Indications And Dose
Acute leukaemia | Chronic myeloid leukaemia ▶BY MOUTH ▶Adult: 100–200 mg/m2 daily, can be given at various stages of treatment in short-term cycles
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Drug reference
Acute leukaemia | Chronic myeloid leukaemia ▶BY MOUTH ▶Adult: 100–200 mg/m2 daily, can be given at various stages of treatment in short-term cycles
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Absent thiopurine methyltransferase activity
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Thiopurine methyltransferase status CAUTIONS, FURTHER INFORMATION ▶Thiopurine methyltransferase The enzyme thiopurine methyltransferase (TPMT) metabolises thiopurine drugs (azathioprine, mercaptopurine, tioguanine); the risk of myelosuppression is increased in patients with reduced activity of the enzyme, particularly for the few individuals in whom TPMT activity is undetectable. Patients with absent TPMT activity should not receive thiopurine drugs; those with reduced TPMT activity may be treated under specialist supervision. ▶Long-term therapy Long-term therapy is no longer recommended because of the high risk of liver toxicity.
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Consider measuring thiopurine methyltransferase (TPMT) activity before starting tioguanine therapy.
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RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES See Cytotoxic drugs p. 938.
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→Appendix 1: tioguanine
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▶Common or very common Bone marrow failure. gastrointestinal disorders. hepatic disorders. hyperbilirubinaemia. hyperuricaemia. hyperuricosuria. nodular regenerative hyperplasia. oesophageal varices. sinusoidal obstruction syndrome. splenomegaly. stomatitis. thrombocytopenia. uric acid nephropathy. weight increased ▶Frequency not known Photosensitivity reaction
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Ensure effective contraception during treatment in men or women.
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Avoid (teratogenicity reported when men receiving tioguanine have fathered children). See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.
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Discontinue breast-feeding.
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Manufacturer advises caution. Dose adjustments Manufacturer advises consider dose reduction.
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Dose adjustments Reduce dose.
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Monitor liver function weekly—discontinue if liver toxicity develops.
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: capsule Tablet ▶Tioguanine (Non-proprietary) Tioguanine 40 mg Tioguanine 40mg tablets | 25 tablet P £109.57 DT = £109.57
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100–200 mg/m2 daily, can be given at various
First-line fragment. Read the complete Indications and Dose section above.
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