Application Mercaptopurine Purinethol:
Acute lymphoblastic leukemia, acute myelogenous leukemia (including acute leukemia mielotsitarny), exacerbation of chronic myeloid leukemia, chorionepithelioma uterus, reticulosis, chronic granulocytic leukemia.
Contra Mercaptopurine Purinethol:
Hypersensitivity, resistance of tumor suppression function of bone marrow (leukopenia with leukocyte counts less 3Ї109 / L, thrombocytopenia with platelet counts less 100Ї109 / l), chickenpox, shingles and other infections, abnormal liver function and kidney disease, gout or nephrolithiasis in history .
Application Mercaptopurine during pregnancy and breastfeeding:
Contraindicated in pregnancy. Application Mercaptopurine mercaptopurine during pregnancy was accompanied by an increased risk of miscarriage or premature birth. At the time of treatment should stop breastfeeding.
Side effects Mercaptopurine Purinethol:
The nervous system and sensory organs: headache, weakness.
With the cardiovascular system and blood: the most common – anemia, leukopenia, thrombocytopenia (in the period of active therapy in acute myelogenous leukemia patients is often marked a period of relative bone marrow aplasia, it is important to carry out appropriate maintenance treatment).
From the digestive tract: nausea, vomiting, diarrhea, loss of appetite, hepatotoxic action (a toxic-allergic genesis and often occurs when excess doses of 2.5 mg / kg / day) or cholestasis (jaundice of sclera or skin), rarely – stomatitis ( usually at high doses), ulceration in the gastrointestinal tract, hepatic encephalopathy.
From the urogenital system: less often – or hyperuricemia nephropathy.
For the skin: hyperpigmentation of the skin, skin rash, itching.
Other: decreased immunity and susceptibility to infections.
Interaction Mercaptopurine Purinethol:
Allopurinol, probenecid, sulfinpyrazone, colchicine increase the (relative) activity and toxicity. Allopurinol enhances the toxic effect due to slowing metabolism. On the background urikozuricheskih arthrifuge increased risk of developing nephropathy. In a joint application with indirect anticoagulants mercaptopurine may increase the anticoagulant activity and / or risk of bleeding as a result of reduction in hepatic synthesis of coagulation factors and platelet disorders education, or reduce anticoagulant activity by increasing the synthesis or activation of prothrombin. Myelotoxicity drugs or radiation therapy additively suppress bone marrow function. Other immunosuppressive drugs (corticosteroids, azathioprine, chlorambucil, corticotropin, cyclophosphamide, cyclosporine) increases the risk of infections and secondary tumors (enhancement of immunosuppressive action). Simultaneous treatment with doxorubicin significantly increases the risk of hepatotoxicity. There is a complete cross-resistance between mercaptopurine and thioguanine. In combination with live virus vaccines may cause intensification of vaccine virus replication, strengthening the side effects of vaccines and decrease antibody production in response to the introduction of both living and inactivated vaccines.
Overdose Mercaptopurine Purinethol:
Symptoms: immediate – anorexia, nausea, vomiting, diarrhea, delayed – myelosuppression, liver dysfunction, gastro-enteritis.
Treatment: symptomatic (not an effective antagonist, hemodialysis almost effective).
Dosage and administration Mercaptopurine Purinethol:
Inside. Adults and children inside the initial dose – 2.5 mg / kg / day or 80-100 mg / m 2 (mean, 100-200 mg – adults, 50 mg – for children 5 years of age). May increase the dose to 5 mg / kg / day (maximum) for 4 weeks. Maintenance dose: 1,5-2,5 mg / kg or 50-100 mg / m 2 per day. Patients with hepatic and / or renal failure dose is decreased. In appointing simultaneously with allopurinol (300-600 mg / day) applied only 1/3-1/4 normal dose of mercaptopurine (reduction in the intensity of metabolism due to blockade of xanthine oxidase).
The daily dose is usually used only once.
Also used in combination chemotherapy.
Precautions Mercaptopurine Purinethol:
Designate caution for the elderly (more likely age for renal dysfunction) and children (required decreasing doses), patients who previously held radiation or chemotherapy, in patients with renal tumors, renal and liver failure.
The patient should be cautioned about the toxicity of the drug and its non-use without consulting your doctor. May increase the risk of secondary cancer and kidney disease (caused by the increased formation of uric acid). To avoid the risk of kidney disease should not be used in combination with mercaptopurine urikozuricheskie funds. With careful use of anti-tumor or after radiation therapy.
Caution is advised when handling tablets (split them in half) to avoid contamination of hands or by inhaling the drug.
Dental treatment should be completed before the start of therapy or deferred until the normalization of the blood picture (possibly increasing the risk of microbial infections, slow healing process, bleeding gums). In the course of treatment to be careful when using the toothbrush filaments or toothpicks.
Use caution with combination therapy, you should take each medicine at the appointed time.
During treatment it is important to use enough liquid and the subsequent intensification of diuresis for removal of uric acid.
During the period of treatment is not recommended for vaccination with viral vaccines, should avoid contact with people who have received polio vaccine, with patients with bacterial infections. Apply the live virus vaccine in patients with leukemia in remission should not be at least 3 months after the last course of chemotherapy. Immunization of oral polio vaccine persons who are in close contact with the patient, especially family members, should be postponed.
The signs of depression of bone marrow function, unusual bleeding or bleeding, black tarry stools, blood in urine or feces or point red spots on the skin requires immediate medical advice.
Caution to avoid accidental cuts with sharp objects (with a safety razor, scissors), avoid contact sports activities or other situations in which the possibility of hemorrhage or trauma.
In patients with developing countries as a result of mercaptopurine thrombocytopenia recommended special precautions (limiting the frequency of venipuncture, refusal to IM injections, testing urine, feces, and secrets for occult blood, preventing constipation, avoiding the use of acetylsalicylic acid, etc. ).
Special instructions Mercaptopurine Purinethol:
Treatment should be under close clinical and haematological control. During and after treatment (within 2 weeks) at least 2 times a week, spend the control of peripheral blood and bone marrow hematopoiesis. Should be monitored for liver and kidney function, levels of uric acid in the blood.
To prevent hyperuricemia recommend drinking plenty of fluids, if necessary – allopurinol, and alkalinization of urine. As the number of leukocytes and platelets below an acceptable level, the propensity to bleeding or the appearance of jaundice mercaptopurine should be abolished. Need to carefully monitor the blood picture and, if necessary, to carry out maintenance therapy and blood transfusions. Patients with the development of leukopenia should be observed carefully for signs of infection, if necessary, prescribe antibiotics. Patients with neutropenia with an increase in body temperature broad-spectrum antibiotics prescribed empirically before the results of bacteriological examinations and related diagnostic tests.
In treatment of any sexual partners is recommended to use contraception.
