Introduction
Puri-Nethol is used in the treatment of blood cancer. It shows its working by decreasing the number of red blood cells, which is produced by the body.
Puri-Nethol can be taken with or without food or you can have it one hour before or 2 hours after the meal. Your doctor will decide what dose is necessary and how often you need to take it. This will depend on what you are being treated for and may change from time to time. You should take it exactly as your doctor has advised. Taking it in the wrong way or taking too much can cause very serious side effects. It may take several weeks or months for you to see or feel the benefits but do not stop taking it unless your doctor tells you to.
The most common side effects of this medicine include nausea, vomiting, rash, diarrhea, and loss of appetite. This medicine may reduce the number of blood cells (decrease red blood and white blood cells) in your blood, thereby, increasing the susceptibility to infections. Regular blood tests are required to check your blood cells along with heart, liver, and blood uric acid levels. You have to avoid driving or attention seeking activity if you experience dizziness while taking this medicine.
Before taking it, tell your doctor if you have heart disease, liver, or kidney problems or are taking any medicines to treat infections. Many other medicines can affect, or be affected by, this medicine so let your doctor know all medications you are using. This medicine is not recommended during pregnancy or while breastfeeding. The use of effective contraception by both males and females during treatment is important to avoid pregnancy.
Side effects of Puri-Nethol
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
How to use Puri-Nethol
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. Puri-Nethol may be taken with or without food, but it is better to take it at a fixed time.
How Puri-Nethol works
Puri-Nethol interferes with the growth of DNA and RNA of the cancer cells by substituting their building blocks. It prevents the cancer cells from growing and multiplying.
Indication
Acute lymphatic leukaemia, Crohn's disease
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.
Contraindication
Pregnancy and lactation. Prior resistance to mercaptopurine or thioguanine; severe liver disease; severe bone marrow suppression.
Mode of Action
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.
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
Side Effect
>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.
Interaction
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.