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

Pediatr Blood Cancer. 2019 Apr;66(4):e27577. doi: 10.1002/pbc.27577. Epub 2018 Dec 13.

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.

Keywords: 6-mercaptopurine; acute lymphoblastic leukemia; allopurinol; hypoglycemia.

Publication types

  • Case Reports

MeSH terms

  • Allopurinol / administration & dosage
  • Allopurinol / pharmacokinetics
  • Child
  • Female
  • Humans
  • Hypoglycemia* / blood
  • Hypoglycemia* / chemically induced
  • Hypoglycemia* / prevention & control
  • Male
  • Mercaptopurine* / administration & dosage
  • Mercaptopurine* / adverse effects
  • Mercaptopurine* / pharmacokinetics
  • Thioguanine / metabolism*

Substances

  • Allopurinol
  • Mercaptopurine
  • Thioguanine