thioguanine

Indications

• acute non-lymphocytic leukemia
  • remission induction
  • consolidation
  • maintenance
• treatment of chronic myelogenous leukemia
• acute lymphoblastic leukemia
• acute myeloid leukemia

Contraindications

• history of previous resistance to thioguanine or 6-mercapto- purine

pregnancy category = d

Dosage

• drink plenty of liquids
• dosage reduction with renal or hepatic insufficiency

Tabs: 40 mg.

Monitor

• uric acid
• complete blood count (CBC)
• liver function tests (serum ALT, serum AST, serum bilirubin, serum alkaline phosphatase) weekly initially, then monthly

Adverse effects

• common (> 10%)
  • mild nausea/vomiting*, anorexia, stomatitis, diarrhea
  • myelosuppression
    • WBC & platelet: moderate
    • onset 7-10 days
    • nadir: 14 days
    • recovery: 21 days
• less common (1-10%)
  • hyperuricemia, unsteady gait, rash
• uncommon (< 1%)
  • neurotoxicity, hepatitis, jaundice, veno-occlusive hepatic disease, photosensitivity

* emetic potential low Toxicology: not dialyzable; treatment is supportive

Drug interactions

• busulfan

• drug interaction(s) of mercaptopurine in combination with allopurinol

Laboratory

• thioguanine in serum/plasma
• 6-thioguanine in erythrocytes

More general terms

• mercaptopurine; thiopurine

Additional terms

• acute myeloid leukemia (AML)
• chronic myeloid leukemia (CML, granulocytic leukemia)

Database

• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=2723601
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=407008
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=1537