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Purixan 20mg/ml Oral Suspension
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Indications & Clinical Uses
- Purixan 20 mg/mL (mercaptopurine) is a thiopurine antimetabolite chemotherapy oral suspension, the same active substance as Purinethol tablets but formulated as a liquid to allow precise, weight-based dosing, particularly for children who cannot swallow tablets.
- It is approved in the United States and, under the same brand, in the European Union and UK, for the treatment of acute lymphoblastic leukaemia (ALL) in adults and children as part of a combination chemotherapy maintenance regimen, given once remission has been achieved with other treatment; it is not used for initial induction therapy.
- Purixan must not be assumed interchangeable millilitre-for-tablet with Purinethol or other mercaptopurine tablets - the dose in mg needs recalculating and the bottle must be shaken well before each dose to ensure even mixing.
- Treatment is prescribed and monitored only by a specialist in cancer or blood disorders.
Side Effects
- Myelosuppression - low white blood cells, low platelets, and anaemia - affects more than 1 in 10 people taking Purixan and is the most common reaction, so regular blood counts are essential.
- Reactions in roughly 5 to 20 percent of patients include loss of appetite, nausea, vomiting, diarrhoea, malaise, and skin rash.
- Seek urgent medical attention for signs of infection (fever, sore throat, chills), unusual bruising or bleeding, or yellowing of the skin or eyes, which can indicate potentially fatal liver damage (hepatotoxicity); liver function is checked regularly during treatment.
- Rarely, mercaptopurine has been associated with secondary cancers such as hepatosplenic T-cell lymphoma and with macrophage activation syndrome, a serious overactive immune reaction.
- Purixan does not carry a current FDA boxed warning, but these serious risks still require close specialist monitoring.
- Always measure doses with the oral syringe provided, never a household spoon.
Precautions & Warnings
- Before starting Purixan, TPMT and NUDT15 genetic testing is recommended, since reduced enzyme activity greatly increases the risk of severe myelosuppression and usually means starting at a lower dose; homozygous deficiency may need around a tenth of the standard dose.
- Full blood counts and liver function tests are monitored regularly throughout treatment, with doses adjusted or paused for significant myelosuppression or liver toxicity.
- Purixan can cause fetal harm and is linked to a higher rate of first-trimester miscarriage, so women should use effective contraception during treatment and discuss pregnancy plans with their specialist beforehand; breastfeeding is generally avoided since safety in nursing infants is not established.
- Discuss any live vaccines with the treating specialist before your child or you receive them, since mercaptopurine suppresses the immune response.
- Shake the bottle well before every dose and store away from children given its cytotoxic content.
Avoid Interactions
- Allopurinol and other xanthine oxidase inhibitors block the breakdown of mercaptopurine and can cause severe toxicity; when allopurinol must be used together with Purixan, the dose is reduced to about one-quarter to one-third of the usual amount under close monitoring.
- Other bone-marrow-suppressing medicines, including aminosalicylates such as sulfasalazine, mesalazine and olsalazine, can add to the myelosuppressive effect of Purixan and increase the risk of low blood counts.
- Combining Purixan with other immunosuppressive treatments raises infection risk, and live vaccines should generally be avoided during treatment unless your specialist advises otherwise.
- Warfarin's anticoagulant effect may be reduced when taken with mercaptopurine, so closer monitoring is needed.
- Tell your healthcare provider about every medicine, herbal product and supplement being used before starting or while taking Purixan.
References
Frequently Asked Questions
Purixan (mercaptopurine) is a liquid chemotherapy medicine used to keep acute lymphoblastic leukaemia (ALL) in remission, as part of a combination maintenance regimen in adults and children. It's given once remission is first achieved with other treatment, not for initial induction therapy.
Purixan is an oral suspension taken once daily by mouth, measured with the oral syringe provided, never a household spoon. Shake the bottle well before every dose. Your dose depends on your body weight, weight-adjusted for children, and is checked against your blood counts.
Low blood counts (in more than 1 in 10 people), reduced appetite, nausea, vomiting, and diarrhoea are common with Purixan. Get urgent help for fever, signs of infection, unusual bruising or bleeding, or yellowing skin or eyes, which can mean serious liver damage.
Avoid allopurinol unless your specialist lowers your Purixan dose, since it raises mercaptopurine levels and toxicity risk. Discuss any live vaccines with your care team before having them, and tell them about every other medicine, including aminosalicylates like mesalazine, which add to bone marrow suppression.
No. Purixan is a 20 mg/mL liquid and Purinethol is a 50 mg tablet of the same drug, mercaptopurine, but the dose in milligrams must be recalculated between the two - they are not simply interchangeable millilitre-for-tablet. Always follow the specific dose your specialist prescribes for Purixan.
No. Purixan can cause fetal harm and is linked to a higher miscarriage rate in early pregnancy, so effective contraception is needed during treatment. Discuss pregnancy plans with your specialist before starting or stopping treatment, and avoid breastfeeding since safety for infants is not established.
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