Mercaptopurine interactions

Food & lifestyle

• food

  Moderate

  Absorption

  Limited data suggest that food may decrease the oral bioavailability of 6-mercaptopurine (6-MP).

  What to do: Until more information is available regarding the effect of food on 6-MP absorption, it may be advisable to take 6-MP on an empty stomach 1 hour before or 2 hours after a meal.

  1 source

  1. Schmidt LE, Dalhoff K "Food-drug interactions." Drugs 62 (2002): 1481-502

Conditions

Conditions in which Mercaptopurine needs care, as documented in this source.

• Bone Marrow Failure Disorders

  Major

  Mercaptopurine induces dose-related myelosuppression which can be delayed. Leukopenia, thrombocytopenia, and anemia have been reported during mercaptopurine therapy. Therapy should be administered cautiously in patients with myelosuppression and therapy should be withheld at the first indication of an abnormally large reduction of any bone marrow element. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Close monitoring of hematopoietic function is recommended.

  1 source

  1. "Product Information. Purinethol (mercaptopurine)." Glaxo Wellcome (2001):

• Infections

  Major

  Because of their cytotoxic effects on rapidly proliferating tissues, antineoplastic agents frequently can, to varying extent, induce myelosuppression. The use of these drugs may be contraindicated in patients with known infectious diseases. All patients should be instructed to immediately report any signs or symptoms suggesting infection such as fever, sore throat, or local infection during antineoplastic therapy. Close clinical monitoring of hematopoietic function is recommended.

  39 sources

  1. Sanders C, Perez EA, Lawrence HJ "Opportunistic infections in patients with chronic lymphocytic leukemia following treatment with fludarabine." Am J Hematol 39 (1992): 314-5
  2. "Product Information. Methotrexate (methotrexate)." Lederle Laboratories (2002):
  3. "Product Information. Platinol (cisplatin)." Bristol-Myers Squibb (2001):
  4. "Product Information. Vepesid (etoposide)." Bristol-Myers Squibb (2001):
  5. "Product Information. Novantrone (mitoxantrone)." Immunex Corporation (2001):
  6. "Product Information. Mutamycin (mitomycin)." Bristol-Myers Squibb (2001):
  7. "Product Information. Ifex (ifosfamide)." Bristol-Myers Squibb (2001):
  8. "Product Information. Thiotepa (thiotepa)." Hikma USA (formerly West-Ward Pharmaceutical Corporation) (2001):

  Show all 39 sourcesShow fewer sources

  9. Girmenia C, Mauro FR, Rahimi S "Late listeriosis after fludarabine plus prednisone treatment." Br J Haematol 87 (1994): 407-8
  10. Schilling PJ, Vadhan-Raj S "Concurrent cytomegalovirus and pneumocystis pneumonia after fludarabine therapy for chronic lymphocytic leukemia." N Engl J Med 323 (1990): 833-4
  11. Frame JN, Dahut WL, Crowley S "Fludarabine and acute tumor lysis in chronic lymphocytic leukemia." N Engl J Med 327 (1992): 1396-7
  12. Bastion Y, Coiffier B, Tigaud JD, Espinouse D, Bryon PA "Pneumocystis pneumonia in a patient treated with fludarabine for chronic lymphocytic leukemia." Eur J Cancer 27 (1991): 671
  13. "Product Information. Fludara (fludarabine)." Berlex Laboratories (2001):
  14. "Product Information. Idamycin (idarubicin)." Pharmacia and Upjohn (2001):
  15. "Product Information. Matulane (procarbazine)." Roche Laboratories (2001):
  16. "Product Information. DTIC-Dome (dacarbazine)." Bayer (2001):
  17. "Product Information. Adriamycin PFS (doxorubicin)." Pharmacia and Upjohn (2001):
  18. "Product Information. Leustatin (cladribine)." Ortho Biotech Inc (2001):
  19. "Product Information. Gemzar (gemcitabine)." Lilly, Eli and Company (2001):
  20. "Product Information. Hycamtin (topotecan)." SmithKline Beecham (2001):
  21. "Product Information. Taxotere (docetaxel)." Rhone Poulenc Rorer (2001):
  22. "Product Information. Taxol (paclitaxel)." Bristol-Myers Squibb (2001):
  23. "Product Information. Nipent (pentostatin)." Hospira Inc (2001):
  24. "Product Information. Tabloid (thioguanine)." Prasco Laboratories (2001):
  25. "Product Information. Xeloda (capecitabine)." Roche Laboratories (2001):
  26. "Product Information. Alkeran (melphalan)." Glaxo Wellcome (2022):
  27. "Product Information. Purinethol (mercaptopurine)." Glaxo Wellcome (2001):
  28. "Product Information. Leukeran Tablets (chlorambucil)." Glaxo Welcome, Research Triangle Pk, NC.
  29. "Product Information. Doxil (doxorubicin liposomal)." Sequus Pharmaceuticals Inc (2001):
  30. "Product Information. Cytosar-U (cytarabine)." Pharmacia and Upjohn (2001):
  31. "Product Information. Uracil Mustard (uracil mustard)." Roberts Pharmaceutical Corporation (2001):
  32. "Product Information. Jevtana (cabazitaxel)." sanofi-aventis (2010):
  33. "Product Information. Halaven (eribulin)." Eisai Inc (2010):
  34. "Product Information. Keytruda (pembrolizumab)." Merck & Co., Inc (2014):
  35. "Product Information. Blincyto (blinatumomab)." Amgen USA (2014):
  36. "Product Information. Opdivo (nivolumab)." Bristol-Myers Squibb (2014):
  37. "Product Information. Unituxin (dinutuximab)." United Therapeutics Corporation (2015):
  38. "Product Information. Empliciti (elotuzumab)." Bristol-Myers Squibb (2015):
  39. "Product Information. Pepaxto (melphalan flufenamide)." Oncopeptides Inc. (2021):

• Liver Diseases

  Major

  Mercaptopurine is hepatotoxic. Hepatic injury can occur at any dosage, however, increased frequency of injury occurs when doses exceed 2.5 mg/kg/day. Deaths due to hepatic necrosis have been reported. Patients should be instructed to immediately report any signs of hepatotoxicity such as jaundice, hepatic dysfunction such as, jaundice, dark urine, right upper quadrant pain, or anorexia. Therapy with mercaptopurine should be administered cautiously in patients with or predisposed to compromised hepatic function. Clinical monitoring of hepatic function and determination of the etiology of hepatic dysfunction is recommended.

  1 source

  1. "Product Information. Purinethol (mercaptopurine)." Glaxo Wellcome (2001):

• Thiopurine S methyltranferase deficiency

  Major

  Thioguanine is closely related structurally and functionally to mercaptopurine. A rare deficiency in the enzyme thiopurine methyltransferase (TMPT) results in an increased sensitivity to the myelosuppressive effects of both drugs causing rapid bone marrow suppression following initial mercaptopurine or thioguanine administration. Therapy with thioguanine or mercaptopurine should be administered cautiously and at a reduced dose in patients with TMPT deficiency.

  1 source

  1. "Product Information. Tabloid (thioguanine)." Prasco Laboratories (2001):

• Kidney Diseases

  Moderate

  Mercaptopurine is excreted in the urine as unchanged drug and metabolites. Renal elimination may be reduced in patients with impaired renal function. Therapy with mercaptopurine should be initiated at a reduced dosage in patients with compromised renal function. Clinical monitoring of renal function is recommended.

  1 source

  1. "Product Information. Purinethol (mercaptopurine)." Glaxo Wellcome (2001):