Tabloid
Tabloid (thioguanine) is a chemotherapy medication. It’s FDA-approved to treat acute nonlymphocytic leukemia, such as acute myeloid leukemia (AML). But Tabloid (thioguanine) isn't a recommended option in current guidelines, likely because there are other medications that work better and are less likely to cause serious side effects. Tabloid (thioguanine) is a tablet that's taken by mouth once daily. Some side effects of this medication include lower blood cell count (myelosuppression) and serious liver problems.
What is Tabloid (thioguanine)?
What is Tabloid (thioguanine) used for?
Acute nonlymphocytic leukemia (including acute myeloid leukemia, or AML) during induction and consolidation treatment phases
How Tabloid (thioguanine) works
Tabloid (thioguanine) is an antimetabolite known as a purine analog. A purine is one of the building blocks of genetic material called deoxyribonucleic acid (DNA).
Tabloid (thioguanine) works by acting like a purine. It goes into cancer cells and sneaks into their DNA. Once there, Tabloid (thioguanine) prevents the cancer cells from making copies of themselves, which can lead to cell death. As a result, the cancer cells can’t grow or spread as well.
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What are the side effects of Tabloid (thioguanine)?
Common Side Effects
- Lower blood cell counts
- High uric acid
- Nausea
- Vomiting
- Lower appetite
- Mouth sores
Serious Side Effects
- Serious infections: temperature of 100.4 degrees Fahrenheit, with or without other symptoms, such as chills, cough, muscle aches, very fast heartbeat, confusion
- Serious bleeds: severe tiredness, bruising that won't go away or bleeding that's difficult to stop
- Serious liver problems: nausea, vomiting, tiredness, stomach pain or swelling, pale-colored stool, dark-colored urine, yellowing of the whites of the eyes or skin
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
blood in the urine or stools
chills
hoarseness
joint pain, stiffness, or swelling
lower back, side, or stomach pain
painful or difficult urination
pinpoint red spots on the skin
swelling of the feet or lower legs
unusual bleeding or bruising
Incidence not known
Bloody, black, or tarry stools
decrease in the amount of urine
indigestion
noisy, rattling breathing
right upper abdominal pain and fullness
severe stomach pain, cramping, or burning
stomach bloating
swelling of the fingers or hands
trouble breathing
troubled breathing at rest
vomiting of material that looks like coffee grounds, severe and continuing
yellow eyes or skin
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Blurred vision
cloudy urine
confusion
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
general feeling of discomfort or illness
increased sweating
unusual tiredness or weakness
vomiting
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:
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 of Tabloid (thioguanine)
Pros
Taken by mouth, so good for people who don’t like needles
Taken once daily
Cons
Can raise your risk of serious infections
Brand name only
Pharmacist tips for Tabloid (thioguanine)
Taking Tabloid (thioguanine) can raise your risk of getting a serious infection because this medication can lower white blood cell (WBC) counts as a side effect. During treatment, you can help prevent infections by washing your hands often, avoiding crowds, and washing raw fruits and vegetables thoroughly before eating them.
Check your body temperature regularly while you're taking Tabloid (thioguanine), ideally once a day. Call your oncologist immediately if your temperature is 100.4 degrees Fahrenheit or higher because this means you have a fever. Sometimes, a fever might be the only sign that you’re sick.
Tabloid (thioguanine) can raise your risk of serious bleeds because this medication can cause your platelet level to drop. If appropriate, your oncologist might recommend you avoid taking other medications that can raise your risk of bleeding, such as aspirin or ibuprofen (Advil). You might also avoid shaving with a blade razor, and use an electric razor instead.
Tabloid (thioguanine) sometimes causes nausea and vomiting. Your oncologist will prescribe antiemetics, like ondansetron (Zofran) or prochlorperazine (Compazine), for you to take at home (if they haven’t already). If the nausea or vomiting becomes too bothersome, contact your oncology care team.
Females who are taking Tabloid (thioguanine)] should avoid breastfeeding during treatment. It's unclear whether Tabloid (thioguanine)] can get into breast milk and whether it affects breastfed babies, but there’s a possible risk of harm if it does.
Ask your oncologist about the best way to handle and store Tabloid (thioguanine) safely. Anticancer medications can be harmful to people who handle or come in contact with them. Store Tabloid (thioguanine) in a safe place away from children and pets.
If you have leftover medication, ask your oncologist how to dispose of it. They might allow you or a family member to bring it to their office or clinic for proper disposal.
Frequently asked questions about Tabloid (thioguanine)
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What are the risks and warnings for Tabloid (thioguanine)?
Tabloid (thioguanine) 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.
Liver toxicity
Some people taking Tabloid (thioguanine) have developed serious liver problems such as veno-occlusive disease or portal hypertension. Liver problems were more commonly reported in children taking Tabloid (thioguanine) as maintenance therapy for acute lymphoblastic leukemia (ALL). Because of this risk, Tabloid (thioguanine) isn’t recommended to be used as maintenance treatment. Your oncologist will monitor your liver health with lab tests. If results suggest liver problems, they might ask you to pause treatment while they look into it. Contact your oncology team right away if you have stomach pain, a swollen stomach, or yellowish eyes or skin.
Lower blood cell counts
Tabloid (thioguanine) commonly causes low blood cell counts, including white blood cells (WBCs), red blood cells (RBCs), and platelets. This can lead to problems like feeling more tired (from low RBCs) and higher risk for bleeding (from low platelets). It can also raise your risk for serious and life-threatening infections (from low WBCs). Your oncologist will check your blood cell counts often during treatment. If your counts are too low, your oncologist might make adjustments to your treatment to give your body time to make new blood cells.
To lower your risk of getting sick, it’s important to wash your hands often and avoid crowds. Also, check your temperature regularly, and call your oncologist right away if your temperature is 100.4 degrees Fahrenheit or higher. In addition, let your oncology team know right away if you notice bruises that won’t go away or bleeding that’s difficult to stop; these might be signs that your platelet level is too low.
Serious risk for people with a specific genetic condition
Tabloid (thioguanine) is broken down by two specific proteins: theopurine methyltransferase (TPMT) and nucleotide diphosphatase (NUDT15). Though uncommon, some people have abnormalities in one of these proteins. If these proteins don’t work correctly, they might not break down Tabloid (thioguanine) like they’re supposed to, which means Tabloid (thioguanine) stays active in your body for longer. This can lead to worse side effects. Because of this, if you have an abnormality in one of these proteins, your oncologist will lower your dose of Tabloid (thioguanine). Before you start treatment, they can check if you have either of these conditions with a lab test.
Harm to unborn baby
- Risk factors: Pregnancy
Tabloid (thioguanine) hasn’t been well-studied in pregnancy. But based on animal studies and the way Tabloid (thioguanine) works, it’ll likely cause harm to an unborn baby or pregnancy loss (miscarriage). If you’re able to have babies, you should use birth control while taking Tabloid (thioguanine). If you become pregnant while taking Tabloid (thioguanine), contact your oncologist right away.
Tabloid (thioguanine) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 40mg | 25 tablets | $13306.98 | $532.28 |
Typical dosing for Tabloid (thioguanine)
Your oncologist will determine your dose of Tabloid (thioguanine) based on what other anticancer medications you’re taking and your body surface area (BSA), which takes into account your height and weight.
An example of Tabloid (thioguanine) dose is 40 mg/m2 by mouth once daily for 3 weeks during induction treatment for AML.
Your oncology care team will let you know how long you need to take Tabloid (thioguanine).
Interactions between Tabloid (thioguanine) and other drugs
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.
How much does Tabloid (thioguanine) cost?
Tabloid (thioguanine) contraindications
Cancer that doesn’t respond to treatment with mercaptopurine
What are alternatives to Tabloid (thioguanine)?
Acute nonlymphocytic leukemia (including acute myeloid leukemia, or AML) during induction and consolidation treatment phases
Tabloid (thioguanine) images
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References
Best studies we foundAmerican Cancer Society. (2018). What is acute myeloid leukemia?
American Cancer Society. (2019). Chemotherapy safety.
American Cancer Society. (2024). Anemia (low red blood cell counts).
American Cancer Society. (2024). Chemotherapy for acute myeloid leukemia (AML).
American Cancer Society. (2024). Fevers.
American Cancer Society. (2024). Neutropenia (low white blood cell counts).
American Cancer Society. (2024). Thrombocytopenia (low platelet count).
Arthur, C. K., et al. (2018). Treatment of elderly and unfit AML patients with prolonged administration of low dose cytarabine and thioguanine achieves high complete remission rates in an outpatient setting. Blood.
Centers for Disease Control and Prevention. (n.d.). What you need to know: Neutropenia and risk for infection.
Crawford, J., et al. (2024). The impact of myelosuppression on quality of life of patients treated with chemotherapy. Future Oncology.
Dean, L., et al. (2020). Thioguanin therapy and TPMT and NUDT15 genotype. Medical Genetics Summaries.
Gupta, A., et al. (2018). Tumor lysis syndrome. Journal of the American Medical Association Oncology.
Howard, S. C., et al. (2011). The tumor lysis syndrome. The New England Journal of Medicine.
Leukemia & Lymphoma Society. (n.d.). Chemotherapy and drug therapy: AML.
LiverTox. (2014). Purine analogues. National Institute of Diabetes and Digestive and Kidney Diseases.
MedlinePlus. (2023). Uric acid - blood.
National Cancer Institute. (n.d.). Acute nonlymphocytic leukemia.
National Cancer Institute. (n.d.). Antimetabolite.
National Cancer Institute. (n.d.). Purine.
National Comprehensive Cancer Network. (2024). Acute myeloid leukemia.
Oliver, T. I., et al. (2023). Portal hypertension. StatPearls.
Senzolo, M., et al. (2007). Veno occlusive disease: Update on clinical management. World Journal of Gastroenterology.
Waylis Therapeutics LLC. (2023). Tabloid- thioguanine tablet [package insert]. DailyMed.
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