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Side effects of mercaptopurine. Mercaptopurine: Uses, Side Effects, and Precautions for This Oral Medication

by alexxlab

What are the common side effects of mercaptopurine. How should mercaptopurine be taken properly. What precautions should be considered when using mercaptopurine. Who should avoid taking mercaptopurine.

Understanding Mercaptopurine: A Comprehensive Overview

Mercaptopurine is a powerful oral medication used in the treatment of various conditions, primarily certain types of cancer and autoimmune disorders. This drug belongs to a class of medications known as antimetabolites, which work by interfering with the growth of certain cells in the body. While it can be highly effective, it’s crucial to understand its proper use, potential side effects, and necessary precautions.

Proper Administration of Mercaptopurine

Administering mercaptopurine correctly is essential for its effectiveness and safety. Here are some key points to remember:

  • Take the medication orally, with or without food, as directed by your doctor.
  • Typically, it’s taken once daily.
  • Drink plenty of fluids while on this medication to help prevent kidney problems.
  • If using the suspension form, shake the bottle well for at least 30 seconds before each dose.
  • Use the provided special measuring device for accurate dosing.
  • Take the medication at the same time each day for consistency.

Can mercaptopurine be taken with food? Yes, mercaptopurine can be taken with or without food. However, it’s important to be consistent with your choice. If you decide to take it with food, continue to do so each time. This helps maintain a steady level of the medication in your system.

Common Side Effects of Mercaptopurine

Like all medications, mercaptopurine can cause side effects. It’s important to be aware of these potential effects and report any concerns to your healthcare provider. Common side effects include:

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

Is hair loss from mercaptopurine permanent? Generally, hair loss from mercaptopurine is temporary. Once the treatment is completed or the dosage is adjusted, hair typically grows back. However, the regrowth pattern may be different from before.

Serious Side Effects Requiring Immediate Attention

While less common, some side effects of mercaptopurine can be serious and require immediate medical attention. These include:

  • Joint pain or swelling
  • Black stools or vomit that looks like coffee grounds (indicating possible gastrointestinal bleeding)
  • Signs of kidney problems, such as changes in urination or lower back pain
  • Symptoms of liver disease, including persistent nausea/vomiting, abdominal pain, yellowing of eyes/skin, or dark urine
  • Signs of bone marrow suppression: unusual tiredness, pale skin, easy bruising/bleeding, or frequent infections

How quickly do serious side effects of mercaptopurine manifest? The onset of serious side effects can vary. Some may appear within days of starting treatment, while others may develop over weeks or months. Regular monitoring by your healthcare provider is crucial to detect and address any issues early.

Long-Term Risks and Considerations

Mercaptopurine use comes with some long-term risks that patients and healthcare providers must consider:

  1. Increased risk of certain cancers, particularly lymphoma and skin cancer
  2. Higher risk of infections due to suppressed immune function
  3. Potential liver damage with prolonged use
  4. Fertility issues in both men and women

Does mercaptopurine permanently affect fertility? While mercaptopurine can impact fertility during treatment and for a period afterward, its effects are usually not permanent. However, it’s crucial to discuss fertility preservation options with your doctor before starting treatment, especially if you plan to have children in the future.

Precautions and Contraindications

Certain individuals should exercise caution or avoid using mercaptopurine altogether. These include:

  • People with known allergies to mercaptopurine or azathioprine
  • Individuals with kidney or liver disease
  • Those with certain enzyme deficiencies (TPMT or NUDT15 deficiency)
  • Pregnant women or those planning to become pregnant
  • Breastfeeding mothers

Why is mercaptopurine contraindicated in pregnancy? Mercaptopurine can potentially harm an unborn baby. It can be absorbed through the skin and lungs, so pregnant women or those who may become pregnant should not handle the medication or breathe in the dust from the tablets.

Drug Interactions and Considerations

Mercaptopurine can interact with various other medications and substances, potentially altering its effectiveness or increasing the risk of side effects. Some notable interactions include:

  • Allopurinol: Can increase mercaptopurine levels in the body
  • Warfarin: May require dose adjustments when used with mercaptopurine
  • Live vaccines: Should be avoided while on mercaptopurine due to increased infection risk
  • Certain antibiotics: May affect mercaptopurine metabolism

How do drug interactions with mercaptopurine affect treatment? Drug interactions can either increase or decrease the levels of mercaptopurine in your body, potentially leading to increased side effects or reduced effectiveness. It’s crucial to inform your healthcare provider about all medications, supplements, and herbal products you’re taking to avoid potential interactions.

Monitoring and Follow-up Care

Regular monitoring is essential when taking mercaptopurine to ensure its effectiveness and detect any potential issues early. This typically involves:

  • Regular blood tests to check blood cell counts and liver function
  • Periodic physical examinations
  • Skin cancer screenings
  • Monitoring for signs of infection or unusual bleeding

How often should blood tests be done while on mercaptopurine? The frequency of blood tests can vary depending on individual factors, but typically, they are done weekly or bi-weekly at the start of treatment, then less frequently as the treatment progresses. Your doctor will determine the appropriate schedule based on your specific situation.

Special Considerations for Pediatric Patients

Mercaptopurine is sometimes used in pediatric patients, particularly for certain types of leukemia or inflammatory bowel diseases. Special considerations for this population include:

  • Closer monitoring for side effects
  • Potential impact on growth and development
  • Increased risk of certain cancers, particularly in young patients with inflammatory bowel disease
  • Need for age-appropriate education about the medication and its effects

Are there long-term effects of mercaptopurine use in children? While mercaptopurine can be effective in treating certain conditions in children, long-term use may have implications for growth, development, and future cancer risk. Regular follow-ups and monitoring are crucial to manage these potential long-term effects.

Managing Side Effects of Mercaptopurine

While some side effects of mercaptopurine can be serious, many can be managed effectively. Here are some strategies:

  • Anti-nausea medications for managing nausea and vomiting
  • Proper hydration and dietary adjustments for diarrhea
  • Regular exercise and a balanced diet to combat fatigue
  • Sun protection measures to reduce skin cancer risk
  • Proper hygiene and avoiding crowds to reduce infection risk

Can lifestyle changes help in managing mercaptopurine side effects? Yes, certain lifestyle modifications can significantly help in managing side effects. Maintaining a healthy diet, staying hydrated, getting regular exercise (as approved by your doctor), and practicing good hygiene can all contribute to better tolerance of the medication and overall well-being during treatment.

Alternative Treatments and Combination Therapies

In some cases, mercaptopurine may be used in combination with other treatments, or alternatives may be considered. These can include:

  1. Other chemotherapy drugs
  2. Targeted therapies
  3. Immunosuppressants
  4. Radiation therapy
  5. Surgical interventions

When might alternatives to mercaptopurine be considered? Alternatives or combination therapies might be considered if mercaptopurine is not effectively controlling the condition, if side effects are too severe, or if the patient has contraindications to mercaptopurine use. The choice of treatment always depends on the individual patient’s condition, overall health, and response to therapy.

Patient Education and Support

Proper education and support are crucial for patients taking mercaptopurine. This includes:

  • Understanding the importance of medication adherence
  • Recognizing and reporting side effects promptly
  • Knowing when to seek immediate medical attention
  • Understanding the need for regular follow-ups and monitoring
  • Accessing support groups or counseling services if needed

How can patients ensure they’re taking mercaptopurine safely? Patients can ensure safe use of mercaptopurine by following their doctor’s instructions carefully, reporting any side effects promptly, attending all scheduled follow-up appointments, and staying informed about their condition and treatment. It’s also important to keep all healthcare providers informed about the use of mercaptopurine to avoid potential drug interactions.

Research and Future Directions in Mercaptopurine Use

Ongoing research continues to explore new applications and improvements in the use of mercaptopurine. Some areas of focus include:

  • Personalized dosing based on genetic factors
  • Development of new formulations with fewer side effects
  • Combination therapies for enhanced efficacy
  • Long-term studies on cancer risk and other potential late effects
  • Use in new indications beyond current applications

What advancements can we expect in mercaptopurine treatment in the near future? Future advancements may include more personalized treatment approaches based on genetic testing, which could help optimize dosing and minimize side effects. Additionally, new formulations or delivery methods may be developed to improve the drug’s efficacy and tolerability.

Mercaptopurine in Different Medical Conditions

While primarily known for its use in certain cancers, mercaptopurine has applications in various medical conditions:

  1. Acute lymphoblastic leukemia (ALL)
  2. Chronic myeloid leukemia (CML)
  3. Inflammatory bowel diseases (Crohn’s disease and ulcerative colitis)
  4. Certain autoimmune disorders
  5. Organ transplant rejection prevention

How does the use of mercaptopurine differ across various conditions? The dosing, duration of treatment, and combination with other therapies can vary significantly depending on the condition being treated. For example, in leukemia, it might be used as part of a multi-drug regimen, while in inflammatory bowel disease, it might be used as a long-term maintenance therapy.

Economic Considerations and Access to Mercaptopurine

The cost and accessibility of mercaptopurine can be significant factors in treatment decisions. Considerations include:

  • Insurance coverage and out-of-pocket costs
  • Availability of generic versions
  • Patient assistance programs
  • Global access and availability issues
  • Cost-effectiveness compared to alternative treatments

Are there programs to help patients afford mercaptopurine? Yes, there are various patient assistance programs available, both through pharmaceutical companies and non-profit organizations. These programs can help eligible patients access mercaptopurine at reduced or no cost. Additionally, generic versions of the drug may be available at lower prices.

Mercaptopurine in Special Populations

The use of mercaptopurine requires special considerations in certain populations:

  1. Elderly patients: May require dose adjustments due to decreased kidney function
  2. Patients with liver disease: May need closer monitoring and potential dose reductions
  3. Individuals with genetic variations affecting drug metabolism
  4. Patients with a history of cancer or increased cancer risk
  5. Those with compromised immune systems

How is mercaptopurine dosing adjusted for patients with kidney or liver disease? In patients with kidney or liver disease, mercaptopurine dosing may need to be reduced to prevent accumulation of the drug in the body. The exact adjustment depends on the severity of the organ dysfunction and is determined by the healthcare provider based on regular monitoring of kidney and liver function tests.

The Role of Pharmacogenomics in Mercaptopurine Therapy

Pharmacogenomics, the study of how genes affect a person’s response to drugs, plays a crucial role in optimizing mercaptopurine therapy. Key aspects include:

  • Testing for TPMT and NUDT15 enzyme deficiencies
  • Personalizing dosing based on genetic profiles
  • Predicting likelihood of severe side effects
  • Improving overall treatment efficacy and safety

How does genetic testing impact mercaptopurine treatment? Genetic testing can identify patients who may be at higher risk for severe side effects due to enzyme deficiencies. For these patients, starting with a lower dose of mercaptopurine and carefully monitoring their response can help prevent potentially life-threatening complications while still providing effective treatment.

Mercaptopurine and Quality of Life Considerations

While mercaptopurine can be life-saving or disease-modifying for many patients, it’s important to consider its impact on quality of life:

  1. Managing chronic side effects
  2. Balancing treatment benefits with potential risks
  3. Psychological impact of long-term medication use
  4. Effects on daily activities and lifestyle
  5. Long-term health considerations

How can patients maintain a good quality of life while on mercaptopurine? Maintaining a good quality of life while on mercaptopurine involves a multifaceted approach. This includes effective management of side effects, maintaining open communication with healthcare providers, seeking psychological support if needed, and making appropriate lifestyle adjustments. Many patients find that joining support groups or connecting with others on similar treatments can be helpful in coping with the challenges of long-term medication use.

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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