What are the potential side effects of taking mercaptopurine? How can you manage these side effects? Get all the answers you need to stay informed about this medication.

Understanding Mercaptopurine and Its Side Effects

Mercaptopurine, also known as 6-mercaptopurine, is a medication primarily used to treat certain types of cancer, including acute lymphoblastic leukemia (ALL) and inflammatory bowel diseases like Crohn’s disease and ulcerative colitis. While this medication can be highly effective in managing these conditions, it is important to be aware of its potential side effects.

Common Side Effects of Mercaptopurine

When taking mercaptopurine, you may experience some of the following common side effects:

• Nausea and vomiting
• Diarrhea
• Loss of appetite
• Temporary hair loss

These side effects are often mild and may improve over time as your body adjusts to the medication. If they persist or worsen, be sure to inform your healthcare provider.

Serious Side Effects of Mercaptopurine

In some cases, mercaptopurine can cause more serious side effects. It’s important to be aware of the following and seek immediate medical attention if you experience any of them:

• Joint pain or swelling
• Black or tarry stools
• Vomiting that looks like coffee grounds
• Signs of kidney problems, such as changes in urine output or pain in the lower back or sides
• Symptoms of liver disease, such as persistent nausea or vomiting, abdominal pain, yellowing of the skin or eyes, or dark urine
• Unusual tiredness, pale skin, signs of infection (sore throat, fever, chills), or easy bruising or bleeding, which may indicate low blood cell counts

Potential Increased Cancer Risk

Mercaptopurine may slightly increase the risk of developing certain types of cancer, such as lymphoma, skin cancer, and cervical cancer. This risk is higher in children and young adults being treated for inflammatory bowel diseases. Regular monitoring by your healthcare provider is essential to detect any changes early.

Allergic Reactions to Mercaptopurine

Although rare, it is possible to have a serious allergic reaction to mercaptopurine. Seek immediate medical attention if you experience symptoms such as a rash, itching or swelling (especially of the face, tongue, or throat), dizziness, or difficulty breathing.

Managing Side Effects of Mercaptopurine

If you experience any side effects while taking mercaptopurine, it’s important to notify your healthcare provider right away. They may be able to adjust your dosage, prescribe additional medications to manage the side effects, or recommend strategies to make the treatment more tolerable.

Remember, the benefits of mercaptopurine in treating your condition typically outweigh the risks of side effects. With proper monitoring and management, many people are able to successfully take this medication and achieve positive health outcomes.

Frequently Asked Questions

What should I do if I miss a dose of mercaptopurine?. If you miss a dose of mercaptopurine, take it as soon as you remember unless it is almost time for your next dose. In that case, skip the missed dose and resume your regular dosing schedule. Do not double up on doses to make up for a missed one.

Can I drink alcohol while taking mercaptopurine?. It’s generally best to avoid or limit alcohol consumption while taking mercaptopurine, as alcohol can potentially increase the risk of side effects or interact with the medication. Discuss your alcohol use with your healthcare provider to determine the best approach for your situation.

What should I do if I experience severe side effects from mercaptopurine?. If you experience severe or concerning side effects, such as those listed in the “Serious Side Effects” section, contact your healthcare provider immediately or seek emergency medical attention. Your provider may need to adjust your medication or provide additional treatment to manage the side effects.

Is it safe to take mercaptopurine during pregnancy?. Mercaptopurine can be harmful to an unborn baby, so it’s generally not recommended for use during pregnancy. If you are pregnant or planning to become pregnant, be sure to discuss the risks and benefits with your healthcare provider before taking this medication.

mercaptopurine oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

How to use Mercaptopurine

Read the Patient Information Leaflet if available from your pharmacist before you start taking mercaptopurine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth with or without food as directed by your doctor, usually once daily. Drink plenty of fluids while taking this medication unless otherwise directed by your doctor. Doing so may help decrease the risk of certain side effects (kidney problems).

If you are using the suspension, shake the bottle well for at least 30 seconds before each dose. Carefully measure the dose using the provided special measuring device. Do not use a household spoon because you may not get the correct dose. Avoid getting any of the suspension on your skin or in your eyes. If contact occurs, wash the affected skin area or rinse your eyes with water. Consult your pharmacist for details.

The dosage is based on your medical condition, weight, and response to treatment. Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of serious side effects will increase.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day.

Since this drug can be absorbed through the skin and lungs and may harm an unborn baby, women who are pregnant or who may become pregnant should not handle this medication or breathe the dust from the tablets.

Side Effects

Nausea, vomiting, diarrhea, and loss of appetite may occur. Temporary hair loss may also occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

People using this medication may have serious side effects. However, you have been prescribed this drug because your doctor has judged that the benefit to you is greater than the risk of side effects. Careful monitoring by your doctor may decrease your risk.

Tell your doctor right away if you have any serious side effects, including: joint pain/swelling, black stools, vomit that looks like coffee grounds, signs of kidney problems (such as change in the amount of urine, pain in the lower back/side).

Get medical help right away if you have any very serious side effects, including: symptoms of liver disease (such as nausea/vomiting that doesn’t stop, stomach/abdominal pain, yellowing eyes/skin, dark urine).

This medication may decrease bone marrow function, an effect that may lead to a low number of blood cells such as red cells, white cells, and platelets. This effect can cause anemia, decrease your body’s ability to fight an infection, or cause easy bruising/bleeding. Tell your doctor right away if you develop any of the following symptoms: unusual tiredness, pale skin, signs of infection (such as sore throat that doesn’t go away, fever, chills), easy bruising/bleeding.

Mercaptopurine may rarely increase your risk of developing certain types of cancer (such as lymphoma, skin, cervical). This risk is higher in children/young adults being treated for certain bowel diseases (such as Crohn’s disease, ulcerative colitis). Keep all medical and laboratory appointments. Tell your doctor right away if you develop any of the following symptoms: swollen abdomen, swollen lymph nodes, night sweats, unexplained weight loss, unusual skin changes (such as new skin lesion or bump, or change in size or color of a mole), unusual vaginal bleeding/discharge.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US – Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before taking mercaptopurine, tell your doctor or pharmacist if you are allergic to it; or to azathioprine; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, liver disease, cancer, certain enzyme disorders (TPMT deficiency, NUDT15 deficiency).

Mercaptopurine can make you more likely to get infections or may make current infections worse. Stay away from anyone who has an infection that may easily spread (such as chickenpox, COVID-19, measles, flu). Talk to your doctor if you have been exposed to an infection or for more details.

Tell your health care professional that you are using mercaptopurine before having any immunizations/vaccinations. Avoid contact with people who have recently received live vaccines (such as flu vaccine inhaled through the nose).

To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.

This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Since this drug can be absorbed through the skin and lungs and may harm an unborn baby, women who are pregnant or who may become pregnant should not handle this medication or breathe the dust from the tablets.

Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using mercaptopurine. Mercaptopurine may harm an unborn baby, especially during the first 3 months of pregnancy. Your doctor should do a pregnancy test before you start this medication. Women of childbearing age should ask about reliable forms of birth control while using this medication and for 6 months after the last dose. Men with female partners of childbearing age should ask about reliable forms of birth control while using this medication and for 3 months after the last dose. If you or your partner become pregnant, or think you are pregnant, talk to your doctor right away about the risks and benefits of this medication.

It is unknown if this drug passes into breast milk. Because of the possible risk to the infant, breast-feeding while using this drug and for 1 week after the last dose is not recommended. Consult your doctor before breast-feeding.

Consult your pharmacist or physician.

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Some products that may interact with this drug are: febuxostat, other drugs that weaken the immune system/increase the risk of infection (such as rituximab, tofacitinib).

This medication may interfere with certain lab tests (such as uric acid levels), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.

Mercaptopurine is very similar to azathioprine. Do not use medications containing azathioprine while using mercaptopurine.

Does Mercaptopurine interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

Do not share this medication with others.

Lab and/or medical tests (such as complete blood count, liver/kidney function) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Store at room temperature away from light and moisture. Do not store in the bathroom. Discard the suspension form of the medication 8 weeks after opening the bottle. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Images

mercaptopurine 50 mg tablet

Color: pale yellowShape: roundImprint: 9 3

This medicine is a pale yellow, round, scored, tablet imprinted with “9 3”.

mercaptopurine 50 mg tablet

Color: off-whiteShape: roundImprint: M 547

This medicine is a pale yellow, round, scored, tablet imprinted with “9 3”.

mercaptopurine 50 mg tablet

Color: pale yellowShape: roundImprint: 54 420

This medicine is a pale yellow, round, scored, tablet imprinted with “9 3”.

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Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

MERCAPTOPURINE (6-MP) | Crohn’s & Colitis Foundation

Modified: February 1, 2023

Dear @[email protected],

Your healthcare team has discussed the following medication with you: mercaptopurine (6-MP). The brand name is Purinethol. Here is some additional information. Let us know if you have any questions regarding this information.

How it works:This medication belongs to a class of drugs called immunomodulators. It helps to reduce irritation and swelling (inflammation) in the intestines. It also decreases the long-term need for steroids. For that reason, it is sometimes referred to as a “steroid-sparing” drug. In some cases, this medication is used by itself. In other cases, this medication is used together with another medication to achieve better results.

How it is taken: Taken as a pill typically once daily, sometimes twice daily. With this medication it can take 3 to 6 months to see an improvement of symptoms. Because it may take a while to see an improvement, they are often given along with another faster-acting medication (such as a steroid).

Common side effects: Infrequently reported side effects may include headache, nausea, vomiting, diarrhea, tiredness, mouth sores, rash, fever, joint pain, and liver inflammation.

Special considerations:  Less common side effects include inflammation of the pancreas (pancreatitis), infections, lymphoma (cancer of the lymph nodes), and skin cancer. Women who are pregnant or wish to become pregnant should talk to their healthcare team before taking this medication.

Monitoring: Blood tests should be performed frequently to check for medication effects on the bone marrow and liver. Blood tests may also be performed to check levels of mercaptopurine metabolites. Skin exams should occur regularly by a primary care provider or dermatology to rule out early skin cancer. Women who are taking this medication should continue to get regular Pap smears, as recommended by their gynecologist. 

Points to remember: Before taking this medication, let your doctor know about other medical conditions that you may have or other medications (even over-the-counter medications or complementary therapies) you may be taking.

Other tips: The best way to control your disease is by taking your medication as directed. Even when you do not have any symptoms, it is very important to continue taking your medication to prevent your disease from becoming active again. Do not alter the amount of the medication or how frequently you take it on your own. If you have any side effects or you continue to have symptoms, speak to your healthcare team immediately.

For further information, please check out http://www. ibdmedicationguide.org/ or follow this link:

/sites/default/files/2020-03/immunomodulators.pdf

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Use of mercaptopurine in the treatment of children with cancer

Chemotherapy

Trademarks:

Purixan®, Purinethol®

Other names:

6-MP

Often used for:

Leukemia, lymphoma

Mercaptopurine is a drug used in chemotherapy. Its action is aimed at slowing down or stopping cell growth. The drug is prescribed in combination with other drugs.

The rate of breakdown of mercaptopurine is individual for each patient, since it depends on the work of certain enzymes. Genetic analysis may be required to determine the quality of the enzymes in a particular patient. Patients with a lower rate of cleavage of mercaptopurine are given a lower dose of the drug. Read more: Thiopurine methyltransferase (TPMT) and medications

During therapy, the patient will need regular tests to check blood counts and monitor liver function. The level of mercaptopurine in the blood can be monitored with subsequent dosage adjustments.

Oral liquid form

Oral tablets

• Low blood counts (may lead to increased risk of infection, bleeding, anemia and/or fatigue)
• Liver disorders
• Nausea and vomiting (usually mild, appearing in the morning)
• Hypoglycemia (low blood sugar)
• Loss of appetite
• Fatigue or general weakness
• Rash (possibly aggravated by sun exposure)
• Skin darkening
• Increased sensitivity to solar radiation
• Ulcers in the mouth
• Diarrhea

The listed side effects are not observed in all patients who are prescribed mercaptopurine. The most common side effects are highlighted in bold, but others are not excluded. Report all possible side effects to your doctor or pharmacist.

Some patients may experience long-term side effects or long-term effects that remain from the time of taking the drug or appear only several months or years after the end of the drug. Possible long-term effects of mercaptopurine therapy:

• Liver disorders
• Secondary cancer

Be sure to discuss these and other recommendations with your doctor or pharmacist.

• Your doctor may prescribe a separate medicine for nausea and vomiting.
• This drug may cause the skin to become more sensitive to sunlight and increase the risk of sunburn. It is necessary to protect the skin from sunlight. Use sunscreen and wear sun protection clothing. Avoid sun exposure if possible.
• Sexually active patients should use contraceptives during therapy and for 6 months after stopping the drug.
• Pregnant or breastfeeding patients should notify their physician.
• Caregivers should follow instructions for safe handling and disposal of chemotherapy drug and avoid contact with patient body fluids. Traces of the drug may be present in the patient’s body fluids for up to 48 hours after ingestion.

Mercaptopurine home use:

• Mercaptopurine should be taken at about the same time every day.
• Mercaptopurine should be stored at room temperature.
• When using liquid mercaptopurine, shake the vial for at least 30 seconds before filling the intralaryngeal syringe. Rinse the syringe thoroughly after each use.
• Take your dose as soon as possible if you miss it. Do not do this only if the next appointment is less than 6 hours away. In no case do not double the dose at the next dose!
• Do not use an expired drug.
• Follow instructions for safe handling and disposal.

More about Mercaptopurine

• Protecting caregivers from the adverse effects of drugs
• Oral home chemotherapy drugs
• Thiopurine methyltransferase (TPMT) and drugs
• Sex life in therapy

Learn more about Mercaptopurine

instructions for use, price, analogues, composition, indications

To avoid complications, mercaptopurine should only be used under the supervision of physicians experienced in the use of cytostatics. During treatment, detailed blood tests should be performed daily. Early detection of hepatotoxicity is ensured by regular “liver” tests (every week – at the beginning of therapy, every month – during maintenance therapy): “liver” transaminases; alkaline phosphatase, bilirubin. In patients with a history of liver disease or who are receiving other potentially hepatotoxic drugs, such tests should be performed more frequently. Patients should be warned about the need to immediately stop treatment if jaundice occurs. These disorders are usually reversible with timely discontinuation of mercaptopurine. During remission induction, when rapid cell lysis occurs, the concentration of uric acid in the blood and urine should be monitored to avoid hyperuricemia and / or hyperuricosuria and the risk of developing uric acid nephrourolithiasis. To prevent hyperuricemia, drinking plenty of fluids is recommended, if necessary – allopurinol and alkalinization of urine.

Myelosuppression is reversible if the drug is stopped in a timely manner. After completion of treatment, the number of leukocytes and platelets may continue to decrease (delayed effect), therefore, at the first sign of an excessively large decrease in their number, treatment should be temporarily discontinued.

Patients with congenital deficiency of the enzyme thiopurine methyltransferase (TPMT) are more susceptible to the rapid development of myelosuppression after the appointment of mercaptopurine, therefore, if possible, genetic and phenotypic analysis of the activity of the thiopurine methyltransferase (TPMT) enzyme should be performed.

In view of the fact that there is no antidote, it is necessary to carefully monitor the blood picture and, if necessary, carry out maintenance therapy and blood transfusion.

During the period of treatment of any of the sexual partners, it is recommended to use reliable methods of contraception.

Use mercaptopurine with caution in patients with a history of gout or nephrolithiasis who have previously received antitumor or radiation therapy. In patients with impaired liver and / or kidney function, dosage adjustment is required. In patients with inhibition of bone marrow hematopoiesis, with acute viral (including chicken pox, herpes zoster), fungal and bacterial diseases, with sucrase / isomaltase deficiency, with fructose intolerance, mercaptopurine is used with caution.

The preparation contains lactose. Therefore, it is not recommended for use in patients with congenital galactosemia, Lapp lactase deficiency and galactose/glucose malabsorption.

With caution use mercaptopurine in children under 2 years of age.

Care is advised when handling tablets (eg splitting them in half) to avoid contamination of hands or inhalation of the drug.

In patients with congenital deficiency of the enzyme thiopurine methyltransferase (TPMT), the use of mercaptopurine can lead to the development of severe myelosuppression. With the simultaneous administration of drugs that inhibit TPMT (for example, olsalazine, mesalazine, sulfalazine), severe myelosuppression may increase. There may be a relationship between reduced TPMT enzyme activity and secondary leukemia and myelodysplasia in individuals receiving mercaptopurine in combination with other cytotoxic drugs.

If possible, the activity of the TPMT enzyme should be monitored before using mercaptopurine. Some laboratories have appropriate equipment to monitor TPMT enzyme activity, but this test is optional to identify patients at increased risk of developing toxicity with mercaptopurine treatment.

During treatment with mercaptopurine, immunization with vaccines containing live microorganisms is not recommended. Contact with polio vaccine recipients with bacterial infections should be avoided. Live vaccines should not be used in patients with leukemia in remission for at least 3 months after the last course of chemotherapy. poliomyelitis of people in close contact with such a patient, especially family members, should be delayed.

If you are receiving immunosuppressive therapy while taking mercaptopurine, you are at an increased risk of developing:

– Tumors, including skin cancer. When using mercaptopurine, avoid excessive exposure to sunlight, wear closed clothing and use a sunscreen with a high protection factor.

– lymphoproliferative diseases:

• A regimen that includes several immunosuppressive drugs (including mercaptopurine) can lead to lymphoproliferative disorders, sometimes fatal.

• Simultaneous administration of several immunosuppressants increases the risk of developing lymphoproliferative diseases associated with the Epstein-Barr virus.

– hemophagocytic syndrome (excessive activation of macrophages (white blood cells) associated with inflammation), which usually occurs in people with certain types of arthritis.

In experimental studies, it was found that mercaptopurine has a carcinogenic and mutagenic effect.

An increase in the number of chromosomal aberrations in peripheral blood lymphocytes was observed in patients with leukemia, in a patient with hypernephroma who took mercaptopurine at an unspecified dose, and in patients with chronic kidney disease who took mercaptopurine at a dose of 0.