Mercaptopurine with Doxorubicin Interaction Details
Brand Names Associated with Mercaptopurine
- 6-MP
- Mercaptopurine
- Purinethol®
- Purixan®
Brand Names Associated with Doxorubicin
- Adriamycin®
- Doxorubicin
- Hydroxydaunomycin Hydrochloride
- Hydroxydoxorubicin Hydrochloride
- Rubex®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 29, 2023
Interaction Effect
An increased risk of hepatotoxicity
Interaction Summary
Hepatic dysfunction developed in all 11 patients with refractory leukemia who received DOXOrubicin hydrochloride and 6-mercaptopurine concurrently (with and without vincristine and prednisone). Due to this increased risk of mercaptopurine-induced hepatotoxicity, caution should be exercised if DOXOrubicin is coadministered with mercaptopurine. Although no formal drug interaction studies have been done with DOXOrubicin hydrochloride liposome injection, it may interact with drugs known to interact with the conventional formulation of DOXOrubicin .
Severity
Major
Onset
Unspecified
Evidence
Established
How To Manage Interaction
Use caution when prescribing DOXOrubicin to patients who take mercaptopurine. Concomitant use may increase the risk of mercaptopurine-induced hepatotoxicity.
Mechanism Of Interaction
Unknown
Literature Reports
A) Concurrent administration of DOXOrubicin and 6-mercaptopurine led to hepatoxicity, manifested by elevated total serum bilirubin, alkaline phosphatase, and AST, in all patients tested. Intravenous DOXOrubicin hydrochloride 50 mg/m(2) every 2 to 3 weeks per cycle was coadministered with 6-mercaptopurine 500 mg/m(2) IV daily for 5 days per cycle every 2 to 3 weeks, with and without vincristine and prednisone, in 11 patients with refractory leukemia .
Mercaptopurine Overview
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Mercaptopurine is used alone or with other chemotherapy drugs to treat acute lymphocytic leukemia (ALL; also called acute lymphoblastic leukemia and acute lymphatic leukemia; a type of cancer that begins in the white blood cells). Mercaptopurine is in a class of medications called purine antagonists. It works by stopping the growth of cancer cells.
Doxorubicin Overview
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Doxorubicin is used in combination with other medications to treat certain types of bladder, breast, lung, stomach, and ovarian cancer; Hodgkin's lymphoma (Hodgkin's disease) and non-Hodgkin's lymphoma (cancer that begins in the cells of the immune system); and certain types of leukemia (cancer of the white blood cells), including acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML, ANLL). Doxorubicin is also used alone and in combination with other medications to treat certain types of thyroid cancer and certain types of soft tissue or bone sarcomas (cancer that forms in muscles and bones). It is also used to treat neuroblastoma (a cancer that begins in nerve cells and occurs mainly in children) and Wilms' tumor (a type of kidney cancer that occurs in children). Doxorubicin is in a class of medications called anthracyclines. It works by slowing or stopping the growth of cancer cells in your body.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.