6 mercaptopurine side effects

Purinethol

SIDE EFFECTS

The principal and potentially serious toxic effects of mercaptopurine are bone marrow toxicity and hepatotoxicity (see WARNINGS and PRECAUTIONS).

Hematologic

The most frequent adverse reaction to mercaptopurine is myelosuppression. The induction of completeremission of acute lymphatic leukemia frequently is associated with marrow hypoplasia. Patients without TPMT enzyme activity (homozygous-deficient) are particularly susceptible to hematologic toxicity, and somepatients with low or intermediate TPMT enzyme activity are more susceptible to hematologic toxicity thanpatients with normal TPMT activity (see WARNINGS: Bone Marrow Toxicity), although the latter can alsoexperience severe toxicity. Maintenance of remission generally involves multiple-drug regimens whose component agents cause myelosuppression. Anemia, leukopenia, and thrombocytopenia are frequentlyobserved. Dosages and also schedules are adjusted to prevent life-threatening cytopenias.

Renal

Hyperuricemia and/or hyperuricosuria may occur in patients receiving mercaptopurine as a consequence ofrapid cell lysis accompanying the antineoplastic effect. Renal adverse effects can be minimized by increased hydration, urine alkalinization, and the prophylactic administration of a xanthine oxidase inhibitor such asallopurinol. The dosage of mercaptopurine should be reduced to one third to one quarter of the usual dose ifallopurinol is given concurrently.

Gastrointestinal

Intestinal ulceration has been reported. Nausea, vomiting, and anorexia are uncommon during initialadministration, but may increase with continued administration. Mild diarrhea and sprue-like symptoms have been noted occasionally, but it is difficult at present to attribute these to the medication. Oral lesions arerarely seen, and when they occur they resemble thrush rather than antifolic ulcerations.

Miscellaneous

The administration of mercaptopurine has been associated with skin rashes and hyperpigmentation. Alopecia has been reported.

Drug fever has been very rarely reported with mercaptopurine. Before attributing fever to mercaptopurine,every attempt should be made to exclude more common causes of pyrexia, such as sepsis, in patients withacute leukemia.

Oligospermia has been reported.

Read the entire FDA prescribing information for Purinethol (Mercaptopurine)

Mercaptopurine

Mercaptopurine is a cancer medicine that interferes with the growth and spread of cancer cells in the body.

Mercaptopurine is used to treat acute lymphoblastic leukemia (ALL). Mercaptopurine is sometimes given with other cancer medications.

Mercaptopurine may also be used for purposes not listed in this medication guide.

You should not use mercaptopurine if you have ever used mercaptopurine or thioguanine (Tabloid) and they were not effective in treating your condition.

Some people using mercaptopurine have developed a rare fast-growing type of lymphoma (cancer). This condition affects the liver, spleen, and bone marrow, and it can be fatal.

Using mercaptopurine may also increase your risk of developing other types of cancer, such as skin cancer or uterine cancer.

Call your doctor at once if you have symptoms of lymphoma, such as: fever, night sweats, weight loss, tiredness, feeling full after eating only a small amount, pain in your upper stomach, easy bruising or bleeding, dark urine, or jaundice (yellowing of the skin or eyes).

You should not use mercaptopurine if you are allergic to it, or if you have ever used mercaptopurine or thioguanine (Tabloid) and they were not effective in treating your condition.

Some people using mercaptopurine have developed a rare fast-growing type of lymphoma (cancer). This condition affects the liver, spleen, and bone marrow, and it can be fatal. This has occurred mainly in teenagers and young adults using mercaptopurine or similar medicines to treat Crohn’s disease or ulcerative colitis.

However, people with autoimmune disorders (including rheumatoid arthritis, Crohn’s disease, ankylosing spondylitis, and psoriasis) may have a higher risk of lymphoma. Talk to your doctor about your individual risk.

Using mercaptopurine may also increase your risk of developing other types of cancer, such as skin cancer or uterine cancer. Ask your doctor about your specific risk.

To make sure mercaptopurine is safe for you, tell your doctor if you have:

  • liver disease;
  • kidney disease;
  • an inherited condition in which your body cannot produce enough of the enzyme thiopurine methyltransferase (TPMT);
  • any type of viral, bacterial, or fungal infection; or
  • ulcerative colitis (treated with mesalamine, sulfasalazine, or similar medicines).

Do not use mercaptopurine if you are pregnant. It could harm the unborn baby. Use effective birth control, and tell your doctor if you become pregnant during treatment.

It is not known whether mercaptopurine passes into breast milk or if it could harm a nursing baby. You should not breast-feed while taking mercaptopurine.

Generic Name: mercaptopurine (mer KAP toe PURE een)
Brand Name: Purixan, Purinethol

Medically reviewed by Drugs.com on May 30, 2019 – Written by Cerner Multum

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What is mercaptopurine?

Mercaptopurine is used to treat acute lymphoblastic or lymphocytic leukemia. Mercaptopurine is sometimes given with other cancer medications.

Mercaptopurine may also be used for purposes not listed in this medication guide.

Important Information

You should not use mercaptopurine if you have ever used mercaptopurine or thioguanine and they were not effective in treating your condition.

Some people using mercaptopurine have developed a rare fast-growing type of lymphoma (cancer). This condition affects the liver, spleen, and bone marrow, and it can be fatal.

Call your doctor at once if you have symptoms of lymphoma, such as: fever, night sweats, tiredness, stomach bloating, feeling full, easy bruising or bleeding, or weight loss.

Before taking this medicine

You should not use this medicine if you are allergic to mercaptopurine or thioguanine, or if you have ever used mercaptopurine or thioguanine and they were not effective in treating your condition.

Mercaptopurine may cause a rare type of lymphoma (cancer) of the liver, spleen, and bone marrow that can be fatal. Talk with your doctor about your own risk.

Using mercaptopurine may also increase your risk of developing other types of cancer. Ask your doctor about your specific risk.

Tell your doctor if you have ever had:

  • liver disease;

  • kidney disease;

  • an inherited condition in which your body cannot produce enough of the enzyme thiopurine methyltransferase (TPMT);

  • any type of viral, bacterial, or fungal infection; or

  • ulcerative colitis (treated with mesalamine, sulfasalazine, or similar medicines).

Mercaptopurine may harm an unborn baby, especially when used during the first trimester. Use effective birth control to prevent pregnancy, and tell your doctor if you become pregnant.

You should not breastfeed while taking mercaptopurine.

How should I take mercaptopurine?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

Shake the oral suspension (liquid) before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

Use care when handling mercaptopurine tablets or oral suspension. mercaptopurine may be dangerous if it gets in your eyes or on your skin. If this occurs, wash your skin with soap and water or rinse your eyes with water. Seek medical attention if you have redness, itching, or swelling even after rinsing off the medicine. Ask your doctor or pharmacist how to dispose of unused medicine no longer needed.

Mercaptopurine can increase your risk of bleeding, infection, or liver problems. You will need frequent medical tests. Your next dose may be delayed based on the results.

Mercaptopurine can affect your kidneys. Drink plenty of liquids to keep your kidneys working properly.

You may be given other medication to help prevent serious side effects on your kidneys. Keep using this medicine for as long as your doctor has prescribed.

Store mercaptopurine at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

What happens if I miss a dose?

Call your doctor for instructions if you miss a dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Early symptoms of an overdose may include loss of appetite, nausea, vomiting, or diarrhea. Later symptoms may include fever or flu-like symptoms.

What should I avoid while taking mercaptopurine?

Do not receive a “live” vaccine while using mercaptopurine. The vaccine may not work as well and may not fully protect you from disease. Live vaccines include measles, mumps, rubella (MMR), polio, rotavirus, typhoid, yellow fever, varicella (chickenpox), zoster (shingles), and nasal flu (influenza) vaccine.

Avoid being near people who are sick or have infections. Tell your doctor at once if you develop signs of infection.

mercaptopurine can pass into body fluids (urine, feces, vomit). Caregivers should wear rubber gloves while cleaning up a patient’s body fluids, handling contaminated trash or laundry or changing diapers. Wash hands before and after removing gloves. Wash soiled clothing and linens separately from other laundry.

Mercaptopurine side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • low blood cell counts–fever, chills, tiredness, mouth sores, skin sores, easy bruising, unusual bleeding, pale skin, cold hands and feet, feeling light-headed or short of breath;

  • liver problems–loss of appetite, nausea, vomiting, diarrhea, upper stomach pain, swelling in your midsection, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or

  • symptoms of lymphoma–fever, night sweats, tiredness, stomach bloating, feeling full, weight loss.

Common side effects may include:

  • low blood cell counts;

  • bruising or bleeding;

  • nausea, vomiting, loss of appetite;

  • diarrhea;

  • rash, changes in skin color;

  • hair loss; or

  • general ill feeling.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect mercaptopurine?

Mercaptopurine can harm your liver, especially if you also use certain medicines for infections, tuberculosis, depression, birth control, hormone replacement, high cholesterol, heart problems, high blood pressure, seizures, pain, or arthritis (including Tylenol, Advil, Motrin, or Aleve).

Tell your doctor about all your other medicines, especially:

  • allopurinol;

  • olsalazine, mesalazine, sulfasalazine or similar medicines;

  • sulfamethoxazole and trimethoprim; or

  • warfarin (Coumadin, Jantoven).

This list is not complete. Other drugs may affect mercaptopurine, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2018 Cerner Multum, Inc. Version: 11.01.

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Consumer resources

  • Mercaptopurine Tablets
  • Mercaptopurine Suspension
  • Mercaptopurine (Advanced Reading)

Other brands: Purinethol, Purixan

Professional resources

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Related treatment guides

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Mercaptopurine for Crohn’s disease and ulcerative colitis

Is there anything I should know before taking mercaptopurine?

  • You will have screening carried out before starting mercaptopurine. This will include checking for levels of enzymes in your blood and being screened for immunity to the chickenpox virus and for other infections. You may also be screen for tuberculosis (TB)
  • You will need regular blood tests and monitoring. As mercaptopurine reduces the number of white and red blood cells, as well as platelets, you will need blood tests to check levels of these cells and also to check your liver function. You kidney function should also be tested every six months
  • You will be more sensitive to sunlight. You should avoid sunbeds, strong sunlight and use sun cream with a high SPF
  • You are at a slightly increased risk of developing certain cancers, such as skin cancer and lymphoma
  • You may get ill more often. As mercaptopurine suppresses the immune system you may find that you pick up more colds, coughs, infections and other illnesses and find it hard to get rid of them or they may develop into more serious illnesses. You should also avoid contact with people who have illnesses such as chicken pox
  • If you are male or female taking mercaptopurine and want to have a baby you should discuss this with your doctor before getting pregnant or if you find out you or your partner are pregnant. Manufacturers recommend patients, or their partners, who are pregnant or likely to get pregnant should not take the drug. However, experts believe it can be taken where the benefits outway the risks
  • If you have liver or kidney problems you should inform your doctor and you may need to be monitored while taking the medication or be given different medication
  • You can be allergic to mercaptopurine
  • You shouldn’t have any live vaccines while taking mercaptopurine or within six months of stopping. These include vaccines for polio, yellow fever, tuberculosis, German measles and MMR (measles, mumps and rubella). You can have a flu vaccine as long as it is the inactivated version. If you come into contact with someone who has recently had a live vaccine there is a chance the infection could be passed onto you

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