Alert: 6-Mercaptopurine May Be Erroneously Dispensed Instead of Propylthiouracil

Blum, Manfred; Peck, Valerie; Seltzer, Terry F.; Goldberg-Berman, Judith

doi:10.1089/thy.2005.15.1315

Cited by 4 publications

(6 citation statements)

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“…In contrast to the previously published literature about thiopurine overdoses and our findings for calcineurin inhibitor overdoses, where iatrogenic errors accounted for 38% and 46% respectively of the reported cases [1]–[6], [11], iatrogenic dosing errors only accounted for 8% of the current series. This may be due to the fact that the trade names for propylthiouracil and 6-MP in Switzerland are Propycil® and Puri-Nethol® respectively, which are more markedly different than in the USA where the mix-up errors occurred (Propylthiouracil® and Purinethol® respectively) [3], [6].…”

Section: Discussioncontrasting

confidence: 99%

“…This retrospective analysis of thiopurine overdoses reported to a single national poison centre between 1995 and 2013 adds a further 40 cases to the eight case reports currently published in the medical literature [1]–[6]. A large dataset such as the one presented here allows patterns, outcomes and management strategies of thiopurine overdoses to be more comprehensively assessed.…”

Section: Discussionmentioning

confidence: 96%

“…The current literature includes four adult cases, none of which were with suicidal intent and four paediatric cases [1]–[6]. Three of the adult cases were iatrogenic where 6-MP had been dispensed instead of propylthiouracil [3], [6] and the remaining case was accidental due to failure to understand the prescriber's instructions [1]. Among published cases in children, two were with suicidal intent [2], [5] and two were accidental ingestions by siblings of children receiving 6-MP [4].…”

Section: Discussionmentioning

confidence: 99%

“…This may be due to the fact that the trade names for propylthiouracil and 6-MP in Switzerland are Propycil® and Puri-Nethol® respectively, which are more markedly different than in the USA where the mix-up errors occurred (Propylthiouracil® and Purinethol® respectively) [3], [6]. Furthermore, intravenous and liquid oral formulations, which accounted for almost three quarters of the CNI iatrogenic overdoses, are much less commonly used for the administration of thiopurines.…”

Section: Discussionmentioning

confidence: 99%

“…Patients taking these agents or their household contacts may be intentionally or accidentally exposed to overdose. Despite several decades of experience in using thiopurines and a good knowledge about long-term toxicity, the published information regarding acute toxicity in overdoses only consists of a small number of case reports from different centres [1]–[6].…”

Section: Introductionmentioning

confidence: 99%

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Acute Thiopurine Overdose: Analysis of Reports to a National Poison Centre 1995–2013

Gregoriano¹,

Ceschi²,

Rauber-Lüthy³

et al. 2014

PLoS ONE

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Literature regarding acute human toxicity of thiopurines is limited to a handful of case reports. Our objectives were to describe all cases of overdose with thiopurines reported to the Swiss Toxicological Information Centre between 1995–2013. A retrospective analysis was performed to determine circumstances, magnitude, management and outcome of overdose with these substances. A total of 40 cases (14 paediatric) were reported (azathioprine, n = 35; 6-mercaptopurine, n = 5). Of these, 25 were with suicidal intent, 12 were accidental and 3 were iatrogenic errors. The magnitude of overdose ranged from 1.5 to 43 (median 8) times the usual dose in adults. Twelve cases (30%) had attributable symptoms. The majority of these were minor and included gastrointestinal complaints and liver function test and blood count abnormalities. Symptoms were experienced by patients who took at least 1.5-times their usual daily thiopurine dose. Overdoses over two or more consecutive days, even if of modest size, were less well tolerated. One case of azathioprine and allopurinol co-ingestion over consecutive days led to agranulocytosis. Decontamination measures were undertaken in 11 cases (10 activated charcoal, 1 gastric lavage) and these developed fewer symptoms than untreated patients. This study shows that acute overdoses with thiopurines have a favourable outcome in the majority of cases and provides preliminary evidence that gastrointestinal decontamination with activated charcoal may reduce symptom development after overdose of these substances if patients present to medical services soon after ingestion.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute Thiopurine Overdose: Analysis of Reports to a National Poison Centre 1995–2013

Gregoriano¹,

Ceschi²,

Rauber-Lüthy³

et al. 2014

PLoS ONE

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Current awareness: Pharmacoepidemiology and drug safety

2006

Pharmacoepidemiology and Drug

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In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of pharmacoepidemiology and drug safety. Each bibliography is divided into 20 sections: 1 Books, Reviews & Symposia; 2 General; 3 Anti‐infective Agents; 4 Cardiovascular System Agents; 5 CNS Depressive Agents; 6 Non‐steroidal Anti‐inflammatory Agents; 7 CNS Agents; 8 Anti‐neoplastic Agents; 9 Haematological Agents; 10 Neuroregulator‐Blocking Agents; 11 Dermatological Agents; 12 Immunosuppressive Agents; 13 Autonomic Agents; 14 Respiratory System Agents; 15 Neuromuscular Agents; 16 Reproductive System Agents; 17 Gastrointestinal System Agents; 18 Anti‐inflammatory Agents ‐ Steroidal; 19 Teratogens/fetal exposure; 20 Others. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted.

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Drugs that act on the immune system

Aronson¹

2011

Side Effects of Drugs Annual

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Alert: 6-Mercaptopurine May Be Erroneously Dispensed Instead of Propylthiouracil

Cited by 4 publications

References 0 publications

Acute Thiopurine Overdose: Analysis of Reports to a National Poison Centre 1995–2013

Acute Thiopurine Overdose: Analysis of Reports to a National Poison Centre 1995–2013

Current awareness: Pharmacoepidemiology and drug safety

Drugs that act on the immune system

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