Mercaptopurine

Mercaptopurine treats a certain type of blood cancer. It can cause low platelet count, so tell your doctor right away if you notice unusual bleeding, such as nosebleeds, or bruising under your skin.

Mercaptopurine Overview

Reviewed: July 24, 2013
Updated: 

Mercaptopurine is a prescription medication used to treat a type of cancer called acute lymphatic/lymphoblastic leukemia, or ALL. Mercaptopurine belongs to a group of drugs called purine antagonists, which work by stopping the growth of cancer cells.

This medication comes in tablet form and is taken once a day, with or without food. This medication is also available in suspension form and is taken once a day.

Common side effects of mercaptopurine include changes in blood counts (anemia, neutropenia, thrombocytopenia), nausea, vomiting, hair loss, and rash.

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  • Leukemia, Lymphocytic, Chronic, B-cell
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  • Precursor Cell Lymphoblastic Leukemia-lymphoma

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Mercaptopurine Cautionary Labels

precautionsprecautionsprecautionsprecautions

Uses of Mercaptopurine

Mercaptopurine is a prescription medication used to treat a type of cancer called acute lymphatic/lymphoblastic leukemia, or ALL.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Mercaptopurine Brand Names

Mercaptopurine may be found in some form under the following brand names:

Mercaptopurine Drug Class

Mercaptopurine is part of the drug class:

Side Effects of Mercaptopurine

Serious side effects have been reported with mercaptopurine. See the “Mercaptopurine Precautions” section.

Common side effects of mercaptopurine include changes in blood counts (anemia, neutropenia, thrombocytopenia), nausea, vomiting, hair loss, and rash.

This is not a complete list of mercaptopurine side effects. Ask your doctor or pharmacist for more information.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Mercaptopurine Interactions

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

  • allopurinol (Zyloprim, Aloprim, Lopurin)
  • thioguanine (Tabloid, 6-TG, 6-Thioguanine)
  • aminosalicylates such as mesalamine (Apriso, Asacol, Pentasa), olsalazine (Dipentum), and sulfasalazine (Azulfidine)
  • blood thinners such as warfarin (Coumadin, Jantoven)
  • doxorubicin (Doxil)
  • trimethoprim/sulfamethoxazole (Bactrim, Septra)

This is not a complete list of mercaptopurine drug interactions. Ask your doctor or pharmacist for more information.

Mercaptopurine Precautions

Serious side effects have been reported with mercaptopurine including the following:

  • lowered blood counts. This is medically known as bone marrow suppression. Bone marrow suppression can lead to thrombocytopenia, anemia, and leukopenia.
    • thrombocytopenia. This is a condition in which your blood has a lower than normal number of blood cell fragments called platelets. Tell your healthcare provider right away if you have the following signs and symptoms of thrombocytopenia:
      • mild to serious bleeding
      • purple, brown, and red bruises (purpura)
      • small red or purple dots on your skin (petechiae)
      • prolonged bleeding, even from minor cuts
      • bleeding or oozing from the mouth or nose, especially nosebleeds or bleeding from brushing your teeth
      • abnormal vaginal bleeding (especially heavy menstrual flow)
      • blood in the urine or stool or bleeding from the rectum. Blood in the stool can appear as red blood or as a dark, tarry color. Taking iron supplements also can cause dark, tarry stools.
      • headaches and other neurological symptoms. These problems are very rare, but you should discuss them with your doctor.
    • anemia. This is a condition in which your blood has a lower than normal number of red blood cells. Tell your healthcare provider right away if you have the following signs and symptoms of anemia:
      • shortness of breath
      • dizziness
      • headache
      • coldness in the hands and feet
      • pale skin
      • chest pain
    • leukopenia. This is a condition when there are a low number of white blood cells in your body. These cells help fight infections. You may become more susceptible to infections and even to negative reactions of live vaccines if you are taking mercaptopurine. Tell your healthcare provider if you are feeling “under the weather” or are running a fever. Also, let your healthcare provider know if you are scheduled to receive a vaccination, as your response to vaccines may be diminished and live vaccinations can make you sick.
  • a decline in liver function. Tell your healthcare provider if you have any signs or symptoms of liver damage, which include the following:
    • yellowing of the skin or eyes
    • nausea
    • vomiting
    • fatigue
    • itching
  • intestinal ulceration. Tell your healthcare provider if you have any signs or symptoms such as nausea, vomiting, bleeding from any site, or symptoms suggestive of anemia.

Do not take mercaptopurine if you:

  • are allergic to mercaptopurine or to any of its ingredients
  • have already taken this drug and it has shown to be ineffective
  • have already taken thioguanine (Tabloid, 6-TG, 6-Thioguanine) and it has shown to be ineffective

Mercaptopurine Food Interactions

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of mercaptopurine, there are no specific foods that you must exclude from your diet when receiving this medication.

Inform MD

Before taking mercaptopurine, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

  • are allergic to mercaptopurine or to any of its ingredients
  • have already taken this drug and it has shown to be ineffective
  • have already taken thioguanine (Tabloid, 6-TG, 6-Thioguanine) and it has shown to be ineffective
  • have liver problems
  • have kidney problems
  • have blood problems
  • have any type of infection
  • are scheduled to receive a vaccine
  • are scheduled to receive surgery
  • have a genetic deficiency with a specific enzyme called the TPMT enzyme
  • are pregnant or breastfeeding

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Mercaptopurine and Pregnancy

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Mercaptopurine falls into category D. It has been shown that use of mercaptopurine in pregnant women caused some babies to be born with problems. However, in some serious situations, the benefit of using this medication may be greater than the risk of harm to the baby.

Avoiding pregnancy while taking mercaptopurine is recommended in women of childbearing potential.

Mercaptopurine and Lactation

Tell your doctor if you are breastfeeding or plan to breastfeed.

It is not known if mercaptopurine crosses into human milk. Because many medications can cross into human milk and because of the possibility for serious adverse reactions in nursing infants with use of this medication, a choice should be made whether to stop nursing or stop the use of this medication. Your doctor and you will decide if the benefits outweigh the risk of using mercaptopurine.

Mercaptopurine Usage

Take mercaptopurine exactly as prescribed.

This medication comes in tablet form and is taken once a day, with or without food.

This medication is also available in suspension form and is taken once a day.

Oral Suspension

  • Shake the bottle vigorously for at least 30 seconds to ensure the oral suspension is well mixed.
  • Mercaptopurine oral suspension is pink in color but because it contains a natural fruit extract, the color of the suspension may vary from pink to brown.
  • Once mercaptopurine is opened, it should be used within 6 weeks.
  • Make sure you get a oral syringe and suitable adaptor, from the pharmacy, that will allow you to measure the dose correctly.
  • If the syringe is intended for multiple use, wash the syringe with warm ‘soapy’ water and rinse well. Hold the syringe under water and move the plunger up and down several times to make sure the inside of the syringe is clean. Ensure the syringe is completely dry before use of the syringe again for dosing and store the syringe in a hygienic place with the medicine.

If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of mercaptopurine at the same time.

Mercaptopurine Dosage

Take mercaptopurine exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The mercaptopurine dose your doctor recommends will be based on the following:

  • the condition being treated
  • other medical conditions you have
  • other medications you are taking
  • how you respond to this medication
  • whether or not you have a genetic deficiency of the TPMT enzyme
  • your liver function
  • your kidney function
  • your age

The recommended dose range for mercaptopurine is 1.5 to 2.5 mg/kg/day once daily.

Mercaptopurine Overdose

If you take too much this medication, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If this medication is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.
 

Other Requirements

  • Store mercaptopurine at room temperature between 15° to 25°C (59° to 77°F).
  • Store in a dry place.
  • Keep this and all medicines out of the reach of children.