mercaptopurine and Gout

Topics: Animals; Antibody Formation; Bacteria; Bone Marrow; Drug Resistance, Microbial; Eukaryota; Gout; Humans; Intestinal Mucosa; Mercaptopurine; Neoplasms; Nephrotic Syndrome; Nucleic Acids; Nucleotidases; Oxidoreductases; Phosphotransferases; Platelet Adhesiveness; Protein Biosynthesis; Purines; Rats; Transferases; Viruses

BACKGROUND Pancytopenia is a hematological condition which is characterized by decreases in all three cellular elements: RBC, WBC, and platelets. As a result, patients with pancytopenia are more prone to anemia, infections, and excessive bleeding. Pancytopenia can be caused by medications or drug interactions that suppress the bone marrow. This case report highlights a drug interaction between allopurinol and mercaptopurine which led to pancytopenia and septic infection, resulting in the patient's death. This could easily have been avoided if a clinical pharmacist had been consulted. CASE REPORT A 55-year-old female patient with a past medical history of gout, depression, back pain, and type 2 diabetes was recently diagnosed with ulcerative colitis and was discharged with a new prescription of mercaptopurine. After 2 months of concurrent use of allopurinol and mercaptopurine, she developed infected foot ulcers, which progressed rabidly to sepsis. At the time, her laboratory findings confirmed pancytopenia. Despite treatment, the patient died. CONCLUSIONS This case illustrates the importance of consulting a clinical pharmacist in order to avoid such medical error. The dose of mercaptopurine should be reduced to 25% of the recommended dose when it is given concurrently with allopurinol to reduce the risk of pancytopenia. Health care providers should think about the significant role of clinical pharmacy services. In our case, there were no clinical pharmacist involved in the care of this patient, and as a result of such negligence, the patient lost her life.

Topics: Allopurinol; Colitis, Ulcerative; Diabetic Foot; Drug Interactions; Fatal Outcome; Female; Gout; Gout Suppressants; Humans; Immunosuppressive Agents; Mercaptopurine; Middle Aged; Pancytopenia; Pharmacists; Pharmacy Service, Hospital; Referral and Consultation; Sepsis

Topics: Adult; Allopurinol; Azathioprine; Clostridioides difficile; Colitis, Ulcerative; Crohn Disease; Drug Interactions; Drug Therapy, Combination; Enterocolitis, Pseudomembranous; Female; Gout; Gout Suppressants; Histoplasmosis; Humans; Immunosuppressive Agents; Male; Mercaptopurine; Middle Aged; Psoas Abscess; Tumor Necrosis Factor-alpha

Similarity of the morphological picture of gouty nephropathy and primary glomerulonephritides in which purine antagonists turned out to be effective, a positive effect of azathioprine (Az) and 6-mercaptopurine (MP) on purine metabolism, and changes in immunity indices revealed in gout (hyperproduction of immunoglobulins and circulating immune complexes) necessitates the use of antimetabolites in combined therapy of gout patients with proteinuric and latent types of nephropathy. A prolonged use of Az and MP at a daily dose of 50-100 mg often leads to the recovery or improvement of lowered renal function, disappearance of the urinary syndrome, and suppression of hyperuricemia. Uricosuppressors without purine antagonists produce a weaker effect on the course of a renal process, and the treatment of such patients without the use of basic drugs has proved to be utterly ineffective. Strict control over Az and MP therapy makes side-effects of the drugs rare, and they can be easily done away with after reducing a drug dose.

Topics: Adult; Azathioprine; Drug Therapy, Combination; Gout; Humans; Kidney Diseases; Mercaptopurine; Middle Aged; Time Factors; Uric Acid

Topics: Allopurinol; Blood Cell Count; Cell Movement; Colchicine; Diet; Drug Synergism; Gastrointestinal Diseases; Gout; Hemorrhage; Humans; Indomethacin; Leukocytes; Mercaptopurine; Phenylbutazone; Probenecid; Purines; Uric Acid

Topics: Adenine; Adolescent; Aminopterin; Azaguanine; Blood Urea Nitrogen; Carbon Isotopes; Cell Line; Creatinine; Drug Resistance; Electrophoresis, Starch Gel; Erythrocytes; Fibroblasts; Gout; Guanine; Humans; Hypoxanthines; Lesch-Nyhan Syndrome; Male; Mercaptopurine; Pentosyltransferases; Purines; Uric Acid

Topics: Adult; Angiotensin II; Animals; Bile Duct Neoplasms; Biliary Tract Diseases; Blood Pressure; Carbon Tetrachloride Poisoning; Chemical and Drug Induced Liver Injury; Chloramphenicol; Endopeptidases; Erythromycin; Female; Gout; Hepatitis; Humans; Hypertension; Liver; Liver Cirrhosis; Liver Diseases; Liver Function Tests; Liver Neoplasms; Male; Mercaptopurine; Middle Aged; Nephrotic Syndrome; Rats

Topics: Abnormal Karyotype; Blood Cell Count; Bone Marrow Examination; Busulfan; Chromosome Aberrations; Chromosome Disorders; Geriatrics; Gout; Hemoglobinometry; Humans; Kidney Calculi; Leukemia; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukemia, Myeloid; Mercaptopurine; Nephrectomy; Prednisone

Topics: Antimetabolites; Gout; Humans; Leukemia; Mercaptopurine; Pharmacology; Psoriasis; Purines; Pyrazoles; Pyrimidines

Topics: Adolescent; Black People; Colchicine; Gout; Humans; Leukemia; Leukemia, Lymphoid; Lymphocytes; Mercaptopurine; Prednisone; Toxicology