Mercaptopurine: Difference between revisions

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{{Drugbox |
{{DrugProjectFormSinglePage
| IUPAC_name = 3,7-dihydropurine-6-thione
|authorTag=<!--Overview-->
| image = Mercaptopurine.svg
|aOrAn=a
| width = 200px
|hasBlackBoxWarning=Yes
| CAS_number = 50-44-2
|adverseReactions=<!--Black Box Warning-->
| ATC_prefix = L01
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| ATC_suffix = BB02
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| PubChem = 667490
 
| DrugBank = APRD01096.txt
* Content
| C = 5 | H = 4 | N = 4 | S = 1
 
| molecular_weight = 152.181 g/mol
<!--Adult Indications and Dosage-->
| bioavailability = 5 to 37%
 
| metabolism = ?
<!--FDA-Labeled Indications and Dosage (Adult)-->
| elimination_half-life = 60 to 120 min., longer for its active metabolites
|fdaLIADAdult======Condition1=====
| excretion = [[Kidney|Renal]]
 
| pregnancy_category = ?,(Increased Risk of Abortion)
* Dosing Information
| legal_status = ?
 
| routes_of_administration = Oral
:* Dosage
}}
 
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* Dosing Information
 
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=====Condition3=====
 
* Dosing Information
 
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|offLabelAdultGuideSupport======Condition1=====
 
* Developed by:
 
* Class of Recommendation:
 
* Strength of Evidence:
 
* Dosing Information
 
:* Dosage
 
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* Developed by:
 
* Class of Recommendation:
 
* Strength of Evidence:
 
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There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
 
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<!--Clinical Studies-->
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==Overview==
<!--How Supplied-->
'''Mercaptopurine''' (also called 6-Mercaptopurine, 6-MP or its brand name '''Purinethol''') is an [[immunosuppressive drug]] used to treat [[leukemia]]. It is also used for pediatric [[non-Hodgkin's lymphoma]], [[polycythemia vera]], [[psoriatic arthritis]], and [[inflammatory bowel disease]] (such as [[Crohn's Disease]] and [[ulcerative colitis]]).
|howSupplied=*
|packLabel=<!--Patient Counseling Information-->
|fdaPatientInfo=There is limited information regarding <i>Patient Counseling Information</i> of {{PAGENAME}} in the drug label.


==Adverse reactions==
<!--Precautions with Alcohol-->
|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.


Some of the [[adverse drug reaction|adverse reaction]]s of taking Mercaptopurine might include diarrhea, nausea, vomiting, loss of appetite, stomach/abdominal pain, weakness, skin rash, darkening of the skin, or hair loss. Serious adverse reactions include mouth sores, fever, sore throat, easy bruising or bleeding, pinpoint red spots on the skin, yellowing of eyes or skin, dark urine, painful or difficult urination. Unlikely but serious side effects include: black or tarry stools ([[melena]]), bloody stools, and bloody urine.
<!--Brand Names-->
|brandNames=* ®<ref>{{Cite web | title =  | url =  }}</ref>


Symptoms of allergic reaction to Mercaptopurine include rash, itching, swelling, dizziness, trouble breathing.
<!--Look-Alike Drug Names-->
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Mercaptopurine causes [[myelosuppression]], suppressing the production of [[white blood cell]]s. It may be toxic to [[bone marrow]]. Weekly blood counts are recommended for patients on mercaptopurine. The patient should stop taking the medication at least temporarily if there is an unexplained, abnormally large drop in white blood cell count, or any other blood count.
<!--Drug Shortage Status-->
|drugShortage=
}}
{{PillImage
|fileName=No image.jpg
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{{LabelImage
|fileName={{PAGENAME}}11.png
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{{LabelImage
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Patients who exhibit myelosuppression or bone marrow toxicity should be tested for [[Thiopurine methyltransferase]] (TPMT) enzyme deficiency. Patients with TPMT deficiency are much more likely to develop dangerous myelosuppression. In such patients it may be possible to continue using mercaptopurine, but at a lower dose.


==Precautions==


Mercaptopurine can lower the body's ability to fight off infection. Those taking mercaptopurine should get permission from a doctor in order to receive [[immunization]]s and [[vaccination]]s. It is also recommended that while on the drug one should avoid those who have recently received oral [[polio]] vaccine.
<!--Label Display Image-->


This drug is traditionally not recommended during pregnancy but this issue has been debated and current evidence indicates that pregnant women on the drug show no increase in fetal abnormalities. However, women receiving mercaptopurine during the first trimester of pregnancy have an increased incidence of abortion. Davis et al 1999 found that mercaptopurine, compared to [[methotrexate]], was ineffective as a single-agent abortifacient; every woman in the mercaptopurine arm of the study had fetal cardiac activity at follow-up (two weeks later) and was given a suction abortion.<ref name=useless_in_abortion>{{cite journal | first = Anne R. | last = Davis | coauthors = Leslie Miller, Hisham Tamimi, and Allen Gown | year = 1999 | month = June | title = Methotrexate Compared With Mercaptopurine for Early Induced Abortion | journal = Obstetrics & Gynecology | volume = 93 | issue = 6 | pages = 904-9 | id = {{PMID|10362152}} | url = http://www.greenjournal.org/cgi/content/full/93/6/904}}</ref>


Mercaptopurine causes changes to [[chromosome]]s in animals and humans. In mice these changes have given rise to lethal [[mutation]]s. Therefore the drug has the potential to be cancer causing in humans.
==See also==
*[[azathioprine]]


==References==
*[http://www.fda.gov/medwatch/SAFETY/2004/jul_PI/Purinethol_PI.pdf FDA Label, Mercaptopurine (PDF)]
<references/>
{{Chemotherapeutic agents}}


[[Category:Immunosuppressive agents]]
[[Category:Chemotherapeutic agents]]


;
<!--Category-->


[[de:Mercaptopurin]]
[[Category:Drug]]
[[fr:Mercaptopurine]]
[[ru:Меркаптопурин]]
{{WH}}
{{WikiDoc Sources}}

Revision as of 21:27, 13 January 2015

Mercaptopurine
Black Box Warning
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];

Disclaimer

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Black Box Warning

ConditionName:
See full prescribing information for complete Boxed Warning.
ConditionName:
  • Content

Overview

Mercaptopurine is a {{{drugClass}}} that is FDA approved for the {{{indicationType}}} of {{{indication}}}. There is a Black Box Warning for this drug as shown here. Common adverse reactions include .

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

Condition1
  • Dosing Information
  • Dosage
Condition2
  • Dosing Information
  • Dosage
Condition3
  • Dosing Information
  • Dosage
Condition4
  • Dosing Information
  • Dosage

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

Condition1
  • Developed by:
  • Class of Recommendation:
  • Strength of Evidence:
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Guideline-Supported Use of Mercaptopurine in adult patients.

Non–Guideline-Supported Use

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Non–Guideline-Supported Use of Mercaptopurine in adult patients.

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding FDA-Labeled Use of Mercaptopurine in pediatric patients.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

Condition1
  • Developed by:
  • Class of Recommendation:
  • Strength of Evidence:
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Guideline-Supported Use of Mercaptopurine in pediatric patients.

Non–Guideline-Supported Use

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Non–Guideline-Supported Use of Mercaptopurine in pediatric patients.

Contraindications

  • Condition1

Warnings

ConditionName:
See full prescribing information for complete Boxed Warning.
ConditionName:
  • Content
  • Description

Precautions

  • Description

Adverse Reactions

Clinical Trials Experience

There is limited information regarding Clinical Trial Experience of Mercaptopurine in the drug label.

Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous

Postmarketing Experience

There is limited information regarding Postmarketing Experience of Mercaptopurine in the drug label.

Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous

Drug Interactions

  • Drug
  • Description

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA):

  • Pregnancy Category


Pregnancy Category (AUS):

  • Australian Drug Evaluation Committee (ADEC) Pregnancy Category

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Mercaptopurine in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Mercaptopurine during labor and delivery.

Nursing Mothers

There is no FDA guidance on the use of Mercaptopurine with respect to nursing mothers.

Pediatric Use

There is no FDA guidance on the use of Mercaptopurine with respect to pediatric patients.

Geriatic Use

There is no FDA guidance on the use of Mercaptopurine with respect to geriatric patients.

Gender

There is no FDA guidance on the use of Mercaptopurine with respect to specific gender populations.

Race

There is no FDA guidance on the use of Mercaptopurine with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Mercaptopurine in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Mercaptopurine in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Mercaptopurine in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Mercaptopurine in patients who are immunocompromised.

Administration and Monitoring

Administration

  • Oral
  • Intravenous

Monitoring

There is limited information regarding Monitoring of Mercaptopurine in the drug label.

  • Description

IV Compatibility

There is limited information regarding IV Compatibility of Mercaptopurine in the drug label.

Overdosage

Acute Overdose

Signs and Symptoms

  • Description

Management

  • Description

Chronic Overdose

There is limited information regarding Chronic Overdose of Mercaptopurine in the drug label.

Pharmacology

There is limited information regarding Mercaptopurine Pharmacology in the drug label.

Mechanism of Action

Structure

File:Mercaptopurine01.png
This image is provided by the National Library of Medicine.

Pharmacodynamics

There is limited information regarding Pharmacodynamics of Mercaptopurine in the drug label.

Pharmacokinetics

There is limited information regarding Pharmacokinetics of Mercaptopurine in the drug label.

Nonclinical Toxicology

There is limited information regarding Nonclinical Toxicology of Mercaptopurine in the drug label.

Clinical Studies

There is limited information regarding Clinical Studies of Mercaptopurine in the drug label.

How Supplied

Storage

There is limited information regarding Mercaptopurine Storage in the drug label.

Images

Drug Images

{{#ask: Page Name::Mercaptopurine |?Pill Name |?Drug Name |?Pill Ingred |?Pill Imprint |?Pill Dosage |?Pill Color |?Pill Shape |?Pill Size (mm) |?Pill Scoring |?NDC |?Drug Author |format=template |template=DrugPageImages |mainlabel=- |sort=Pill Name }}

Package and Label Display Panel

{{#ask: Label Page::Mercaptopurine |?Label Name |format=template |template=DrugLabelImages |mainlabel=- |sort=Label Page }}

Patient Counseling Information

There is limited information regarding Patient Counseling Information of Mercaptopurine in the drug label.

Precautions with Alcohol

  • Alcohol-Mercaptopurine interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

Look-Alike Drug Names

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

  1. Empty citation (help)
  2. "http://www.ismp.org". External link in |title= (help)

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