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At a glance

Mercaptopurine is an anti-cancer medication used for maintenance therapy of acute lymphoblastic leukemia (ALL). It interferes with DNA and RNA formation in cancer cells to stop their growth and division.

Indications
  • Acute lymphoblastic leukemia (ALL) - maintenance therapy (as part of a combination regimen)
  • Crohn's disease (off-label)
Pharmacology

Mercaptopurine is converted intracellularly to active nucleotides that interfere with nucleic acid synthesis and prevent RNA and DNA formation.

Dosage

ALL (Adults):

  • Induction: 2.5 mg/kg/day (usually 100-200 mg/day)
  • Maintenance: 1.5-2.5 mg/kg/day
  • Reduce dose by 75% with allopurinol

ALL (Children): 1.25-2.5 mg/kg/day (50-75 mg/m²); Maintenance: 1.5-2.5 mg/kg/day

Crohn's Disease (Adults): Initial 1-1.5 mg/kg/day; max 125 mg/day

Side effects

Common Side Effects:

  • Nausea, vomiting
  • Skin rash
  • Decreased white blood cell count (neutrophils)
  • Intestinal ulcer
  • Anemia
  • Increased bilirubin
  • Low blood platelets
  • Increased transaminases
  • Diarrhea, loss of appetite
Use in pregnancy

Use in Pregnancy: Mercaptopurine is unsafe during pregnancy (Category D); definite evidence of risk to the fetus. Use only in life-threatening situations with doctor's advice.

Pregnancy Category: D — always consult a doctor before taking during pregnancy.

Precautions & warnings
  • Caution in hepatic and renal dysfunction; monitor hepatic function periodically
  • Myelosuppression - monitor blood counts regularly
  • TPMT deficiency may cause severe myelotoxicity
  • Do not use during pregnancy and lactation
  • Caution when driving or doing activities requiring concentration (may cause dizziness)
Overdose effects

Overdose may cause myelosuppression, nausea, diarrhea; symptomatic treatment.

Storage conditions

Store at 20-25°C.

Mercaptopurine — see the full informationPharmacology, precautions, pregnancy, overdose and the rest on the generic page
⚠️ This information is for educational purposes only — not a substitute for medical advice. Consult a registered physician before taking any medicine.