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What is Purinethol (mercaptopurine), and how does it work?
Generic drug: Purinethol
Brand name: mercaptopurine
What are the side effects of Purinethol?
Common side effects of Purinethol include:
Temporary hair loss may also occur. Normal hair growth should return after treatment with Purinethol has ended. Tell your doctor if you have unlikely but serious side effects of Purinethol including:
What is the dosage for Purinethol?
- The recommended starting dosage of Purinethol is 1.5 mg/kg to 2.5 mg/kg orally once daily as part of combination chemotherapy maintenance regimen. A recommended dosage for patients less than 17 kg is not achievable, because the only available strength is 50 mg. Take Purinethol either consistently with or without food.
- After initiating Purinethol, monitor complete blood count (CBC) and adjust the dose to maintain absolute neutrophil count (ANC) at a desirable level and for excessive myelosuppression. Evaluate the bone marrow in patients with prolonged myelosuppression or repeated episodes of myelosuppression to assess leukemia status and marrow cellularity.
- Evaluate thiopurine S-methyltransferase (TPMT) and nucleotide diphosphatase (NUDT15) status in patients with severe myelosuppression or repeated episodes or myelosuppression [see Dosage Modifications in Patients with TPMT and NUDT15 Deficiency below].
- Do not administer to patients who are unable to swallow tablets.
- If a patient misses a dose, instruct the patient to continue with the next scheduled dose.
- Purinethol is a cytotoxic drug. Follow special handling and disposal procedures.
Dosage Modifications In Patients With TPMT And NUDT15 Deficiency
- Consider testing for TPMT and NUDT15 deficiency in patients who experience severe myelosuppression or repeated episodes of myelosuppression.
Homozygous Deficiency In Either TPMT Or NUDT15
- Patients with homozygous deficiency of either enzyme typically require 10% or less of the recommended dosage.
- Reduce the recommended starting dosage of Purinethol in patients who are known to have homozygous TPMT or NUDT15 deficiency.
Heterozygous Deficiency In TPMT And/Or NUDT15
- Reduce the Purinethol dose based on tolerability.
- Most patients with heterozygous TPMT or NUDT15 deficiency tolerate the recommended dosage, but some require a dose reduction based on adverse reactions.
- Patients who are heterozygous for both TPMT and NUDT15 may require more substantial dose reductions.
Dosage Modifications In Renal And Hepatic Impairment
- Use the lowest recommended starting dosage for Purinethol in patients with renal impairment (CLcr less than 50 mL/min).
- Adjust the dosage to maintain absolute neutrophil count (ANC) at a desirable level and for adverse reactions.
- Use the lowest recommended starting dosage for Purinethol in patients with hepatic impairment.
- Adjust the dosage to maintain absolute neutrophil count (ANC) at a desirable level and for adverse reactions.
Dosage Modification With Concomitant Use Of Allopurinol
- Reduce the dose of Purinethol to one-third to one-quarter of the current dosage when coadministered with allopurinol.
What drugs interact with Purinethol?
- The concomitant administration of Purinethol and warfarin may decrease the anticoagulant effectiveness of warfarin.
- Monitor the international normalized ratio (INR) in patients receiving warfarin and adjust the warfarin dosage as appropriate.
- Purinethol can cause myelosuppression. Myelosuppression may be increased when Purinethol is coadministered with other products that cause myelosuppression. Enhanced myelosuppression has been noted in some patients also receiving trimethoprim-sulfamethoxazole. Monitor the CBC and adjust the dose of Purinethol for excessive myelosuppression.
- Aminosalicylates (e.g., mesalamine, olsalazine or sulfasalazine) may inhibit the TPMT enzyme, which may increase the risk of myelosuppression when coadministered with Purinethol. When aminosalicylates and Purinethol are coadministered, use the lowest possible doses for each drug and monitor more frequently for myelosuppression.
- Purinethol can cause hepatotoxicity. Hepatotoxicity may be increased when Purinethol is coadministered with other products that cause hepatotoxicity. Monitor liver tests more frequently in patients who are receiving Purinethol with other hepatotoxic products.
Is Purinethol safe to use while pregnant or breastfeeding?
- Purinethol can cause fetal harm when administered to a pregnant woman.
- Pregnant women who receive mercaptopurine have an increased incidence of miscarriage and stillbirth.
- There are no data on the presence of mercaptopurine or its metabolites in human milk, the effects on the breastfed child, or the effects on milk production.
- Because of the potential for serious adverse reactions in the breastfed child, women should not breastfeed during treatment with Purinethol and for 1 week after the last dose.
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Purinethol (mercaptopurine) is used to slow the growth of cancer cells. Purinethol is also used to treat certain types of leukemia. Common side effects of Purinethol include nausea, vomiting, diarrhea, loss of appetite, itching or skin rash, or darkened skin color. Temporary hair loss may also occur.
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Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Leukemia is a type of cancer of the blood cells in which the growth and development of the blood cells are abnormal. Strictly speaking, leukemia should refer only to cancer of the white blood cells (the leukocytes) but in practice it can apply to malignancy of any cellular element in the blood or bone marrow, as in red cell leukemia (erythroleukemia).
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Leukemia is a group of cancers of the blood affecting the white blood cells. White blood cells are the infection-fighting cells of the body. In adults, leukemia is most common in people older than 55 years, with the average age of diagnosis being 66 years. It is also one of the most common cancers in children and adults younger than 20 years. The survival rate is higher for younger people.
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Though it's difficult to say why some people develop cancer while others don't, research shows that certain risk factors increase a person's odds of developing cancer. These risk factors include growing older, family history of cancer, diet, alcohol and tobacco use, and exposure to sunlight, ionizing radiation, certain chemicals, and some viruses and bacteria.
How Does Leukemia Kill?
Leukemia is a cancer of the white blood cells of the bone marrow. Patients with leukemia have an over-production of a particular blood cell type in the body, the white blood cells (cells that fight infection, and provide immunity).
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The prognosis depends on the type of leukemia, the extent of the disease, age of the patient, and the general condition of the patient. Some patients can go into complete remission. The average five-year survival rate of leukemia is 60-65%.
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BRCA genes (BRCA 1 and 2, when normal, repair damaged DNA) are among the genetic mutations linked to breast cancer, ovarian cancer, and other cancers when mutated. Every woman with a BRCA mutation is at high risk for breast cancer, irrespective of whether she has a family history of breast cancer or not. By age 80, a woman with a BRCA mutation has about an 80% chance of developing breast cancer. BRCA1 and BRCA2 gene mutations also increase the risk of ovarian cancer, by 54% and 23%, respectively.
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Chronic lymphocytic leukemia is a cancer of the blood and bone marrow. With this type of cancer, the marrow creates too many abnormal lymphocytes. There are five stages of chronic lymphocytic leukemia.
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Childhood acute lymphoblastic leukemia is the most common type of cancer in children. Symptoms and signs include fever, easy bruising, bone or joint pain, weakness, loss of appetite, and painless lumps in the neck, underarm, stomach, or groin. Treatment depends upon staging and may include chemotherapy, radiation, or stem cell transplant.
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