Prevention of mercaptopurine-induced hypoglycemia using allopurinol to reduce methylated thiopurine metabolites

Matthew B. Miller, Julienne Brackett, Eric S. Schafer, Rachel E. Rau

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Skewing of mercaptopurine (6-MP) metabolism preferentially toward the 6-methylmercaptopurine (6-MMP) metabolite over the antileukemic metabolite 6-thioguanine (6-TGN) is associated with 6-MP-related hepatotoxocity. Allopurinol when coadministered with 6-MP can reduce this skewing and ameliorate the associated adverse effects. The cases we report here demonstrate that aberrant overproduction of 6-MMP is also associated with profound 6-MP-associated hypoglycemia, which can be reversed by administration of allopurinol. This case series contributes to the scant literature on 6-MP-induced hypoglycemia and provides evidence that addition of allopurinol to reduced dose 6-MP can successfully manage this severe toxicity.

Original languageEnglish (US)
Article numbere27577
JournalPediatric Blood and Cancer
Volume66
Issue number4
DOIs
StatePublished - Apr 2019
Externally publishedYes

Keywords

  • 6-mercaptopurine
  • acute lymphoblastic leukemia
  • allopurinol
  • hypoglycemia

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

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