Formulary
Tioguanine [Specialist drug]: Indications, Dosing, Side Effects and Interactions
Tioguanine [Specialist drug] clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Tioguanine [Specialist drug]: Indications, Dosing, Side Effects and Interactions
Tioguanine [Specialist drug] clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Acute leukaemia,Chronic myeloid leukaemia**
- **Adult** (By Mouth): Specialist drug - access specialist resources for dosing information.
Side effects
For tioguanine [Specialist drug] Common or very common Bone marrow failure; gastrointestinal disorders; hepatic disorders; hyperbilirubinaemia; hyperuricaemia; hyperuricosuria; nodular regenerative hyperplasia; oesophageal varices; sinusoidal obstruction syndrome; splenomegaly; stomatitis; thrombocytopenia; uric acid nephropathy; weight increased Frequency not known Photosensitivity reaction Side-effects, further information Manufacturer advises tioguanine is not recommended for maintenance or long-term continuous therapy because of the high risk of hepatic toxicity. If hepatic toxicity develops, discontinue treatment.
Pregnancy
Important safety information For tioguanine [Specialist drug] Risks of incorrect dosing of oral anti-cancer medicines See Cytotoxic drugs . MHRA/CHM advice: Thiopurines and intrahepatic cholestasis of pregnancy (May 2025) Intrahepatic cholestasis of pregnancy (ICP) has been reported in a small number of patients taking azathioprine or mercaptopurine. Due to similar metabolic pathways, the risk of ICP is considered applicable to all drugs in the thiopurine class, including tioguanine. Thiopurine-induced ICP usually occurs earlier in pregnancy than non-drug-induced ICP and may not respond to ursodeoxycholic acid, however, stopping or reducing the dose of the thiopurine may improve liver-function tests. Some case reports resulted in fetal death, therefore early diagnosis and discontinuation or dose reduction of the thiopurine may minimise adverse effects in the fetus. Healthcare professionals are advised to undertake a case-by-case assessment if ICP occurs and consider the risks versus benefits of stopping or continuing thiopurine treatment. Non-fasting serum-bile acids should be measured in patients with ICP to identify pregnancies at particular risk of spontaneous preterm birth ( 40 micromol/litre) or stillbirth ( 100 micromol/litre). Patients and carers should be advised to seek immediate medical attention if signs or symptoms of ICP occur.
Medicinal forms
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Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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