Mercaptopurine Side Effects

Brand Names: Purinethol

Please note - some side effects for Mercaptopurine may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA at http://www.fda.gov/medwatch/ or 1-800-FDA-1088 (1-800-332-1088).

Side Effects of Mercaptopurine - for the Consumer

Mercaptopurine

All medicines may cause side effects, but many people have no, or minor, side effects. No COMMON side effects have been reported with Mercaptopurine . Seek medical attention right away if any of these SEVERE side effects occur when using Mercaptopurine:

Severe allergic reactions (rash; itching; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); dark urine; darkening of the skin; fever, chills, or sore throat; increased or painful urination; loss of appetite; nausea; pale stools; severe or persistent diarrhea; sores or white patches in the mouth; stomach pain, swelling, or tenderness; unusual bleeding or bruising; unusual growths or lumps; unusual tiredness or weakness; vomiting; yellowing of the skin or eyes.

Mercaptopurine Side Effects - for the Professional

Mercaptopurine

The principal and potentially serious toxic effects of Mercaptopurine are bone marrow toxicity and hepatotoxicity.

Hematologic: The most frequent adverse reaction to Mercaptopurine is myelosuppression. The induction of complete remission of acute lymphatic leukemia frequently is associated with marrow hypoplasia. Patients without TPMT enzyme activity (homozygous-deficient) are particularly susceptible to hematologic toxicity, and some patients with low or intermediate TPMT enzyme activity are more susceptible to hematologic toxicity than patients with normal TPMT activity, although the latter can also experience severe toxicity. Maintenance of remission generally involves multiple-drug regimens whose component agents cause myelosuppression. Anemia, leukopenia, and thrombocytopenia are frequently observed. Dosages and also schedules are adjusted to prevent life-threatening cytopenias.

Renal: Hyperuricemia and/or hyperuricosuria may occur in patients receiving Mercaptopurine as a consequence of rapid cell lysis accompanying the antineoplastic effect. Renal adverse effects can be minimized by increased hydration, urine alkalinization, and the prophylactic administration of a xanthine oxidase inhibitor such as allopurinol. The dosage of Mercaptopurine should be reduced to one third to one quarter of the usual dose if allopurinol is given concurrently.

Gastrointestinal: Intestinal ulceration has been reported. Nausea, vomiting, and anorexia are uncommon during initial administration, but may increase with continued administration. Mild diarrhea and sprue-like symptoms have been noted occasionally, but it is difficult at present to attribute these to the medication. Oral lesions are rarely seen, and when they occur they resemble thrush rather than antifolic ulcerations.

Miscellaneous: The administration of Mercaptopurine has been associated with skin rashes and hyperpigmentation. Alopecia has been reported.

Drug fever has been very rarely reported with Mercaptopurine. Before attributing fever to Mercaptopurine, every attempt should be made to exclude more common causes of pyrexia, such as sepsis, in patients with acute leukemia. Oligospermia has been reported.

Side Effects by Body System

Hematologic

Hematologic effects including myelosuppression have been reported. Myelosuppression is the most frequent adverse reaction reported with the use of mercaptopurine. Anemia, leukopenia, and thrombocytopenia have also been reported frequently.

Renal

Hyperuricemia may occur as a consequence of rapid cell lysis. Adverse effects may be minimized by increasing hydration, urine alkalinization, and the prophylactic administration of a xanthine oxidase inhibitor (such as allopurinol).

Renal effects including hyperuricemia have been reported.

Gastrointestinal

Gastrointestinal effects including intestinal ulceration have been reported. Nausea, vomiting, and anorexia have been infrequently reported during initial administration. Mild diarrhea and sprue-like symptoms have been reported occasionally. Oral lesions have been reported rarely. An increased risk of pancreatitis may be associated with the investigational use of mercaptopurine in inflammatory bowel disease.

The mild diarrhea and sprue-like symptoms are not necessarily related to the mercaptopurine.

Oral lesions resemble thrush rather than antifolic ulcerations.

Hepatic

Hepatic effects including a small number of deaths which may have been attributed to hepatic necrosis have been reported.

Dermatologic

Dermatologic effects have included skin rashes, alopecia, and hyperpigmentation.

Genitourinary

Genitourinary side effects including oligospermia have been reported.

Other

Before the drug fever is assumed to be caused by mercaptopurine, the clinician should exclude more common causes of pyrexia such as sepsis in patients with acute leukemia.

Other effects including drug fever have been reported very rarely.

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