(mercaptopurine) is a nucleoside metabolic inhibitor indicated for the treatment of patients with acute lymphoblastic leukemia (ALL) as a component of a combination maintenance therapy regimen.
Mercaptopurine is a purine antagonist which is converted intracellularly into its active nucleotides, including thioinosinic acid. The nucleotides inhibit several reactions which ultimately interferes with nucleic acid synthesis and prevents the formation of RNA and DNA.
The starting dose of it in multi-agent combination chemotherapy maintenance regimens is 1.5 to 2.5 mg/kg (50 to 75 mg/m2) as a single daily dose. Use absolute neutrophil count to guide dosing.
Anticoagulant action of warfarin may be inhibited by mercaptopurine. Enhanced toxicity with myelosuppressive drugs.
Myelosuppression: Monitor complete blood count (CBC) and adjust the dose of PURIXAN for severe neutropenia and thrombocytopenia. Evaluate patients with repeated severe myelosuppression for thiopurine Smethyltransferase (TPMT) deficiency. Patients with homozygous-TPMT deficiency require substantial dose reductions of PURIXAN. ? Hepatotoxicity: Monitor transaminases and bilirubin. Hold or adjust the dose of PURIXAN. ? Immunosuppression: Due to the immunosuppression associated with maintenance chemotherapy for ALL,response to all vaccines may be diminished and there is a risk of infection with live virus vaccines. Consult immunization guidelines for immunocompromised children. ? Embryo-fetal toxicity: PURIXAN can cause fetal harm. Advise women of potential risk to a fetus.
anemia,neutropenia,and thrombocytopenia. Less common (5-20% of patients) elevated transaminases,elevated bilirubin,intestinal ulceration,nausea,vomiting,anorexia,diarrhea and rashes.
It can cause fetal harm. Advise women of potential risk to a fetus. It is not known whether mercaptopurine is excreted in human milk. Because many drugs are excreted in human milk,and because of the potential for serious adverse reactions in nursing infants from mercaptopurine,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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