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Mercaptopurine Coupon - Mercaptopurine 50mg tablet

mercaptopurine

Generic Purinethol
Used for Leukemia
Used for Leukemia

Mercaptopurine (also known as 6-mercaptopurine or 6-MP) is used for acute lymphoblastic leukemia (ALL). It’s typically taken together with other anticancer medications. Mercaptopurine is also commonly used off-label for certain gut problems (Crohn’s disease and ulcerative colitis). This medication is taken by mouth as a tablet or an oral suspension. While the tablet is only available as a generic, the oral liquid is only available under the brand name Purixan. Mercaptopurine has unpleasant side effects, like low appetite, stomach upset, and feeling unwell.

Reviewed by:
reviewer
Cydnee Ng, PharmD
reviewer
Sonja Jacobsen, PharmD, BCPS, BCOP
Last reviewed on June 12, 2023
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsCostAlternativesLatest newsImagesReferencesPricesMedicare
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What is Mercaptopurine?

What is Mercaptopurine used for?

  • Acute lymphoblastic leukemia (ALL)

How Mercaptopurine works

Mercaptopurine is a type of antimetabolite medication called a nucleoside metabolic inhibitor. It stops cancer cells from being able to make their own genetic material. This kills cancer cells and stops cancer growth.

Drug Facts

Common BrandsPurixan
Drug ClassNucleoside metabolic inhibitor
Controlled Substance ClassificationNot a controlled medication
Generic StatusLower-cost generic available
AvailabilityPrescription only
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$157.50(save 59.64%)
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$63.57
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What are the side effects of Mercaptopurine?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Other Side Effects

  • Mouth sores
  • Itchy skin or hives
  • Darkening of skin color
  • Infection

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Low blood cell counts: fever, sore throat, frequent infections, unusual bleeding or bruising, pale skin, tiredness
  • Liver problems: yellowing of the skin or eyes, dark urine, pale stools, loss of appetite, stomach bloating

Source: DailyMed

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Black, tarry stools

bleeding gums

clay colored stools

cough or hoarseness

dark urine

decreased appetite

fever or chills

headache

loss of appetite

lower back or side pain

nausea, vomiting

painful or difficult urination

pale skin

pinpoint red spots on the skin

rash, itchy skin

stomach pain or tenderness

swelling of the feet or lower legs

trouble with breathing upon exertion

unusual bleeding or bruising

unusual tiredness or weakness

yellow eyes or skin

Less common

Chest pain

joint pain

sore throat

sores, ulcers, or white spots on the lips or in the mouth

swollen glands

Incidence not known

Anxiety

blurred vision

cold sweats

coma

confusion

constipation

depression

diarrhea

dizziness

fast heartbeat

heartburn

increased hunger

increased sensitivity of the skin to sunlight

indigestion

joint pain, stiffness, or swelling

nervousness

nightmares

redness or other discoloration of the skin

seizures

severe sunburn

shakiness

slurred speech

stomach cramping or burning

vomiting of blood or material that looks like coffee grounds

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

Darkening of the skin

Incidence not known

Hair loss or thinning of the hair

low sperm count

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of Mercaptopurine

thumbs-up

Pros

Taken by mouth once a day

Can use in children

Available as tablets, as well as an oral liquid for people who have trouble swallowing pills

thumbs-down

Cons

Has a lot of side effects, such as low blood cell counts and stomach upset

Raises risk of infection

Requires regular blood tests during treatment to check for side effects and safety

pharmacist-tips

Pharmacist tips for Mercaptopurine

pharmacist

  • Take mercaptopurine at the same time each day, with or without food. Make sure you're consistent — either choose to always take it on an empty stomach or with a meal. Food can change how much mercaptopurine gets absorbed into your body.

    • Wear protective clothing and sunscreen to protect your skin from the sun. Mercaptopurine can make your skin more sensitive to the sun, which can raise your risk for getting sunburns more easily.

      • Be sure to wash your hands well with soap and warm water often and try to stay away from people who are ill. Mercaptopurine can weaken your immune system, which can raise your risk of infections.

        • Before getting any vaccines, let your provider know that you’re taking mercaptopurine. This medication can weaken the immune system, which can affect how well vaccines work or affect how safe certain vaccines are for you. Your provider can make sure the vaccines you’re planning to get are appropriate for you.

          • If you or your partner is able to become pregnant, use birth control while you’re taking mercaptopurine. Continue to use birth control for 3 months (for men) or for 6 months (for women) after you stop the medication. can cause harm to an unborn baby. Let your provider know if you or your partner becomes pregnant during treatment.

            • Ask your provider or pharmacist about how handle and throw away any leftover mercaptopurine safely. This medication can be harmful to others. Don’t place it in your household trash or pour it down the sink.

              Tips for the mercaptopurine oral liquid (Purixan)

              • Follow your provider's directions to measure and take your dose. You can also watch the instructional video to review how to use Purixan. Ask your provider or pharmacist if you're not sure how to take the oral liquid.

                • Shake the bottle for at least 30 seconds before each use to make sure it's mixed well. Then, use the provided press-in bottle adapter and oral syringes to measure and take mercaptopurine. Don't use household measuring or kitchen spoons since they might not be accurate and cause you to take the wrong amount of medication.

                  • After taking your mercaptopurine dose, drink some water to make sure you've swallowed all of the medication in your mouth.

                    • Keep Purixan at room temperature. It’s good to use for 8 weeks. Throw away any leftover medication after 8 weeks.

                      faqs

                      Frequently asked questions about Mercaptopurine

                      Does mercaptopurine cause hair loss?
                      In clinical studies, some people taking mercaptopurine reported experiencing hair loss. Hair loss appeared to happen later during treatment. If you notice hair loss while you’re taking mercaptopurine, talk to your provider. They can discuss how to manage hair loss. There might also be other causes for your hair loss that your provider can check for.
                      Is mercaptopurine chemotherapy?
                      Yes, mercaptopurine is a type of chemotherapy medication. It works in cancer cells to disrupt how they make their own genetic material. This kills the cancer cells, which helps stop cancer growth.
                      Is mercaptopurine an immunosuppressant?
                      Yes, mercaptopurine can lower the number of white blood cells you have, which can weaken your immune system. As a result, you’re at risk for infections, and your body might have a harder time fighting off infections. The best way to prevent infections is to wash your hands with soap and water often. Try to avoid crowded places or being around people who are ill. Tell your provider if you have a fever, chills, or if you’re getting sick often while you’re taking mercaptopurine.
                      Can mercaptopurine be used for Crohn's disease?
                      Although it isn’t FDA approved for this purpose, mercaptopurine can be used off-label for Crohn’s disease. The American College of Gastroenterology (ACG) guidelines recommend mercaptopurine as an option to treat moderate-to-severe Crohn's disease and prevent flare-ups. Crohn’s disease is an autoimmune condition where your immune system attacks your own gut and causes gut inflammation. Mercaptopurine weakens the immune system, which helps lower gut inflammation. This medication helps lower the amount of corticosteroids (e.g., prednisone) you need to take for flare-ups that might occur. This helps you avoid unpleasant side effects of steroids. Keep in mind that taking mercaptopurine for Crohn's disease can raise your risk for a serious inflammatory condition that causes fever that doesn't go away, low energy, and headaches. If you have Crohn's disease, ask your provider whether mercaptopurine is right for you.
                      Can mercaptopurine be used for ulcerative colitis?
                      While it isn’t FDA approved for this purpose, mercaptopurine can be used off-label for ulcerative colitis (UC). The American College of Gastroenterology (ACG) guidelines say that people with moderate-to-severe UC whose symptoms have gone away with steroid use (“in remission”) can take mercaptopurine to manage their condition and prevent flare-ups. Ulcerative colitis (UC) is an autoimmune condition where your immune system attacks your large intestine and causes gut inflammation. Mercaptopurine weakens the immune system, which helps lower gut inflammation. It’s important to note that taking mercaptopurine for UC can put you at higher risk for a serious inflammatory condition that causes fever that doesn't go away, low energy, and headaches. If you have UC, ask your provider whether mercaptopurine is right for you.
                      What should I do if I miss a dose of mercaptopurine?
                      If you've forgotten to take a dose of mercaptopurine, skip your missed dose. Wait to take the medication at your next regularly scheduled time.
                      Can taking mercaptopurine affect my ability to have children?
                      Based on animal studies, it’s possible for mercaptopurine to cause problems for you to have children in the future. Talk with your provider if you have questions or concerns about how this medication will affect your plans to have children. They can discuss options, like egg freezing or sperm banking, with you.
                      Can I breastfeed while I’m taking mercaptopurine?
                      There's not enough information to know for sure whether it’s safe to breastfeed while you’re taking the medication. But because of the potential for serious harm to your breastfed baby, don't breastfeed during treatment and for 1 week after you stop the medication. Speak with your provider about safe ways to feed your baby.
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                      What are the risks and warnings for Mercaptopurine?

                      Mercaptopurine can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

                      risk-warning

                      Low blood cell counts

                      • Risk factors: Taking allopurinol (Zyloprim), mesalamine, or sulfasalazine (Azulfidine) | Taking other medications that suppress the bone marrow

                        Mercaptopurine causes your bone marrow to make fewer blood cells (bone marrow suppression). As a result, your red blood cell count can drop, leading to anemia. Your white blood cell count can also fall, which raises your risk of infection and affects how well your body can fight them off. In addition, your platelet count can get too low and put you at risk of bleeding. Your risk of these effects might be higher if you also take allopurinol (Zyloprim), mesalamine, or other medications that also suppress the bone marrow.

                        Your provider will check your blood cell counts through blood tests during treatment with mercaptopurine. If your blood cell counts become too low, they might lower your dose. Let your provider know if you feel very tired, get sick often, or have unusual bleeding or bruising while you’re taking mercaptopurine. These can be signs that your blood cell counts are too low.

                        risk-warning

                        Liver problems

                        • Risk factors: Taking higher than recommended doses of mercaptopurine | Taking other medications that can cause liver problems | History of liver disease

                          Mercaptopurine can damage your liver, which can be fatal in severe cases. One symptom of liver damage, yellowing of the skin or eyes (jaundice), usually happens within the first 2 months of starting the medication. But, it can also happen at any time while you’re taking mercaptopurine. Make sure you get your blood drawn regularly during treatment so your provider can check your liver health. Report any symptoms of liver problems, such as yellowing of the skin or eyes, dark urine, pale stools, loss of appetite, diarrhea, and stomach bloating. You might need to stop taking mercaptopurine.

                          risk-warning

                          Development of new cancers during treatment

                          • Risk factors: Taking multiple medications that can weaken the immune system

                            There’s a higher risk that you might develop new cancers while you’re taking mercaptopurine. These new cancers might include other blood cancers or skin cancers. It appears that this risk is related to how much and for how long your immune system has been weakened by mercaptopurine and your other immune-suppressing medications. Speak with your provider if you’re concerned about this risk with mercaptopurine treatment.

                            risk-warning

                            Harm to unborn baby

                            Mercaptopurine can cause harm to the unborn baby when it’s taken during pregnancy. Some women who’ve taken the medication during the first trimester of pregnancy have reported miscarriage (pregnancy loss) and stillbirth. Because of this risk, both men and women who can have children should use birth control during treatment with mercaptopurine. After you stop the medication, continue to use birth control for 3 more months (for men) or 6 more months (for women). Let your provider know if you or your partner becomes pregnant while you’re taking mercaptopurine.

                            dosage

                            Mercaptopurine dosage forms

                            The average cost for 90 tablets of 50mg of Mercaptopurine is $63.57 with a free GoodRx coupon. This is 59.64% off the average retail price of $157.50.
                            tablet
                            Tablet
                            DosageQuantityPrice as low asPrice per unit
                            50mg90 tablets$63.57$0.71

                            Typical dosing for Mercaptopurine

                            This medication is available as generic tablets and a brand-name oral liquid called Purixan.

                            The starting dose is based on your body weight, so your provider will help determine the right dose for you. The recommended starting dose is 1.5 mg/kg to 2.5 mg/kg of weight by mouth once a day.

                            Your dose might differ if you have side effects (e.g., severely low blood cell counts) or if you take allopurinol (Zyloprim).

                            interactions

                            Interactions between Mercaptopurine and other drugs

                            Mercaptopurine may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Mercaptopurine. Please note that only the generic name of each medication is listed below.

                            Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

                            Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

                            Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

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                            alternatives

                            What are alternatives to Mercaptopurine?

                            There are a number of medications that your doctor can prescribe in place of Mercaptopurine. Compare a few possible alternatives below.
                            Mercaptopurine
                            Used for:

                            • Acute lymphoblastic leukemia (ALL)

                            $63.57 Lowest GoodRx priceView Prices
                            Methotrexate
                            Used for:
                            $13.20 Lowest GoodRx priceView Prices
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                            References

                            Best studies we found

                            American Cancer Society. (2018). What is acute lymphocytic leukemia (ALL)?

                            American Cancer Society. (2019). Chemotherapy safety.

                            American Cancer Society. (2019). How chemotherapy drugs work.

                            View All References (18)

                            American Cancer Society. (2020). Low platelet count (bleeding).

                            American Cancer Society. (2020). Preserving fertility in males with cancer.

                            American Cancer Society. (2023). Low red blood cell counts (anemia).

                            American Cancer Society. (2023). Low white blood cell counts (neutropenia).

                            Centers for Disease Control and Prevention. (n.d.). What you need to know: Neutropenia and risk for infection.

                            Grennan, D., et al. (2019). Steroid side effects. Journal of the American Medical Association.

                            Harmand, P. O., et al. (2020). Thiopurine drugs in the treatment of ulcerative colitis: Identification of a novel deleterious mutation in TPMT. Genes.

                            Lerkvaleekul, B., et al. (2018). Macrophage activation syndrome: Early diagnosis is key. Open Access Rheumatology: Research and Reviews.

                            Lichtenstein, G. R., et al. (2018). ACG clinical guideline: Management of Crohn's disease in adults. The American Journal of Gastroenterology.

                            MedlinePlus. (2022). Oral mucositis — self-care.

                            Mylan Pharmaceuticals Inc. (2022). Mercaptopurine tablet [package insert]. DailyMed.

                            National Cancer Institute. (n.d.). Myelosuppression.

                            National Cancer Institute. (n.d.). Second primary cancer.

                            Neurath, M. (2010). Thiopurines in IBD: What is their mechanism of action? Gastroenterology & Hepatology.

                            Nova Laboratories, Ltd. (2022). Purixan suspension [package insert]. DailyMed.

                            Rare Disease Therapeutics, Inc. (n.d.). Video: How to use Purixan.

                            Rubin, D. T., et al. (2019). ACG clinical guideline: Ulcerative colitis in adults. The American Journal of Gastroenterology.

                            Wu, H. L., et al. (2022). Targeting nucleotide metabolism: A promising approach to enhance cancer immunotherapy. Journal of Hematology & Oncology.

                            GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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