Uses of Puri-Nethol: - Blood cancer Acute lymphatic leukaemia, Crohn's disease Pregnancy and lactation. Prior resistance to mercaptopurine or thioguanine; severe liver disease; severe bone marrow suppression.

Cytotoxic Chemotherapy

Mercaptopurine is a purine antagonist which is converted intracellularly into its active nucleotides, including thioinosinic acid. The nucleotides inhibit several reactions which ultimately interferes with nucleic acid synthesis and prevents the formation of RNA and DNA.

How to use Mercaptopurine: Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Mercaptopurine may be taken with or without food, but it is better to take it at a fixed time. Administration: Should be taken on an empty stomach. Best taken on an empty stomach 1 hr before or 2 hr after meals. Ensure adequate fluid intake. Adult Dose: Acute Lymphatic Leukemia Induction: 2.5 mg/kg PO qDay; usually 100-200 mg PO qDay in average adult (other agents preferred) May increase by 5 mg/kg/day after 4 weeks Maintenance: 1.5-2.5 mg/kg PO qDay Reduce dose by 75% if concomitant allopurinol administration Crohn's disease Adult: Initially 1-1.5 mg/kg daily, may increase to 125 mg daily. Hepatic impairment: Dosage may need to be reduced. Child Dose: Acute Lymphatic Leukemia Starting dose: 1.25-2.5 mg/kg (50-75 mg/m²) PO qDay Maintenance: 1.5-2.5 mg/kg PO qDay in combination with methotrexate Renal Dose: Renal Impairment: Dosage may need to be reduced.

Anticoagulant action of warfarin may be inhibited by mercaptopurine. Enhanced toxicity with myelosuppressive drugs. Potentially Fatal: Effects enhanced by allopurinol (reduce dose of mercaptopurine). Other hepatotoxic drugs (e.g. doxorubicin) potentiate toxicity.

Pregnancy and lactation. Prior resistance to mercaptopurine or thioguanine; severe liver disease; severe bone marrow suppression.

Common - Nausea - Vomiting - Rash - Decreased white blood cell count (neutrophils) - Intestinal ulcer - Anemia (low number of red blood cells) - Increased bilirubin in the blood - Low blood platelets - Increased transaminase level in blood - Diarrhea - Loss of appetite >10% Elevated LFT's (15%) 1-10% Nausea (10%),Vomiting (10%),Stomatitis (3-10%),Thrombocytopenia (3-10%),Rash (1-3%),Diarrhea (1-3%),Dizziness (1-3%),Alopecia (1-3%),Leukopenia (1-3%) Frequency Not Defined Fatigue,Anorexia,Headache,Chills and fever,Chest pain,Mucositis,Upper respiratory infection,Cough,Ulceration of intestine,Ulcerative stomatitis,Myelosuppressionm,Decreased hematocrit,Hepatotoxicity,Decreased resistance to infections,Hyperuricemia,Nephrotoxicity,Increased risk of pancreatitis in pts with IBD,Hyperpigmentation of skin,Arthralgias,Eye discomfort,Tinnitus Potentially Fatal: Myelosuppression; hepatotoxicity, cholestatic jaundice.

Pregnancy category D. There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).

Precaution: Hepatic or renal dysfunction; monitor hepatic function periodically. Mercaptopurine is potentially carcinogenic. Thiopurine S-methyl transferase (TPMT) deficiency; porphyria. Lactation: not known if excreted in breast milk, do not nurse

Store at 20-25° C

Cytotoxic Chemotherapy

Mercaptopurine is a purine antagonist which is converted intracellularly into its active nucleotides, including thioinosinic acid. The nucleotides inhibit several reactions which ultimately interferes with nucleic acid synthesis and prevents the formation of RNA and DNA.

Pregnancy category D. There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).