Mercaptopurine (MP) is a drug used to treat leukemia, especially acute lymphocytic leukemia and acute myeloid leukemia. This drug belongs to a class of substances called anti-metabolites, as these substances block the building blocks of cancerous cells, preventing their development.
Mercaptopurine is also used to treat autoimmune diseases such as Crohn's disease, ulcerative colitis, and lupus.
Like other anti-cancer drugs, mercaptopurine suppresses the production of various blood cells in the bone marrow, which causes anemia. Patients are also more susceptible to infections and abnormal bleeding.

Trade name	Company name
PURINETHOL 50MG TAB	GLAXOWELLCOME

Pregnancy

. Mercaptopurine and azathioprine are the most commonly used immunomodulatory agents most commonly encountered during

Pregnancy

in women with inflammatory bowel disease. Both drugs require caution. In addition to the listed indications, mercaptopurine is used as an adjunct to prevent organ rejection after transplantation. There are no adequate reports or well- controlled studies of mercaptopurine in pregnant women. Inflammatory bowel disease can be challenging. Women with quiescent disease are likely to have an uncomplicated pregnancy, whereas those with active disease are more likely to suffer spontaneous abortion, stillbirth, IUGR, and exacerbation of disease. In women considering pregnancy, an active episode should be treated aggressively and remission accomplished before 652

Pregnancy

is attempted. A woman who unexpectedly conceives while her disease is active should be treated aggressively, as remission provides the greatest hope for a favorable outcome. The treatment of AML typically involves a complex drug regimen that includes mercaptopurine. Multiple case reports suggest the use of mercaptopurine can produce a complete and sustained remission culminating in the delivery of a normally developed infant.

Fetal Health

There are no adequate reports or well-controlled studies of mercaptopurine in human fetuses. It likely crosses the human placenta as transient but severe neonatal bone marrow hypoplasia is reported. The impact of mercaptopurine use during the 1st trimester on development is controversial. Retrospective studies conclude there is no increased prevalence of anomalies. However, a more recent population-based cohort study concluded the risk of malformation is increased more than 6-fold. In a second recent report, the incidence of fetal loss was higher in women with inflammatory bowel disease previously treated with mercaptopurine compared to those who had not been so treated. Whether this was related to their older age at conception, longer duration of disease, initially more severe disease, or use of mercaptopurine could not be determined. Although it was suggested mercaptopurine increases the risk of spontaneous abortion, it proved a poor abortifacient in one prospective trial. Exposure during the 2nd and 3rd trimesters does affect the fetal immune system, and birth weight may be reduced. Toxic effects on the neonatal pancreas, liver, and lymphocytes are reported. Rodent studies reveal teratogenicity perhaps mediated by DNA modification or drug-induced changes in mineral metabolism (zinc). Malformations include cleft palate, micrognathia and agnathia, microglossia, short limbs, and gut herniation. Zinc supplementation reduces the risk of an adverse effect.

Breastfeeding

There is no published experience in nursing women. It is unknown whether mercaptopurine enters human breast milk. Until such data become available, it is perhaps best to avoid immunosuppressive medications while breastfeeding.

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Gen name	Trade name	Catagory name
Mercaptopurine	PURINETHOL 50MG TAB

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