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Thiopurine methyltransferase (TPMT) is an enzyme that breaks down (metabolizes) thiopurines. Thiopurines include three medications: 6- mercaptopurine (6-MP), 6-thioguanine (6-TG), and azathioprine (see this link http://www.pharmgkb.org/search/annotatedGene/tpmt/index.jsp. 6-MP and 6-TG are often used to treat leukemia or lymphoma. Like many drugs, their effectiveness and side effects can vary from person to person. One of the reasons why this difference occurs is because each person’s ability to metabolize thiopurines is different based on variations in the TPMT gene. Every person can be classified into one of 3 possible genotype groups. We use a different starting dose of 6-MP and 6-TG for the different genotype groups. By changing the dose based on a patient’s genotype, there are fewer side effects (due to low blood counts).
Azathioprine: Consider reducing the dose of azathioprine to 0.6 to 2 mg/kg/day.
Mercaptopurine: Consider starting mercaptopurine doses at 30 to 70% of the normal dose.
Thioguanine: Consider starting thioguanine doses at 30 to 50% of the normal dose.
Azathioprine: Consider an alternative agent or reducing the dose of azathioprine by 90% and administer three times per week instead of daily.
Mercaptopurine: For non-malignant conditions, consider alternative agents; for malignancy, reduce the dose of mercaptopurine by 90% and administer three times per week instead of daily.
Thioguanine: Consider an alternative agent or reducing the dose of thioguanine by 90% and administer three times per week instead of daily.
More information for patients...
More information for healthcare professionals, visit www.pharmGKB.org.
Legal Disclaimer: This page is intended to provide implementers with guidance on establishing a clinical pharmacogenetic program at their institution. Information contained on this page is for information and educational purposes only. Although reasonable efforts have been made to ensure that the information provided on this page is current, complete and, where appropriate, based on scientific evidence, St. Jude Children's Research Hospital makes no assurances as to whether the provided information will at all times be current or complete. St. Jude Children's Research Hospital, in offering this document, is not providing medical advice or offering a consultative opinion, and is not establishing a treatment relationship with any given individual. You, therefore, should not substitute information contained herein for your own professional judgment, nor should you rely on information provided herein in rendering a diagnosis or choosing a course of treatment for a particular individual.