Mercaptopurine

Brand names of mercaptopurine

  • Purinethol

Mercaptopurine is a prescription drug belonging to the group of medications called anti-metabolites and is used to treat cancer. This medication works by impeding the growth of cancer cells. This drug not only inhibits the growth of the cancer cells, but also their spread inside the body. This medication is available in tablet form and is meant for taking by mouth with a full glass of water. Mercaptopurine appears similar to a regular cell nutrient that is required by cells for growth. When the cancer cells absorb mercaptopurine, the latter impedes the growth of the cells. In effect, this prescription drug is generally prescribed for patients suffering from severe lymphatic leukemia (leukemia marked by an anomalous increase in the number of white blood cells) or acute myelogenous leukemia (a form of leukemia distinguished by propagation of myeloid tissue and an unusual augmentation in the number of granulocytes, myelocytes and myeloblasts in the circulating blood). Normally, this medication is administered concurrently with other anti-cancer medicines.

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Things you need to tell your physician before taking mercaptopurine

People who are suffering from cancer, especially acute case of leukemia, ought to adopt a number of precautions before they start taking the prescription drug mercaptopurine. In effect, before you start taking this medication, you should tell your physician about all your medical conditions, medical history and the prescription, over-the-counter as well as herbal medications being taken by you, particularly if you are taking allopurinol (Zyloprim); any anti-coagulant or 'blood thinner' like warfarin (Coumadin); aspirin and/ or vitamins. Most importantly, you need to tell your physician if you have an allergic reaction to mercaptopurine, any of its ingredients or any other drug in general.

Before you start using mercaptopurine, you should be aware that this cancer medication may possibly get in the way of the regular menstrual cycle (menstruation period) in women, while it may also put an end to production of sperm in men. At the same time, one should not take it for granted that she cannot be become pregnant or that he cannot get someone pregnant while taking this medication. Prior to taking this anti-cancer drug women should especially tell their doctors if they are pregnant, planning pregnancy or breastfeeding. Women should also not intend to have children while they are receiving chemotherapy or even for some time after the treatment.

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In effect, using mercaptopurine is not recommended during pregnancy as it may cause harm to the fetus. This anti-cancer medication may perhaps be especially harmful during the first three months of pregnancy. In case you are already pregnant or believe that you may become pregnant while taking this medication, consult your physician immediately and get necessary medical help. While you need to discuss the issue in detail with your physician, be careful to use a reliable birth control method to avoid getting pregnant while taking this medication.

Although it is yet to be ascertained whether mercaptopurine passes on to breast milk, it is advisable that nursing mothers avoid using this medication while breast feeding, since it has the potential to harm the infant. Anyways, it is always better for nursing mothers to consult their physician before breast feeding.

Most importantly, if you are taking this anti-cancer medication, talk to your physician before taking any vaccination, for instance inoculation against measles or flu shots.

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Mercaptopurine should not be taken in case the patient is suffering from certain other health conditions. Prior to using this anti-cancer drug tell your physician or pharmacist if a particular drug, for instance thioguanine, did not prove to be beneficial for you in the past. In fact, knowing this aspect will help to understand how effective mercaptopurine would be for you or how well it would suit you. As aforementioned, before using mercaptopurine tell your physician about your entire medical history, particularly if you have or had have any blood complaints, such as low blood cell counts, anemia, kidney problems, including kidney stones, liver ailments, gout, pancreatitis (inflammation of the pancreas) and/ or radiation therapy.

While you are using the anti-cancer drug mercaptopurine, be careful not to get injured, bruised and/ or cut. It is advisable that you exercise caution while using sharp or pointed objects, such as nail cutters, knives, razors etc, and also try to keep away from any activity that require physical contact, for instance contact sports. In addition, if you have to undergo any surgery or dental procedure, inform your surgeon and/ or dentist that you are taking mercaptopurine.

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People taking mercaptopurine should essentially avoid using alcoholic beverages as it may augment the risk of stomach or esophageal irritation or may even cause damage to the liver. As far as possible, try to restrict your consumption of alcoholic drinks. Even elderly people using this anti-cancer medication ought to exercise extra caution since they are more susceptible to the adverse effects of this drug, particularly its effect on the liver and bone marrow.

Patients who suffer from particular hereditary problems, such as absence of thiopurine methyltransferase enzyme (TPMT), are like to have more of the side effects of the anti-cancer drug mercaptopurine and, hence, may be required to adjust their dosage of the medication. It is advisable to talk to your physician regarding this aspect and if you require undertaking any kind of tests for this particular inborn problem.

Usage

The prescription drug mercaptopurine is meant for treating specific types of cancer, especially acute lymphatic leukemia and/ or acute myelogenous leukemia.

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In addition, mercaptopurine is also prescribed for people enduring several types of autoimmune ailments, for instance rheumatoid arthritis, systemic lupus erythematosus (an autoimmune inflammatory sickness of the connective tissues), severe idiopathic polyneuritis, macroglobulinemia (an unusually abundance of macroglobulins in the blood serum), idiopathic pulmonary hemosiderosis, myasthenia gravis (a persistent progressive ailment wherein the head and facial muscles become weak and easily weary), multiple sclerosis (a constant progressive ailment of the central nervous system), ulcerative colitis (continual ulceration in the large intestine), and uveitis (inflammation of the uvea). Whichever condition you may be using mercaptopurine for, it is always advisable to talk to your physician regarding the potential risks of using this medication for your health condition.

How to use mercaptopurine

Mercaptopurine is an oral medication that can be taken with or without food, but essentially with a full glass of water (8 ounces). The standard dosage of this anti-cancer drug is one tablet taken daily, or as recommended by your physician. The dosage of mercaptopurine is dependent on the patient's weight, medical condition as well as his/ her response to the therapy. It is advisable not to increase the prescribed dosage of this medication or take an over dose since it would not help in facilitating the treatment or cure you faster than usual. On the contrary, any over dosage of the medication is most likely to augment the risks of the side effects of mercaptopurine. Unless your physician has instructed otherwise, you ought to drink lots of fluid when taking this medication. Drinking plenty of fluids actually helps to minimize the potential side effects of mercaptopurine, such as kidney stones.

As mercaptopurine may possibly be soaked up through the skin as well as the lungs, it is important for pregnant women or those who are planning to get pregnant to keep away from this anti-cancer drug or inhale the dust emancipated from the tablets. This is primarily owing to the fact that mercaptopurine has the potential to cause harm to the fetus, especially during the first three months of pregnancy.

How mercaptopurine works

The prescription anti-cancer drug mercaptopurine eliminates cancer cells by obstructing the production of their genetic substance, thereby preventing the cells from reproducing. In other words, this medication helps to kill the cancer cells by inhibiting their growth and spread to the different parts of the body. Unfortunately, it has been found that using mercaptopurine also has the potential of affecting the development and growth of other types of cells, including healthy cells, in the body and this often results in horrid side effects of this medication.

Mercaptopurine (6-MP) works by contending with hypoxanthine and guanine for the hypoxanthine-guanine phosphoribosyltransferase (HGPRTase) enzyme and itself transforms into thioinosinic acid (TIMP). This intracellular nucleotide slows down numerous reactions concerning inosinic acid (IMP), together with the adaptation of IMP to xanthylic acid (XMP) as well as the conversion of IMP to adenylic acid (AMP) by means of adenylosuccinate (SAMP). Moreover, 6-methylthioinosinate (MTIMP) is formed by the chemical process of methylation (a process of replacing a hydrogen atom with a methyl group) of TIMP. In effect, it has been found that TIMP as well as MTIMP slow down glutamine-5-phosphoribosylpyrophosphate amidotransferase - considered to be the first enzyme that is distinctive to the new (de novo) route for the synthesis of purine ribonucleotide.

Several researches have suggested that it is perhaps possible to recover radiolabeled mercaptopurine from the DNA in the mode of deoxythioguanosine. At the same time, some mercaptopurine is transformed into derivatives of nucleotide of 6-thioguanine (6-TG) owing to the chronological actions of xanthylate (XMP) aminase and inosinate (IMP) dehydrogenase transforming TIMP to thioguanylic acid (TGMP).

There are a number of animal tumours that are resilient to the anti-cancer drug mercaptopurine and it has been found that they have lost the aptitude to transform mercaptopurine into TIMP. Nevertheless, now it is obvious that opposition to mercaptopurine may possibly be acquired by other methods also, especially in the instance of human leukemia. However, scientists are yet to ascertain the precise one or several of the biochemical effects of mercaptopurine as well as if its metabolites are expressly or principally accountable for the death of the cells.

Side effects

Serious
  • blood-tinged urine or stools
  • fever
  • lower back pain or pain in flanks
  • small, red spots on the skin
  • easy bruising
  • black or tarry stools
  • cough or hoarseness
  • shortness of breath
  • bleeding from gums, nose, or other unusual places
  • chills
  • painful, difficult urination
  • low white blood cell and platelet counts
  • liver damage
  • anemia
Common
Less common

Possible interactions

The anti-cancer drug mercaptopurine is known to interact with certain drugs and hence it should not be taken concurrently with them. Hence, before you start taking this medication, it is important to tell your physician regarding all the prescription, over-the-counter and herbal medications as well as supplements, vitamins and minerals that you may be taking to treat other health conditions endured by you. While some drugs may increase the effects of mercaptopurine, the effects of others may be reduced by this anti-cancer medication. Similarly, concurrent usage of some other drugs may result in unpleasant side effects, even toxicity in some organs. Below is a brief discussion regarding a few drugs that should not be used together with mercaptopurine.

Other medicaments
The anti-cancer medication mercaptopurine should not be taken concurrently with warfarin (Coumadin) for it may lessen the effects of this medication and when it is prescribed together, it is essential to check the INR (protime or prothrombin time) quite often.
On the other hand, using mercaptopurine along with allopurinol (Zyloprim) is likely to augment the effects of the anti-cancer medication. In case it is essential to take both the medications simultaneously, the dosage of mercaptopurine ought to be lessened to 33 per cent and sometimes to even as less as 25 per cent.
When mercaptopurine is taken together with amphotericin B (Abelcet) it may result in enhanced risks of kidney toxicity or even spasms of the bronchi. On the other hand, when it is taken with live-virus vaccines, for instance smallpox, the combination may possibly result in life-threatening infections. Taking mercaptopurine concurrently with methotrexate (Mexate, Rheumatrex) may lead to mercaptopurine toxicity. Then again, taking mercaptopurine together with olsalazine (Dipentum) might augment the risk of bone marrow depression.
Herbal medicines or minerals
Many patients are of the impression that taking the herb Echinacea perks up or fortifies their immune systems. Unfortunately, in reality, taking Echinacea is harmful for the immune system if it is used for a prolonged period. Although some cancer patients, who may be using mercaptopurine as well, they may try to use this herb to boost their immune system - Echinacea is never recommended for use by people who have an impaired immune system. Hence, it is advisable to stay away from using this herb, especially while you may be taking the anti-cancer drug mercaptopurine.
Alcohol
Cancer patients taking mercaptopurine should avoid alcoholic beverages totally, as taking them may increase the risk of stomach/ esophageal irritation or even cause damage to the liver.

Storage instructions

The anti-cancer drug mercaptopurine should be stored at normal room temperature varying between 59°F and 77°F (15°C and 25°C) and in a dark and arid place. Light and moisture may spoil the medication. It is important not to store this medication in the bathroom. Ensure that it is kept out of the reach of children and pets.

Unless there is any specific instruction in this regard, never dispose of the medication, even if has lapsed the expiry date, by downing it in the toilet or pouring it in a drain. Ensure that the drug is disposed of properly when it has expired or is no longer required. In effect, it is advisable to discuss the matter with your pharmacist or the neighbourhood disposal company for further details regarding the proper and safe discard of the medicine.

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