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6-Mercaptopurine: Uses, Dosage, Side Effects & Treatment Guide
Summary of Key Points
6-Mercaptopurine is a medication used to treat certain cancers and autoimmune diseases. It works by suppressing the immune system and slowing the growth of abnormal cells. Commonly prescribed for conditions such as leukemia, Crohn’s disease, and ulcerative colitis, it is essential for patients to follow their doctor’s dosing instructions carefully and be aware of potential side effects. If you have any questions about your treatment plan, consider scheduling a telemedicine appointment with one of our healthcare providers.
Names of Medication
US Brand Name: Purinethol (6-mercaptopurine)
Medications often have two names: a brand name and a generic name. The generic name refers to the active ingredient in the medication, which is listed in parentheses.
Pharmacologic Category
Antimetabolite
Immunosuppressant
6-Mercaptopurine Dosage
6-Mercaptopurine is prescribed for various conditions, with the dosage depending on the specific disease being treated. Always consult your healthcare provider before making any changes to your dosage. If you need to speak with a doctor, you can schedule a telemedicine appointment with us at any time.
Acute Lymphoblastic Leukemia (ALL)
Adult Dose: 1.5 to 2.5 mg/kg orally once daily. Treatment is typically long-term, continuing for several months or even years, depending on the patient’s response and remission status.
Crohn’s Disease
Adult Dose: 1 to 1.5 mg/kg orally once daily. The duration of treatment varies based on the patient’s response and the activity of the disease.
Ulcerative Colitis
Adult Dose: 1 to 1.5 mg/kg orally once daily. The length of treatment depends on the patient’s condition and how well they respond to therapy.
Acute Myeloid Leukemia (AML)
Adult Dose: 1.5 to 2.5 mg/kg orally once daily. The duration of treatment is individualized based on the patient’s response to therapy.
Chronic Lymphocytic Leukemia (CLL)
Adult Dose: 1.5 to 2.5 mg/kg orally once daily. The length of treatment depends on the progression of the disease and the patient’s response to therapy.
Non-Hodgkin Lymphoma
Adult Dose: 1.5 to 2.5 mg/kg orally once daily. The duration of treatment varies depending on the patient’s response to therapy.
Autoimmune Hepatitis
Adult Dose: 1 to 1.5 mg/kg orally once daily. Treatment is typically long-term to help maintain remission.
Rheumatoid Arthritis
Adult Dose: 1 to 1.5 mg/kg orally once daily. The duration of treatment depends on the patient’s response to therapy.
Psoriasis
Adult Dose: 1 to 1.5 mg/kg orally once daily. The length of treatment varies depending on the severity of the condition and the patient’s response.
Myasthenia Gravis
Adult Dose: 1 to 1.5 mg/kg orally once daily. The duration of treatment is individualized based on the patient’s response to therapy.
Dosage Forms and Strengths
Tablet: 50 mg
Administration Instructions for 6-Mercaptopurine
6-Mercaptopurine should be taken exactly as prescribed by your healthcare provider. It is usually taken once daily, with or without food. Swallow the tablet whole; do not crush or chew it. To maintain consistent levels of the medication in your body, take it at the same time each day. If you miss a dose, take it as soon as you remember. However, if it’s close to the time for your next dose, skip the missed dose and continue with your regular schedule. Do not take two doses at once.
6-Mercaptopurine Side Effects and Adverse Reactions
Like all medications, 6-mercaptopurine can cause side effects. Some are common and mild, while others are rare but more serious. If you experience any side effects, contact your healthcare provider immediately. You can also schedule a telemedicine appointment with one of our providers to discuss any concerns.
Common Side Effects: Nausea, vomiting, loss of appetite, and mild diarrhea. These symptoms are usually temporary and may improve as your body adjusts to the medication.
Less Common Side Effects: Fatigue, rash, and mouth sores. If these symptoms persist or worsen, they may require medical attention.
Serious Side Effects: Signs of infection (such as fever or chills), unusual bruising or bleeding, dark urine, yellowing of the skin or eyes (jaundice), and severe abdominal pain. These side effects are rare but serious and require immediate medical attention.
Contraindications for 6-Mercaptopurine
A contraindication is a specific situation or condition where a medication should not be used because it may cause harm. Several contraindications should be considered before starting treatment with 6-mercaptopurine.
Allergy to 6-mercaptopurine or thiopurines: If you have a known allergy to 6-mercaptopurine or other thiopurine medications, such as azathioprine, taking this medication could lead to severe allergic reactions, including rash, swelling, or difficulty breathing.
Thiopurine methyltransferase (TPMT) deficiency: Patients with a genetic deficiency in the TPMT enzyme are at a higher risk for severe bone marrow suppression (myelosuppression) when taking 6-mercaptopurine. This can lead to dangerously low blood cell counts, increasing the risk of infections, anemia, and bleeding.
Severe liver disease: 6-Mercaptopurine is metabolized by the liver. Patients with severe liver disease may not process the medication properly, leading to toxic levels in the body and worsening liver function.
Pregnancy: 6-Mercaptopurine may harm an unborn baby. It is generally contraindicated during pregnancy unless the potential benefits outweigh the risks. Always consult your healthcare provider if you are pregnant or planning to become pregnant.
Active infections: Since 6-mercaptopurine can suppress the immune system, it may worsen existing infections or make it harder for your body to fight off new infections.
Drug to Drug Interactions
6-mercaptopurine can interact with other medications, potentially increasing the risk of side effects or reducing its effectiveness. It’s important to inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements. Some significant drug interactions with 6-mercaptopurine include:
Allopurinol (Zyloprim): Allopurinol, commonly prescribed for gout, can elevate 6-mercaptopurine levels in the blood, which may lead to toxicity. If you are taking allopurinol, your doctor may need to adjust your 6-mercaptopurine dosage.
Warfarin (Coumadin): 6-mercaptopurine may reduce the effectiveness of warfarin, a blood thinner, which could increase the risk of blood clots. Your doctor may need to monitor your blood clotting times more closely.
Mesalamine (Asacol, Pentasa): Mesalamine, often used to treat inflammatory bowel disease (IBD), can increase the risk of bone marrow suppression when taken with 6-mercaptopurine.
Aminosalicylates (Sulfasalazine, Balsalazide): These medications, also used for IBD, may similarly raise the risk of bone marrow suppression when combined with 6-mercaptopurine.
Febuxostat (Uloric): Like allopurinol, febuxostat is used to manage gout and can increase the risk of 6-mercaptopurine toxicity. Dose adjustments may be necessary.
6-mercaptopurine in Pregnancy
Is it safe to take 6-mercaptopurine during pregnancy?
6-mercaptopurine is generally not recommended during pregnancy due to potential risks to the developing fetus, such as birth defects, miscarriage, or low birth weight. However, in certain situations, the benefits of continuing treatment may outweigh the risks, particularly in life-threatening conditions. If you are pregnant or planning to become pregnant, it’s essential to discuss your options with your healthcare provider. They can help you carefully weigh the risks and benefits and may suggest alternative treatments. Our telemedicine service is available to assist you in making an informed decision.
6-mercaptopurine while Breastfeeding
Is it safe to take 6-mercaptopurine while breastfeeding?
6-mercaptopurine is generally not recommended while breastfeeding, as it can pass into breast milk and may affect the nursing infant, potentially leading to immune suppression or other adverse effects. If you are breastfeeding or planning to breastfeed, consult your healthcare provider. They may recommend alternative treatments or advise discontinuing breastfeeding while taking 6-mercaptopurine. Our telemedicine providers are available to help you make an informed decision.
Estimated Cost of 6-mercaptopurine Medication
The cost of a 30-day supply of 6-mercaptopurine without insurance can vary depending on the pharmacy and location. With a GoodRX coupon, the estimated cost typically ranges from $30 to $50 for a 50 mg tablet. Be sure to check with your pharmacy for the most accurate pricing, and consider using a coupon or discount program to help reduce costs.
Possible Alternatives to 6-mercaptopurine
Depending on the condition being treated, alternative medications or lifestyle changes may help manage symptoms. Always consult your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are available to help you explore these options.
- Acute lymphoblastic leukemia: Alternatives may include chemotherapy regimens with methotrexate or vincristine. In some cases, bone marrow transplantation may also be considered.
- Crohn’s disease: Biologic therapies such as infliximab (Remicade) or adalimumab (Humira) may be alternatives, along with lifestyle changes like dietary modifications and stress management.
- Ulcerative colitis: Biologic agents like vedolizumab (Entyvio) or tofacitinib (Xeljanz) may be considered. Dietary changes and regular exercise may also help manage symptoms.
- Acute myeloid leukemia: Alternatives may include chemotherapy agents like cytarabine or daunorubicin, or stem cell transplantation.
- Chronic lymphocytic leukemia: Targeted therapies such as ibrutinib (Imbruvica) or venetoclax (Venclexta) may be considered.
- Non-Hodgkin lymphoma: Rituximab (Rituxan) or other chemotherapy regimens may be used as alternatives.
- Autoimmune hepatitis: Alternatives include corticosteroids like prednisone or immunosuppressants such as azathioprine.
- Rheumatoid arthritis: Biologic agents like etanercept (Enbrel) or methotrexate may be used. Physical therapy and exercise may also help manage symptoms.
- Psoriasis: Alternatives include topical treatments, phototherapy, or biologic agents like secukinumab (Cosentyx).
- Myasthenia gravis: Alternatives may include pyridostigmine (Mestinon) or immunosuppressants like azathioprine. Lifestyle changes, such as managing stress and avoiding triggers, may also help.
Recent Updates on 6-mercaptopurine Research
Recent research on 6-mercaptopurine has focused on optimizing dosing strategies to minimize side effects while maintaining its effectiveness, particularly in patients with genetic variations such as TPMT deficiency. Studies are also exploring the use of 6-mercaptopurine in combination with other therapies for conditions like Crohn’s disease and ulcerative colitis. Additionally, there is growing interest in personalized medicine, where genetic testing may help tailor treatment plans to individual patients. If you are interested in how these updates may impact your treatment, our telemedicine providers are available to discuss the latest research with you.
