decide what dose is necessary and how often you need to take it. This will depend on what you are being treated for and may change from time to time. You should take it exactly as your doctor has advised. Taking it in the wrong way or taking too much can cause very serious side effects. It may take several weeks or months for you to see or feel the benefits but do not stop taking it unless your doctor tells you to. The most common side effects of this medicine include nausea, vomiting, rash, diarrhea, and loss of appetite. This medicine may reduce the number of blood cells (decrease red blood and white blood cells) in your blood, thereby, increasing the susceptibility to infections. Regular blood tests are required to check your blood cells along with heart, liver, and blood uric acid levels. You have to avoid driving or attention seeking activity if you experience dizziness while taking this medicine. Before taking it, tell your doctor if you have heart disease, liver, or kidney problems or are taking any medicines to treat infections. Many other medicines can affect, or be affected by, this medicine so let your doctor know all medications you are using. This medicine is not recommended during pregnancy or while breastfeeding. The use of effective contraception by both males and females during treatment is important to avoid pregnancy. Mercaptopurine interferes with the growth of DNA and RNA of the cancer cells by substituting their building blocks. It prevents the cancer cells from growing and multiplying.

• Blood cancer

Mercaptopurine is a purine antagonist which is converted intracellularly into its active nucleotides, including thioinosinic acid. The nucleotides inhibit several reactions which ultimately interferes with nucleic acid synthesis and prevents the formation of RNA and DNA.

Adult Dose: Acute Lymphatic Leukemia Induction: 2.5 mg/kg PO qDay; usually 100-200 mg PO qDay in average adult (other agents preferred) May increase by 5 mg/kg/day after 4 weeks Maintenance: 1.5-2.5 mg/kg PO qDay Reduce dose by 75% if concomitant allopurinol administration Crohn's disease Adult: Initially 1-1.5 mg/kg daily, may increase to 125 mg daily. Hepatic impairment: Dosage may need to be reduced. Child Dose: Acute Lymphatic Leukemia Starting dose: 1.25-2.5 mg/kg (50-75 mg/m²) PO qDay Maintenance: 1.5-2.5 mg/kg PO qDay in combination with methotrexate Renal Dose: Renal Impairment: Dosage may need to be reduced.

Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Mercaptopurine may be taken with or without food, but it is better to take it at a fixed time.

Common: • Nausea • Vomiting • Rash • Decreased white blood cell count (neutrophils) • Intestinal ulcer • Anemia (low number of red blood cells) • Increased bilirubin in the blood • Low blood platelets • Increased transaminase level in blood • Diarrhea • Loss of appetite

[SAFE] Mercaptopurine does not usually affect your ability to drive. Mercaptopurine is used for the treatment of cancer of the blood. Take it with or without food. Do not drive or do anything requiring concentration until you know how it affects you. Use a reliable contraceptive method to prevent pregnancy while you are taking this medicine. Your doctor may get regular blood and urine tests done to monitor your blood cells, kidney and liver function during treatment with this medicine. Inform your doctor immediately if you notice any signs of infection such as fever, sore throat, rash or severe diarrhea.

Pregnancy and lactation. Prior resistance to mercaptopurine or thioguanine; severe liver disease; severe bone marrow suppression.

Anticoagulant action of warfarin may be inhibited by mercaptopurine. Enhanced toxicity with myelosuppressive drugs. Potentially Fatal: Effects enhanced by allopurinol (reduce dose of mercaptopurine). Other hepatotoxic drugs (e.g. doxorubicin) potentiate toxicity.

[CONSULT YOUR DOCTOR] It is not known whether it is safe to consume alcohol with Mercaptopurine. Please consult your doctor.

[CONSULT YOUR DOCTOR] Mercaptopurine is unsafe to use during pregnancy as there is definite evidence of risk to the developing baby. However, the doctor may rarely prescribe it in some life-threatening situations if the benefits are more than the potential risks. Please consult your doctor.

[CONSULT YOUR DOCTOR] Mercaptopurine is probably unsafe to use during breastfeeding. Limited human data suggests that the drug may pass into the breastmilk and harm the baby.

[CAUTION] Mercaptopurine should be used with caution in patients with kidney disease. Dose adjustment of Mercaptopurine may be needed. Please consult your doctor. [CAUTION] Mercaptopurine should be used with caution in patients with liver disease. Dose adjustment of Mercaptopurine may be needed. Please consult your doctor. Inform your doctor if you develop any signs and symptoms of jaundice while taking this medicine.

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