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The following safety information outlines important considerations and warnings associated with the use of mercaptopurine. It is crucial to review these details and consult with your healthcare provider if you have any questions or concerns.

• Blood Cell Count Reduction: Mercaptopurine may lead to decreased production of blood cells in the bone marrow, resulting in anemia due to low red blood cells, increased susceptibility to infections from low white blood cells, and an elevated risk of bleeding from low platelet counts. The risk of these effects is heightened when taken with allopurinol (Zyloprim), mesalamine, sulfasalazine (Azulfidine), or other medications that suppress bone marrow.

• Liver Damage: This medication can potentially harm the liver, with severe cases being fatal. Symptoms like jaundice (yellowing of the skin or eyes) can emerge within the first two months of treatment but may occur at any time. Regular blood tests are recommended to monitor liver function. Report any signs of liver issues, such as yellowing of the skin or eyes, dark urine, pale stools, appetite loss, diarrhea, or stomach bloating, to your healthcare provider. You may need to discontinue use if liver damage is suspected. The risk is greater with higher doses, other liver-affecting drugs, or a history of liver disease.

• Cancer Development: There is an increased risk of developing new cancers, including blood or skin cancers, during treatment with mercaptopurine. This risk correlates with the extent and duration of immune suppression from mercaptopurine and other similar medications. Discuss any concerns with your healthcare provider.

• Pregnancy Risks: Mercaptopurine poses a risk to an unborn baby if taken during pregnancy, with reported cases of miscarriage and stillbirth in the first trimester. Both men and women capable of conceiving should use effective contraception during treatment. Continue using birth control for three months after stopping the medication for men, and for six months for women. Inform your healthcare provider immediately if pregnancy occurs during treatment.

Please ensure all safety precautions are discussed with your healthcare provider to minimize risks while using mercaptopurine.

Common side effects:

• nausea
• vomiting
• diarrhea
• loss of appetite
• temporary hair loss
• general feeling of discomfort
• rash

Less common but important to monitor:

• mouth sores
• itchy skin or hives
• darkening of skin color
• signs of infection

Serious side effects:

• signs of liver problems (persistent nausea, vomiting, stomach pain, yellowing of the skin or eyes, dark urine)
• low blood cell counts (unusual tiredness, pale skin, frequent infections, easy bruising or bleeding)
• increased risk of certain types of cancer
• swollen lymph nodes
• night sweats
• unexplained weight changes
• severe allergic reaction (rash, swelling, dizziness, trouble breathing)

Interactions with high risk of serious adverse effects and should be avoided:

• Febuxostat
• Measles Virus Vaccine, Live
• Mumps Virus Vaccine, Live
• Rotavirus Vaccine, Live
• Rubella Virus Vaccine, Live
• Varicella Virus Vaccine, Live
• Zoster Vaccine, Live
• Azathioprine

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Adenovirus Vaccine
• Alacepril
• Allopurinol
• Bacillus of Calmette and Guerin Vaccine, Live
• Benazepril
• Black Cohosh
• Captopril
• Cholera Vaccine, Live
• Cilazapril
• Dengue Tetravalent Vaccine, Live
• Doxorubicin
• Doxorubicin Hydrochloride Liposome
• Enalaprilat
• Enalapril Maleate
• Fosinopril
• Influenza Virus Vaccine, Live
• Lisinopril
• Mesalamine
• Moexipril
• Mycophenolic Acid
• Olsalazine
• Oxypurinol
• Pentopril
• Perindopril
• Poliovirus Vaccine, Live
• Quinapril
• Ramipril
• Ribavirin
• Smallpox Vaccine
• Spirapril
• Sulfamethoxazole
• Sulfasalazine
• Trandolapril
• Trimethoprim
• Typhoid Vaccine, Live
• Warfarin
• Yellow Fever Vaccine
• Zofenopril

Interactions with low risk that usually do not require a change in therapy:

• Acenocoumarol
• Cyclosporine
• Methotrexate
• Phenprocoumon