II. Indications

III. Mechanism

  1. Synthetic guanosine analog antimetabolite
  2. Thioguanine is phosphorylated by HGPRT (hypoxanthine-guanine phosphoribosyltransferase)
    1. Incorporated into DNA and RNA in place of guanosine
    2. Inhibits DNA and RNA synthesis
  3. Inhibits GPAT (Glutamine-5-phosphoribosylpyrophosphate amidotransferase)
    1. Inhibits Purine synthesis

IV. Medications

  1. Thioguanine 40 mg scored tablets

V. Dosing

  1. See other references for disease specific dosing protocols

VI. Adverse Effects

  1. Alopecia
  2. Hepatotoxicity
  3. Hyperuricemia
  4. Myelosuppression
  5. Thioprine-Related Toxicity (Severe)
    1. Associated with NUDT15 Gene Anomaly (Nudix Hydrolase 15 deficiency)

VII. Safety

  1. Avoid in Pregnancy (any trimester)
    1. Use reliable Contraception
  2. Avoid in Lactation
  3. Monitoring
    1. Complete Blood Count
    2. Liver Function Tests

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