Assess for hypersensitivity prior to initiation. Discontinue use if jaundice becomes apparent or macrophage activation syndrome occurs. Interrupt treatment at 1st sign of abnormal large fall in leukocyte & platelet counts. Not recommended in Lesch-Nyhan syndrome. Patients w/ thiopurine methyltransferase (TPMT) deficiency, NUDT15 variant; prior exposure to or w/ varicella-zoster virus infection. Increased risk of developing lymphoproliferative disorders & other malignancies eg, skin cancers (melanoma & non-melanoma), sarcomas (Kaposi's & non-Kaposi's), uterine cervical cancer
in situ. Limit sun- & UV light exposure. Daily monitoring of FBCs during remission induction; monitor CBCs, platelets during maintenance therapy. Monitor γ-glutamyl transferase & LFTs wkly; uric acid levels in blood & urine. Not to be taken by patients w/ galactose intolerance, complete lactase deficiency or glucose-galactose malabsorption. Cross resistance w/ 6-thioguanine. Not to be co-administered w/ ribavirin. Not recommended w/ live organism vaccines. Avoid concomitant use w/ xanthine oxidase inhibitors. Co-administration w/ TPMT inhibitors eg, olsalazine, mesalazine or sulfasalazine; multiple immunosuppressants; anticoagulants. Renal &/or hepatic impairment. Ensure adequate contraception during & for at least 3 mth after last dose. Avoid use during 1st trimester of pregnancy. Not to be used during lactation. Childn <6 yr or w/ low BMI.
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