Capmerin

Each tablet contains Mercaptopurine 50 mg.

Mercaptopurine is indicated for treatment or maintenance therapy in acute leukemia, acute lymphoblastic leukemia, and acute myelogenous leukemia. Mercaptopurine is also used in the treatment of chronic granulocytic leukemia.

For adults and children the usual dose is 2.5 mg/kg bodyweight per day, but the dose and duration of administration depend on the nature and dosage of other cytotoxic agents given in conjunction with Mercaptopurine. The dosage should be carefully adjusted to suit the individual patient. Mercaptopurine has been used in various combination therapy schedules for acute leukemia and the literature should be consulted for details. Consideration should be given in reducing the dosage in patients with impaired hepatic or renal function. When allopurinol and mercaptopurine are administered concomitantly it is essential that only a quarter of the usual dose of mercaptopurine is given since allopurinol decreases the rate of catabolism of mercaptopurine. Maintenance schedules, the dose may vary from 1.5 to 2.5 mg/kg per day as a single dose. Or as prescribed by the physician.

The principal toxic effects on the bone marrow and hematological toxicity are likely to be more profound with chronic overdosage than with a single ingestion of Mercaptopurine. The risk of overdosage is also increased when allopurinol is being given concomitantly with Mercaptopurine. As there is no known antidote the blood picture should be closely monitored and general supportive measures, together with appropriate blood transfusion, instituted if necessary.

In view of the seriousness of the indications there are no absolute contraindications.

Mercaptopurine is an active cytotoxic agent for use only under the direction of physicians experienced in the administration of such agents.
Since Mercaptopurine is strongly myelosuppressive, full blood counts must be taken daily during remission induction. Patients must be carefully monitored during therapy.
Treatment with Mercaptopurine causes bone marrow suppression leading to leukopenia and thrombocytopenia. The leukocyte and platelet counts continue to fall after treatment is stopped, so at the first sign of an abnormally large fall in the counts, treatment should be interrupted immediately.
Bone marrow suppression is reversible if Mercaptopurine is withdrawn early enough. During remission induction in acute myelogenous leukemia the patient may frequently have to survive a period of relative bone marrow aplasia and it is important that adequate supportive facilities are available.
Mercaptopurine is hepatotoxic and liver function tests should be monitored weekly during treatment. More frequent monitoring may be advisable in those with pre-existing liver disease or receiving other potentially hepatotoxic therapy. The patient should be instructed to discontinue Mercaptopurine immediately if jaundice becomes apparent.
During remission induction when rapid cell lysis is occurring, uric acid levels in blood and urine should be monitored as hyperuricemia and/or hyperuricosuria may develop, with the risk of uric acid nephropathy.
Mercaptopurine in common with other antimetabolites is potentially mutagenic and chromosome damage has been reported in rats and man.
In view of its action on cellular deoxyribonucleic acid (DNA) 6-mercaptopurine is potentially carcinogenic and consideration should be given to the theoretical risk of carcinogenesis with this treatment.
It is advised that care should be taken when handling or dividing these tablets so as not to contaminate hands or to inspire drug.
Use in pregnancy & lactation: Mercaptopurine is embryotoxic in rats. This effect is dose dependent.
Normal offspring have been born after Mercaptopurine therapy during human pregnancy, but abortion, prematurity and malformation have been reported.
Mercaptopurine should be used during pregnancy only if the expected benefits to the mother outweigh the potential risks to the fetus.
Mothers receiving Mercaptopurine should not breast feed.

Mercaptopurine is embryotoxic in rats. This effect is dose dependent.
Normal offspring have been born after Mercaptopurine therapy during human pregnancy, but abortion, prematurity and malformation have been reported.
Mercaptopurine should be used during pregnancy only if the expected benefits to the mother outweigh the potential risks to the fetus.
Mothers receiving Mercaptopurine should not breast feed.

The main adverse effect of treatment with Mercaptopurine is bone marrow depression leading to leukopenia and thrombocytopenia. Mercaptopurine is hepatotoxic in animals and man. The incidence of hepatotoxicity can occur with any dose but more frequently when the recommended dose of 2.5 mg/kg bodyweight daily is exceeded.
The histological findings in man have shown hepatic necrosis and biliary stasis.
Anorexia, nausea, vomiting and oral ulceration may occasionally occur, and intestinal ulceration has rarely been reported.
Rare complications are drug fever and skin rash.

When allopurinol and Mercaptopurine are administered concomitantly it is essential that only a quarter of the usual dose of Mercaptopurine is given since allopurinol decreases the rate of catabolism of Mercaptopurine.
Inhibition of the anticoagulant effect of warfarin, when given with Mercaptopurine, has been reported.

Store at temperatures not exceeding 30°C.

Cytotoxic Chemotherapy

L01BB02 - mercaptopurine ; Belongs to the class of antimetabolites, purine analogues. Used in the treatment of cancer.

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