6-Mercaptopurine: A Comprehensive Medication Profile

Purinethol (6-Mercaptopurine)

6-Mercaptopurine, also known by the brand name Purinethol, is a medication often used in the treatment of certain autoimmune diseases and cancers.

Pharmacologic Category

6-Mercaptopurine falls under the pharmacologic category of immunosuppressants, specifically purine analogs. Other medications in this category include Azathioprine (Imuran), Mycophenolate (CellCept), and Cyclosporine (Neoral).

Dosing

6-Mercaptopurine is used to treat a variety of diseases in adults, including:

Acute Lymphoblastic Leukemia (ALL)

The typical dosage for ALL is 1.5 to 2.5 mg/kg/day, administered orally once daily. The length of treatment varies based on individual response and tolerance.

Chronic Myeloid Leukemia (CML)

The usual dosage for CML is 1.5 to 2.5 mg/kg/day, taken orally once daily.

Non-Hodgkin Lymphoma

The standard dose for Non-Hodgkin Lymphoma is 1.5 to 2.5 mg/kg/day, taken orally once daily.

Autoimmune Hepatitis

For Autoimmune Hepatitis, the dosage is typically 1 to 1.5 mg/kg/day, taken orally once daily.

Crohn’s Disease

For Crohn’s Disease, the dose is typically 1 to 1.5 mg/kg/day, taken orally once daily.

Ulcerative Colitis

For Ulcerative Colitis, the dose is typically 1 to 1.5 mg/kg/day, taken orally once daily.

Vasculitis

In the treatment of Vasculitis, the typical dosage is 1 to 2 mg/kg/day, taken orally once daily.
It’s important to remember that these dosages are general guidelines and the actual dose will depend on a variety of factors including body weight, kidney function, and other medications being used. Always consult with your healthcare provider before making any changes to your medication regimen.

Dosage Forms and Strengths

6-Mercaptopurine is available in tablet form, with strengths of 50 mg.

Administration Instructions

6-Mercaptopurine should be taken orally, with or without food. The medication should be taken at the same time each day to maintain consistent blood levels. It is important to not crush, chew, or break the tablets.

Adverse Reactions and Side Effects

Like all medications, 6-Mercaptopurine can cause side effects. Some of the most common include:

Nausea and Vomiting (Common)

Nausea and vomiting are common side effects of many medications, including 6-Mercaptopurine. This occurs because the medication can irritate the lining of the stomach.

Loss of Appetite (Common)

6-Mercaptopurine may cause a decrease in appetite, often as a result of nausea or changes in taste, which are common side effects of many medications.

Diarrhea (Common)

Diarrhea can be a common side effect of 6-Mercaptopurine as the medication can affect the digestive system’s regular function.

Low Blood Cell Counts (Leukopenia, Anemia, Thrombocytopenia) (Common)

6-Mercaptopurine works by suppressing the immune system and this can lead to a decrease in the number of white blood cells, red blood cells, and platelets. This may increase the risk of infection, cause fatigue, and increase the risk of bleeding.

Liver Toxicity (Uncommon)

Liver toxicity is a potential, though uncommon, side effect of 6-Mercaptopurine. Regular monitoring of liver function tests is recommended during treatment.

Contraindications to taking 6-Mercaptopurine

A contraindication is a specific situation in which a drug, procedure, or surgery should not be used because it may be harmful to the person. Here are contraindications to taking 6-Mercaptopurine:

Pregnancy

6-Mercaptopurine may cause harm to an unborn baby and is therefore contraindicated during pregnancy. If you are pregnant or planning to become pregnant, discuss with your healthcare provider the potential risks and benefits.

Breastfeeding

It is not known whether 6-Mercaptopurine passes into breast milk. Therefore, it is contraindicated in nursing mothers due to the potential risk to the infant.

Severe Liver Disease

Patients with severe liver disease may not be able to metabolize 6-Mercaptopurine effectively, which can lead to increased levels of the drug in the body and potential toxicity.

Drug to Drug Interactions

Certain medications may interact with 6-Mercaptopurine, including:
Allopurinol (Zyloprim) Warfarin (Coumadin) ACE inhibitors like Lisinopril (Prinivil, Zestril) Trimethoprim/Sulfamethoxazole (Bactrim, Septra)

6-Mercaptopurine in Pregnancy

6-Mercaptopurine is classified as a Category D drug in pregnancy, which means there is evidence of human fetal risk based on adverse reaction data, but the potential benefits may warrant use in pregnant women despite potential risks. Always consult with your healthcare provider for personalized advice.

6-Mercaptopurine while Breastfeeding

It is not known whether 6-Mercaptopurine is excreted in human milk. Because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug.

Estimated Cost of Medication

The estimated cost for a 30-day supply of 6-Mercaptopurine (50 mg) without insurance, using a GoodRx coupon, is approximately $60-$80, but this price may vary based on location and specific pharmacy used. Remember, these prices are only estimates and actual costs may vary.

Brief Legal Disclaimer

This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.

Brief Legal Disclaimer: This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.