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The following safety information outlines important considerations for the use of Tabloid (thioguanine). It is essential to discuss any concerns with your healthcare provider to ensure safe and effective treatment.

• Liver Toxicity: There have been reports of serious liver issues, such as veno-occlusive disease or portal hypertension, particularly in children using Tabloid (thioguanine) for maintenance therapy in acute lymphoblastic leukemia (ALL). Due to these risks, it is not recommended for maintenance treatment. Your oncologist will conduct regular liver function tests, and treatment may be paused if liver issues are detected. Immediate consultation with your oncology team is advised if you experience symptoms like stomach pain, abdominal swelling, or yellowing of the skin or eyes.

• Reduced Blood Cell Counts: This medication often leads to decreased levels of white blood cells, red blood cells, and platelets. Such reductions can cause fatigue, increase bleeding risk, and heighten susceptibility to infections. Regular monitoring of blood cell counts is necessary, and treatment adjustments may be made if counts drop significantly.

• Genetic Conditions Impacting Drug Metabolism: Tabloid (thioguanine) is metabolized by the proteins thiopurine methyltransferase (TPMT) and nucleotide diphosphatase (NUDT15). Individuals with abnormalities in these proteins may experience prolonged drug activity and increased side effects. Genetic testing can identify these conditions, and dosage adjustments will be made accordingly.

• Risks During Pregnancy: Although not extensively studied in pregnant individuals, animal studies suggest that Tabloid (thioguanine) could harm an unborn baby or lead to miscarriage. Effective contraception is recommended during treatment. If pregnancy occurs, notify your oncologist immediately.

• Contraindications: Do not use this medication if you have cancer that is unresponsive to treatment with mercaptopurine. Consult your healthcare provider if this condition applies to you.

These points highlight critical safety measures and warnings associated with Tabloid (thioguanine). Always follow your healthcare provider's guidance and report any adverse effects promptly.

When taking Tabloid (thioguanine), it's important to be aware of potential interactions with other substances, as these can affect how the medication works and may increase the risk of side effects.

Alcohol: Consuming alcohol while on thioguanine can heighten the risk of liver damage. It's advisable to avoid or limit alcohol intake during treatment. Be alert for symptoms such as fever, chills, joint pain, unusual bleeding or bruising, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, abdominal pain, dark urine, pale stools, or yellowing of the skin or eyes, as these may indicate liver issues. If you experience any of these, contact your doctor immediately.

Other Medications: Thioguanine may interact with various drugs, potentially altering its effectiveness or increasing side effects. Notably, medications like mesalazine, olsalazine, and Sulfasalazine can inhibit the enzyme thiopurine methyltransferase (TPMT), which is involved in thioguanine metabolism. This inhibition can lead to increased thioguanine levels in the body, raising the risk of toxicity. Additionally, combining thioguanine with other drugs that affect the liver, such as Pyrazinamide, may further elevate the risk of liver damage. Always inform your healthcare provider about all medications, supplements, and herbal products you're currently using to assess potential interactions.

Vaccinations: Thioguanine can weaken your immune system, making live vaccines less effective and increasing the risk of infection. Before receiving any vaccines, including flu shots, consult your doctor to determine the safest options during your treatment.

To ensure your safety and the effectiveness of your treatment, maintain open communication with your healthcare provider about all substances you consume and any new medications you consider starting.