thioguanine

Generic Name: thioguanine (thigh oh GUAH neen)Brand names: Tabloid

What is thioguanine?

Thioguanine is a cancer (antineoplastic) medication. Thioguanine interferes with the growth of cancer cells and slows their growth and spread in the body.

Thioguanine is used to treat blood cancer (acute non-lymphocytic leukemia).

Thioguanine may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about thioguanine?

Thioguanine should only be administered under the supervision of a qualified healthcare provider experienced in the use of cancer chemotherapeutic agents.

Serious side effects have been reported with the use of thioguanine including: allergic reactions (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); decreased bone marrow function and blood problems (extreme fatigue; easy bruising or bleeding; black, bloody or tarry stools; fever or chills; or sore throat); liver problems (yellowing of the skin or eyes, abdominal pain, nausea); severe nausea, vomiting, diarrhea, loss of appetite, or sores in the mouth; and others. Talk to your doctor about the possible side effects from treatment with thioguanine.

What should I discuss with my healthcare provider before taking thioguanine?

Before taking thioguanine, tell your doctor if you have

• thiopurine methyltransferase (TPMT) deficiency (an enzyme deficiency that may be detected by blood tests);

• liver problems;

• a bleeding or blood clotting disorder; or

• bone marrow problems.

You may not be able to take thioguanine, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.

Thioguanine is in the FDA pregnancy category D. This means that thioguanine is known to cause birth defects in an unborn baby. Do not take thioguanine without first talking to your doctor if you are pregnant or could become pregnant during treatment. It is unknown whether thioguanine passes into breast milk. Do not take thioguanine without first talking to your doctor if you are breast feeding a baby.

How should I take thioguanine?

Take this medication exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

Take each dose with a full glass of water.

Your doctor will determine the correct amount and frequency of treatment with thioguanine depending upon the type of cancer being treated and other factors. Talk to your doctor if you have any questions or concerns regarding the treatment schedule.

Your doctor will probably want you to have regularly scheduled blood tests and other medical evaluations during treatment with thioguanine to monitor progress and side effects.

Store thioguanine at room temperature away from moisture and heat.

See also: Thioguanine dosage in more detail

What happens if I miss a dose?

Contact your doctor if you miss a dose of thioguanine.

What happens if I overdose?

If for any reason an overdose of thioguanine is suspected, seek emergency medical attention or contact your healthcare provider immediately.

Symptoms of a thioguanine overdose tend to be similar to side effects caused by the medication, although often more severe.

What should I avoid while taking thioguanine?

Thioguanine can lower the activity of the immune system making you susceptible to infections. Avoid contact with people who have colds, the flu, or other contagious illnesses and do not receive vaccines that contain live strains of a virus (e.g., live oral polio vaccine) during treatment with thioguanine. In addition, avoid contact with individuals who have recently been vaccinated with a live vaccine. There is a chance that the virus can be passed on to you.

Thioguanine side effects

If you experience any of the following serious side effects, seek emergency medical attention or contact your doctor immediately:

• an allergic reaction (shortness of breath; closing of the throat; difficulty breathing; swelling of the lips, face, or tongue; or hives);

• abdominal pain;

• jaundice (yellowing of the skin or eyes);

• extreme fatigue;

• signs of infection such as fever; chills, or sore throat;

• unusual bleeding or bruising;

• black, bloody or tarry stools; or

• severe nausea, vomiting, or diarrhea.

Other less serious side effects may be more likely to occur. Talk to your doctor if you experience

• loss of appetite;

• mild to moderate nausea, vomiting, or diarrhea; or

• mouth sores.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.

Thioguanine Dosing Information

Usual Adult Dose for Acute Nonlymphocytic Leukemia:

Single Agent Chemotherapy: Usual Initial dose: 2 mg/kg/day orally.If, after 4 weeks on this dosage, there is no clinical improvement and no leukocyte or platelet depression, the dosage may be cautiously increased to 3 mg/kg per day. The total daily dose may be given at one time.As a part of combination therapy for induction of remission in patients with acute nonlymphocytic leukemia: 75 to 200 mg/m2/day in 1 to 2 divided doses for 5 to 7 days or until remission is attained.

Usual Geriatric Dose for Acute Nonlymphocytic Leukemia:

Single Agent Chemotherapy: Usual Initial dose: 2 mg/kg/day orally.If, after 4 weeks on this dosage, there is no clinical improvement and no leukocyte or platelet depression, the dosage may be cautiously increased to 3 mg/kg per day. The total daily dose may be given at one time.As a part of combination therapy for induction of remission in patients with acute nonlymphocytic leukemia: 75 to 200 mg/m2/day in 1 to 2 divided doses for 5 to 7 days or until remission is attained.Because clinical studies of thioguanine did not include sufficient numbers of subjects 65 years of age or over to determine whether they respond differently from younger subjects, dose selection for elderly patients should be cautious, usually starting at the low end of the dosing range.

Usual Pediatric Dose for Acute Nonlymphocytic Leukemia:

<3 years: As a part of combination drug therapy for Acute Nonlymphocytic Leukemia: 3.3 mg/kg/day in divided doses twice a day for 4 days.>1 year: As a part of combination therapy for induction of remission in patients with acute nonlymphocytic leukemia: 75 to 200 mg/m2/day in 1 to 2 divided doses for 5 to 7 days or until remission is attained.Single Agent Chemotherapy: Usual Initial dose: 2 mg/kg/day orally.If, after 4 weeks on this dosage, there is no clinical improvement and no leukocyte or platelet depression, the dosage may be cautiously increased to 3 mg/kg per day. The total daily dose may be given at one time.

What other drugs will affect thioguanine?

Do not receive "live" vaccines during treatment with thioguanine. Administration of a live vaccine may be dangerous during treatment with thioguanine.

Before taking thioguanine, talk to your doctor if you are taking any of the following medicines:

• balsalazide (Colazal);

• mesalamine (Asacol, Pentasa, Rowasa);

• olsalazine (Dipentum); or

• sulfasalazine (Azulfidine).

You may not be able to take thioguanine, or you may require a dosage adjustment or special monitoring during treatment.

Drugs other than those listed here may also interact with thioguanine. Talk to your doctor and pharmacist before taking any other prescription or over-the-counter medicines, including vitamins, minerals, and herbal products, during treatment with thioguanine.

Where can I get more information?

• Your pharmacist has additional information about thioguanine written for health professionals that you may read.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 3.02. Revision Date: 4/12/2009 4:39:43 PM.