Thioguanine (6 TG)

What is Thioguanine (6 TG)

Thioguanine is an oral cell cycle-phase specific antineoplastic agent used chiefly in the treatment of acute lymphoblastic leukemia.

It is an antimetabolite chemotherapy agent related to guanine.

Thioguanine is structurally and functionally similar to another antimetabolite, mercaptopurine. The two agents have similar indications, adverse effects, and cross-resistance.

Thioguanine is only FDA-approved for remission induction and remission consolidation therapy for acute myeloid leukemia.

However, it is not recommend for use during maintenance therapy or other long-term continuous treatments due to the high risk of liver toxicity (see Adverse Reactions).

Thioguanine was approved by the FDA in 1966.

Brand Name

Tabloid

Indications

  • acute lymphocytic leukemia (ALL)
  • acute myelogenous leukemia (AML)
  • psoriasis

For use in combination remission induction and remission consolidation therapy for acute myelogenous leukemia (AML)

Side Effects

  1. anemia
  2. anorexia
  3. ascites
  4. biliary obstruction
  5. bleeding
  6. bowel necrosis
  7. elevated hepatic enzymes
  8. fluid retention
  9. GI perforation
  10. hepatic necrosis
  11. hepatitis
  12. hepatomegaly
  13. hyperbilirubinemia
  14. hyperuricemia
  15. infection
  16. jaundice
  17. leukopenia
  18. nausea
  19. neutropenia
  20. pancytopenia
  21. peliosis hepatis
  22. sinusoidal obstruction syndrome (SOS)
  23. splenomegaly
  24. stomatitis
  25. thrombocytopenia
  26. veno-occlusive disease (VOD)
  27. vomiting
  28. weight gain

Monitoring Parameters

  • CBC
  • LFTs

Contraindications

  • ascites
  • biliary obstruction
  • bone marrow suppression
  • breast-feeding
  • chemotherapy
  • children
  • cholestasis
  • dental disease
  • dental work
  • fungal infection
  • hepatic disease
  • herpes infection
  • hyperkalemia
  • hyperphosphatemia
  • hyperuricemia
  • hypocalcemia
  • infection
  • intramuscular injections
  • jaundice
  • neutropenia
  • pregnancy
  • radiation therapy
  • thiopurine methyltransferase deficiency
  • thrombocytopenia
  • tumor lysis syndrome (TLS)
  • vaccination
  • varicella
  • viral infection

Interactions

  • 5-Aminosalicylates
  • Alpha interferons
  • Amlodipine; Celecoxib
  • Antithymocyte Globulin
  • Azelastine; Fluticasone
  • Bacillus Calmette-Guerin Vaccine, BCG
  • Balsalazide
  • Basiliximab
  • Beclomethasone
  • Betamethasone
  • Budesonide
  • Budesonide; Formoterol
  • Busulfan
  • Carbamazepine
  • Celecoxib
  • Ciclesonide
  • Clozapine
  • Corticosteroids
  • Corticotropin, ACTH
  • Cortisone
  • Cyclosporine
  • Deflazacort
  • Dexamethasone
  • Diclofenac
  • Diclofenac; Misoprostol
  • Diflunisal
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Echinacea
  • Efalizumab
  • Esomeprazole; Naproxen
  • Etodolac
  • Famotidine; Ibuprofen
  • Febuxostat
  • Fenoprofen
  • Fludrocortisone
  • Flunisolide
  • Flurbiprofen
  • Fluticasone
  • Fluticasone; Salmeterol
  • Fluticasone; Umeclidinium; Vilanterol
  • Fluticasone; Vilanterol
  • Formoterol; Mometasone
  • Hydrocodone; Ibuprofen
  • Hydrocortisone
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Indomethacin
  • Influenza Virus Vaccine
  • Interferon Alfa-2a
  • Interferon Alfa-2b
  • Interferon Alfa-2b; Ribavirin
  • Interferon Alfa-n3
  • Interferon Alfacon-1
  • Intranasal Influenza Vaccine
  • Ketoprofen
  • Ketorolac
  • Lansoprazole; Naproxen
  • Live Vaccines
  • Measles Virus; Mumps Virus; Rubella Virus; Varicella Virus Vaccine, Live
  • Measles/Mumps/Rubella Vaccines, MMR
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Meloxicam
  • Mesalamine, 5-ASA
  • Methotrexate
  • Methylprednisolone
  • Mometasone
  • Muromonab-CD3
  • Nabumetone
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Nonsteroidal antiinflammatory drugs
  • Olsalazine
  • Oxaprozin
  • Palifermin
  • Pegfilgrastim
  • Peginterferon Alfa-2a
  • Peginterferon Alfa-2b
  • Penicillamine
  • Pexidartinib
  • Piroxicam
  • Platelet Inhibitors
  • Prednisolone
  • Prednisone
  • Riluzole
  • Rofecoxib
  • Rotavirus Vaccine
  • Rubella Virus Vaccine Live
  • Smallpox and Monkeypox Vaccine, Live, Nonreplicating
  • Smallpox Vaccine, Vaccinia Vaccine
  • Sulfasalazine
  • Sulindac
  • Tolmetin
  • Triamcinolone
  • Tuberculin Purified Protein Derivative, PPD
  • Typhoid Vaccine
  • Valdecoxib
  • Varicella-Zoster Virus Vaccine, Live
  • Yellow Fever Vaccine, Live
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