Leukemias, lymphomas, and other hematologic cancers:
Indications for PURIXAN:
Maintenance therapy of acute lymphoblastic leukemia as part of a combination regimen.
Adults and Children:
Shake bottle vigorously for at least 30 secs. Initially 1.5–2.5mg/kg (50–75mg/m2) per day as a single dose. Monitor subsequent doses to maintain desirable ANC level and adjust for excessive myelosuppression. Thiopurine-S-methyltransferase (TPMT) and/or nucleotide diphosphatase (NUDT15)-deficient: if homozygous, may require ≤10% of standard dose; if heterozygous, some may require dose reduction based on toxicities. Renal or hepatic impairment: use lower starting doses; monitor for toxicity. See full labeling.
Myelosuppression; monitor CBCs and adjust dose for severe neutropenia and thrombocytopenia. Consider testing for TPMT and NUDT15 deficiency in patients who experience severe bone marrow toxicities or repeated myelosuppression. Monitor serum transaminase, alkaline phosphatase, and bilirubin levels at weekly intervals when starting therapy, then monthly thereafter; withhold treatment if hepatotoxicity occurs. Pre-existing liver disease: monitor LFTs more frequently. Immunosuppression. Increased risk of lymphoproliferative disorders and other malignancies (eg, skin cancers, sarcomas, uterine cervical cancer). Concomitant multiple immunosuppressants increase risk of Epstein-Barr virus (EBV)-associated lymphoproliferative disorders. Monitor and treat for EBV or cytomegalovirus; discontinue if macrophage activation syndrome occurs, or is suspected. Renal or hepatic impairment. Elderly. Embryo-fetal toxicity. Advise to use effective contraception during and for 6 months (females of reproductive potential) or 3 months (males w. female partners) after the last dose. Pregnancy: exclude status prior to initiation. Nursing mothers: not recommended (during and for 1 week after the last dose).
Reduce dose when concomitant allopurinol. Increased risk of bone marrow suppression with allopurinol, aminosalicylates (eg, olsalazine, mesalamine, sulfasalazine), trimethoprim-sulfamethoxazole. Possibly decreased effectiveness with concomitant warfarin; monitor PT or INR; may need warfarin dose adjustments. Concomitant live virus vaccines: may get suboptimal response and risk of infection. Concomitant with other hepatotoxic drugs; monitor LFTs more frequently.
Myelosuppression, nausea, vomiting, anorexia, diarrhea, malaise, rash, urticaria, hyperuricemia, oral lesions, elevated transaminases, hyperbilirubinemia, hyperpigmentation, pancreatitis; hepatotoxicity.
Renal. Half-life: 1.3 (0.9–5.4) hours.
Susp—100mL (w. oral syringes)