Generic drug: thioguanine
Brand name: Tabloid
What is Tabloid (thioguanine), and how does it work?
Tabloid (thioguanine 40-mg) is a cancer (antineoplastic) medication used to treat certain types of leukemia. Tabloid is sometimes given with other cancer medications. Tabloid may be available in generic form.
What are the side effects of Tabloid?
Common side effects of Tabloid include:
Tabloid brand Thioguanine is a potent drug. It should not be used unless a diagnosis of acute nonlymphocytic leukemia has been adequately established and the responsible physician is knowledgeable in assessing response to chemotherapy.
What is the dosage for Tabloid?
- Tabloid brand Thioguanine is administered orally. The dosage which will be tolerated and effective varies according to the stage and type of neoplastic process being treated.
- Because the usual therapies for adult and pediatric acute nonlymphocytic leukemias involve the use of thioguanine with other agents in combination, physicians responsible for administering these therapies should be experienced in the use of cancer chemotherapy and in the chosen protocol.
- Patients with homozygous deficiency of either TPMT or NUDT15 enzyme typically require 10% or less of the standard thioguanine dosage. Reduce initial dosage in patients who are known to have homozygous TPMT or NUDT15 deficiency.
- Most patients with heterozygous TPMT or NUDT15 deficiency tolerate recommended thioguanine doses, but some require dose reduction based on toxicities.
- Patients who are heterozygous for both TPMT and NUDT15 may require more substantial dosage reductions. Reduce the dosage based on tolerability.
- Ninety-six (59%) of 163 pediatric patients with previously untreated acute nonlymphocytic leukemia obtained complete remission with a multiple-drug protocol including thioguanine, prednisone, cytarabine, cyclophosphamide, and vincristine.
- Remission was maintained with daily thioguanine, 4-day pulses of cytarabine and cyclophosphamide, and a single dose of vincristine every 28 days. The median duration of remission was 11.5 months.
- Fifty-three percent of previously untreated adults with acute nonlymphocytic leukemias attained remission following use of the combination of thioguanine and cytarabine according to a protocol developed at The Memorial Sloan-Kettering Cancer Center. A median duration of remission of 8.8 months was achieved with the multiple-drug maintenance regimen which included thioguanine.
- On those occasions when single-agent chemotherapy with thioguanine may be appropriate, the usual initial dosage for pediatric patients and adults is approximately 2 mg/kg of body weight per day. If, after 4 weeks on this dosage, there is no clinical improvement and no leukocyte or platelet depression, the dosage may be cautiously increased to 3 mg/kg/day. The total daily dose may be given at one time.
- The dosage of thioguanine used does not depend on whether or not the patient is receiving Zyloprim (allopurinol); this is in contradistinction to the dosage reduction which is mandatory when Purinethol (mercaptopurine) or Imuran (azathioprine) is given simultaneously with allopurinol.
- Procedures for proper handling and disposal of anticancer drugs should be considered. Several guidelines on this subject have been published. See prescribing information for more details.
- There is no general agreement that all of the procedures recommended in the guidelines are necessary or appropriate.
What drugs interact with Tabloid?
- There is usually complete cross-resistance between Purinethol (mercaptopurine) and Tabloid brand Thioguanine.
- As there is in vitro evidence that aminosalicylate derivatives (e.g., olsalazine, mesalazine, or sulphasalazine) inhibit the TPMT enzyme, they should be administered with caution to patients receiving concurrent thioguanine therapy.
Is Tabloid safe to use while pregnant or breastfeeding?
- Drugs such as thioguanine are potential mutagens and teratogens. Thioguanine may cause fetal harm when administered to a pregnant woman.
- There are no adequate and well-controlled studies in pregnant women.
- If this drug is used during pregnancy, or if the patient becomes pregnant while taking the drug, the patient should be apprised of the potential hazard to the fetus. Women of childbearing potential should be advised to avoid becoming pregnant.
- It is not known whether this drug is excreted in human milk.
- Because of the potential for tumorigenicity shown for thioguanine, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
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