Adult Dosing

Acute lymphatic leukemia

• Maintenance dose: 1.5-2.5 mg/kg/day PO as a single dose; use with methotrexate or other agents for remission maintenance
• If not clinical improvement after 4 wks dose may be increased to 5 mg/kg/day
• Decrease dose to 66-75% if used concurrently with allopurinol
• Decrease dose by 90% (10% of standard dose) if patient is thioprine methyltransferase enzyme (TPMT) deficient

Crohn's Disease [Non-FDA approved]

• 1-1.5 mg/kg PO qhs

Pediatric Dosing

Acute lymphatic leukemia

• Maintenance dose: 1.5-2.5 mg/kg PO qd; use with methotrexate or other agents for remission maintenance
• If not clinical improvement after 4 wks dose may be increased to 5 mg/kg/day
• Decrease dose to 66-75% if used concurrently with allopurinol
• Decrease dose 90% (10% of standard dose) if patient is thioprine methyltransferase enzyme (TPMT) deficient

Crohn's Disease [Non-FDA approved]

• 1-1.5 mg/kg/day

• Maintenance therapy of acute lymphatic leukemia as a part of combination regimen

• Hypersensitivity to any of the ingredients of the product
• Mercaptopurine or thioguanine resistance

• N/A

Renal Dose Adjustment

• Renal impairment: Dose adjustments not defined; decrease dose

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined; decrease dose

• Therapy may cause bleeding and overwhelming infections due to bone marrow suppression including thrombocytopenia and leukopenia.
• Perform laboratory tests, both genotypic and phenotypic, to determine the TPMT status prior to initiating therapy. Lower dosage for homozygous-TPMT deficiency patients
• Monitor liver function tests since therapy may cause liver dysfunction. Increased risk with doses above 2.5 mg/kg/day
• The concomitant administration of mercaptopurine with other hepatotoxic agents requires especially careful clinical and biochemical monitoring of hepatic function
• Mercaptopurine recipients may manifest decreased cellular hypersensitivities and decreased allograft rejection
• Hepatosplenic T-cell lympoma has been reported primarily in adolescents and young adults. Cases have been fatal. Most associated with concomitant TNF blockers and azathioprine

Cautions: Use cautiously in

• Renal impairment
• Thiopurine methyltransferase (TPMT) deficiency
• Concurrent hepatotoxic agents

Purinethol, Purixan interacts with :

	Allopurinol
	Aloprim
	Copegus
	Febuxostat
	Lopurin
	Rebetol
	Ribasphere
	Ribasphere Ribapak
	Ribavirin
	Uloric
	Virazole
	Zyloprim

Pregnancy Category:D

Breastfeeding: Probably unsafe. Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 29 March 2011)Due to the potential for serious adverse reactions in nursing infants, manufacturer recommends discontinuation of nursing or discontinuation of drug, taking into account the importance of the drug to the mother.

• CNS: Weakness
• GI: Anorexia, diarrhea, nausea, vomiting, GI ulceration, ascites, hepatic encephalopathy, pancreatitis, anorexia, abdominal pain
• IMMU: Immunosuppression, T-cell lymphoma, hepatosplenic
• DERM: Alopecia, hyperpigmentation, rash, hyperpigmentation
• ENDO: Gonadal suppression, oligospermia
• HEPA: Hepatotoxicity, jaundice
• HEMA: Anemia, leukopenia, thrombocytopenia, myelosuppression
• METABOLIC: Hyperuricemia, hyperuricosuria
• MISC: Fever, tumor lysis syndrome

• Antimetabolite; disrupts DNA and RNA synthesis
• Variably and incompletely (5–50%) absorbed after oral administrationistration
• Metabolized by liver; CYP450: Unknown
• Excreted unchanged (50%) by the kidneys
• Half-life: 47 mins

US Trade Name(s)

• Purinethol
• Purixan

US Availability

mercaptopurine (generic)

• TABS: 50 mg

Purinethol

• TABS: 50 mg

Purixan

• SUSP: 20 mg/mL

Canadian Trade Name(s)

• Purinethol

Canadian Availability

Purinethol

• TABS: 50 mg

UK Trade Name(s)

• Puri-Nethol

UK Availability

Puri-Nethol

• TABS: 50 mg

Australian Trade Name(s)

• Puri-Nethol

Australian Availability

Puri-Nethol

• TABS: 50 mg

Hematology/Oncology

Antineoplastics

Antimetabolites

Pricing data from www.DrugStore.com in U.S.A.

• Purinethol 50 MG TABS [Bottle] (GATE)
  30 mg = $207.99
  90 mg = $590.97
• Mercaptopurine 50 MG TABS [Bottle] (ROXANE)
  30 mg = $92.99
  90 mg = $242.98

Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.

Drug Name: Purinethol 50 MG Oral Tablet

Ingredient(s): 6-Mercaptopurine

Imprint: PURINETHOL;04A

Color(s): Yellow

Shape: Round

Size (mm): 9.00

Score: 2

Inactive Ingredient(s): starch, corn / starch, potato / lactose monohydrate / magnesium stearate / stearic acid

Drug Label Author:
Gate Pharmaceuticals

DEA Schedule:
Non-Scheduled