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Mercaptopurine Side Effects

For the Consumer

Applies to mercaptopurine: oral suspension, oral tablet

Along with its needed effects, mercaptopurine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking mercaptopurine:

More Common

  • Black, tarry stools
  • clay colored stools
  • cough or hoarseness
  • dark urine
  • decreased appetite
  • fever or chills
  • headache
  • loss of appetite
  • lower back or side pain
  • nausea, vomiting
  • painful or difficult urination
  • pinpoint red spots on the skin
  • rash, itchy skin
  • stomach pain or tenderness
  • swelling of the feet or lower legs
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • yellow eyes or skin

Less Common

  • Bleeding gums
  • chest pain
  • joint pain
  • pale skin
  • sore throat
  • sores, ulcers, or white spots on the lips or in the mouth
  • swollen glands
  • trouble with breathing upon exertion

Incidence Not Known

Some side effects of mercaptopurine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less Common

  • Darkening of the skin
  • headache

Incidence Not Known

  • Hair loss or thinning of the hair
  • low sperm count

For Healthcare Professionals

Applies to mercaptopurine: oral suspension, oral tablet

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.[Ref]

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).[Ref]

Renal effects including hyperuricemia have been reported.[Ref]

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.[Ref]

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

Oral lesions resemble thrush rather than antifolic ulcerations.[Ref]

Hepatic

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

Dermatologic

Dermatologic effects have included skin rashes, alopecia, and hyperpigmentation.[Ref]

Genitourinary

Genitourinary side effects including oligospermia have been reported.[Ref]

Other

Other effects including drug fever have been reported very rarely.[Ref]

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.[Ref]

Oncologic

Oncologic side effects have included hepatosplenic T-cell lymphoma.

References

1. "Product Information. Purinethol (mercaptopurine)." Glaxo Wellcome, Research Triangle Pk, NC.

2. Cappell MS, Das KM "Rapid development of pancreatitis following reuse of 6- mercaptopurine." J Clin Gastroenterol 11 (1989): 679-81

3. Laidlaw ST, Reilly JT, Suvarna SK "Fatal hepatotoxicity associated with 6-mercaptopurine therapy." Postgrad Med J 71 (1995): 639

4. Rehr EL, Swanson KA, Kern JA "Mercaptopurine-induced fever in a patient with Crohn's disease." Ann Pharmacother 26 (1992): 907-9

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.

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