Dangerous Drug: Mercaptopurine (6-Mercaptopurine, 6-MP)(mer kap toe pyoor’ een)
Purinethol
PREGNANCY CATEGORY D
Drug Classes
Antimetabolite
Antineoplastic
Therapeutic Actions
Tumor-inhibiting properties, probably due to interference with purine nucleotide synthesis and hence with RNA and DNA synthesis, leading to cell death; cell-cycle specific.
Indications
Maintenance therapy of acute lymphatic leukemia (lymphocytic, lymphoblastic) as part of combination therapy
Unlabeled uses: Non-Hodgkin lymphoma, Crohn disease, ulcerative colitis, acute promyelocytic leukemia
Contraindications and Cautions
Contraindicated with allergy to mercaptopurine, prior resistance to mercaptopurine (cross-resistance with thioguanine is frequent), hematopoietic depression, pregnancy, lactation.
Use cautiously with impaired renal function (slower elimination and greater accumulation; reduce dosage).
Available Forms
Tablets—50 mg
Dosages
Adults
Induction therapy: Usual initial dose is 2.5 mg/kg/day PO (about 100–200 mg in adults, 50 mg in the average 5-yr-old child) or 80–100 mg/m2/day PO. Continue daily for several wk. After 4 wk, if no clinical improvement or toxicity, increase to 5 mg/kg/day.
Maintenance therapy after complete hematologic remission: 1.5–2.5 mg/kg/day PO as a single daily dose.
Pediatric patients
Induction therapy: 2.5 mg/kg/day PO or 70–100 mg/m2/day PO; titrate up to 5 mg/kg/day PO or 75 mg m2/day PO.
Maintenance therapy after complete hematologic remission: 1.5–2.5 mg/kg/day PO as a single daily dose.
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