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Tabloid

thioguanine
Used for Leukemia
Used for Leukemia

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.

Last reviewed on July 28, 2024
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What is Tabloid (thioguanine)?

What is Tabloid (thioguanine) used for?

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.

Drug Facts

Common BrandsTabloid
Drug ClassAntimetabolite
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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What are the side effects of Tabloid (thioguanine)?

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

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • 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

cough

fever

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

heartburn

indigestion

nausea

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

weight gain

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

dry mouth

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:

Less common

Loss of appetite

swelling or inflammation of the mouth

weight loss

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 Tabloid (thioguanine)

thumbs-up

Pros

Taken by mouth, so good for people who don’t like needles

Taken once daily

thumbs-down

Cons

Can raise your risk of serious infections

Brand name only

pharmacist-tips

Pharmacist tips for Tabloid (thioguanine)

pharmacist
  • 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) 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.

              faqs

              Frequently asked questions about Tabloid (thioguanine)

              Is Tabloid (thioguanine) still used to treat cancer?
              Tabloid (thioguanine) is approved to treat acute nonlymphocytic leukemia, such as acute myeloid leukemia (AML). But in general, it’s no longer a recommended treatment option in current guidelines. This is likely because there are other medications that are safer or work better at treating AML. But your oncologist might consider Tabloid (thioguanine) as an option depending on different factors, such as how your cancer is doing and what other anticancer medications you're able to take. If you have questions about taking Tabloid (thioguanine), talk to your oncology care team.
              What’s the most common side effect of Tabloid (thioguanine)?
              The most common side effect of Tabloid (thioguanine) is lower blood cell counts, including lower white blood cells (WBC), red blood cells (RBC), and platelets. Having lower blood cell counts can lead to more serious problems, such as serious infections, anemia, and bleeding that’s difficult to stop. Because of these risks, your oncologist order blood draws regularly while you’re taking Tabloid (thioguanine) to see if your blood cell counts are within a safe range. If needed, they’ll lower your dose of Tabloid (thioguanine) or ask you to stop treatment. If you have any unexpected bruising, bleeding, or you feel very tired, contact your oncologist, since these can be signs of low blood cell counts.
              Can Tabloid (thioguanine) cause tumor lysis syndrome (TLS)?
              Yes, Tabloid (thioguanine) can cause a rare, but serious side effect called tumor lysis syndrome (TLS). This is a complication that occurs when cancer cells are destroyed and release what was inside them into the bloodstream. TLS can be dangerous because it can lead to high levels of potassium and uric acid in the blood, which can cause problems with your heart and kidneys. TLS is most common in certain cancers such as lymphoma and leukemia. Your oncologist will monitor you closely through blood tests, especially at the beginning of treatment. Let your oncology care team know right away if you have symptoms of TLS, such as muscle cramps, nausea, or numbness.
              What are TPMT and NUDT15 and what do they have to do with Tabloid (thioguanine)?
              After attacking cancer cells in your body, Tabloid (thioguanine) is broken down by two proteins: theopurine methyltransferase (TPMT) and nucleotide diphosphatase (NUDT15). Though not common, some people have conditions where one of these proteins don't work well. This means their body can't break down Tabloid (thioguanine) properly, which puts them at higher risk for serious side effects related to Tabloid (thioguanine), such as infections. Before you start Tabloid (thioguanine), your oncologist might order a lab test to see if your TMPT and NUDT15 proteins are working properly. If not, they'll likely recommend that you take a lower dose of Tabloid (thioguanine) to lower the risk of side effects.
              Is Tabloid (thioguanine) safe to take in pregnancy?
              Tabloid (thioguanine) hasn’t been studied in human pregnancy, but based on animal studies and the way the medication works, it might cause harm to an unborn baby. If you’re able to become pregnant, your oncologist will likely recommend that you take birth control while taking Tabloid (thioguanine). If you become pregnant while taking Tabloid (thioguanine), contact your oncologist right away.
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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.

              risk-warning

              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.

              risk-warning

              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.

              risk-warning

              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.

              risk-warning

              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.

              dosage

              Tabloid (thioguanine) dosage forms

              The average cost for 25 tablets of 40mg of Tabloid (thioguanine) is $13306.98 with a free GoodRx coupon. This is 18.49% off the average retail price of $16325.64.
              tablet
              Tablet
              DosageQuantityPrice as low asPrice per unit
              40mg25 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

              Interactions between Tabloid (thioguanine) and other drugs

              Tabloid (thioguanine) 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 Tabloid (thioguanine). Please note that only the generic name of each medication is listed below.

              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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              How much does Tabloid (thioguanine) cost?

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              contraindications-icon

              Tabloid (thioguanine) contraindications

              Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Tabloid (thioguanine) will not be safe for you to take.
              alternatives

              What are alternatives to Tabloid (thioguanine)?

              There are a number of medications that your doctor can prescribe in place of Tabloid (thioguanine). Compare a few possible alternatives below.
              Tabloid (thioguanine)
              Used for:
              $13306.98 Lowest GoodRx priceView Prices
              Used for:
              • Acute lymphoblastic leukemia (ALL)

              $63.66 Lowest GoodRx priceView Prices
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              Tabloid (thioguanine) images

              White Round T40 - Tabloid 40mg Tablet
              This medicine is White, Round, Scored Tablet Imprinted With "T40".White Round T40 - Tabloid 40mg Tablet

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              References

              Best studies we found

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

              American Cancer Society. (2019). Chemotherapy safety.

              American Cancer Society. (2024). Anemia (low red blood cell counts).

              View All References (20)

              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.

              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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