Tioguanine

Tioguanine is a medicine used to treat certain types of cancer and leukaemia.

How is tioguanine given?

For the treatment of leukaemia, tioguanine is given by mouth in tablet or liquid form once a day. It should be taken one hour after food in the evening but not with milk products as these affect how the medicine is absorbed. For other types of cancer, tioguanine should be taken as directed by your doctor, nurse or pharmacist.

What are the side effects of tioguanine?

Bone marrow suppression

There will be a temporary reduction in how well your child’s bone marrow works. This means your child may become anaemic, bruise or bleed more easily than usual, and have a higher risk of infection. Your child’s blood counts will be checked regularly to see how the bone marrow is working. Please tell your doctor if your child seems unusually tired, has bruising or bleeding, or any signs of infection, especially a high temperature. Tioguanine doses may be changed weekly according to your child’s blood count.

Diarrhoea

Please tell the doctor or nurse if your child has diarrhoea that is not controlled or persists. It is important that your child drinks plenty of fluids.

Nausea and vomiting

Anti-sickness medicines can be given to reduce or prevent these symptoms. Please tell your doctor or nurse if your child’s sickness is not controlled or persists.

Temporary effect on liver function

Some children are sensitive to tioguanine, which can cause changes in liver function. This should return to normal when the treatment is finished. If your child’s liver function is temporarily serious affected then the treatment will be changed. Blood tests may be taken to monitor your child’s liver function (LFTs). Please contact your doctor immediately if your child complains of pain in his or her right side or develops a yellow skin tinge.

Tioguanine and interactions with other medicines

Some medicines can react with tioguanine, altering how well it works. Always check with your doctor or pharmacist before giving your child any other medicine, including medicines on prescription from your family doctor (GP), medicines bought from a pharmacy (chemist) or any herbal or complementary medicines.

Important information you should know about tioguanine

• Keep all medicines in a safe place where children cannot reach them.
• Tioguanine tablets or liquid should be kept in a cool, dry place away from direct sunlight or heat.
• You should handle these medicines with care, avoiding touching them where possible. If you are pregnant or think you could be pregnant, please discuss handling instructions with your doctor, nurse or pharmacist. Please see our special handling requirements information sheet for further details.
• If your child vomits after taking the dose, inform the doctor or nurse. Do not give them another dose.
• If you forget to give your child their dose, do not give them a double dose. Inform your doctor or nurse and keep to your child’s regular dose schedule.
• Sometimes it is necessarily to halve tablets to get the correct dose. A tablet cutter may be used for this but you should keep it only for cutting chemotherapy tablets.
• If your child cannot swallow tablets, you can ask the pharmacist for the liquid preparation. If this is unsuitable, you can make tablets into a mixture as follows:
  • You will need a small container such as a medicine pot and an oral syringe.
  • If you prefer you can wear a pair of household rubber gloves to protect yourself. Do not use them for any other purpose.
  • Tip the required number of tablets into a clean container.
  • Pour a little water on the tablets and allow to disperse. This may take a few minutes. Do not try to make the tablets disperse faster by stirring or shaking the container.
  • Draw up the dose using the oral syringe and give to your child.
  • Wash the syringe and container in warm, soapy water and do not use for any other purpose.
  • If you accidentally spill the tablets or mixture, wash the area thoroughly with plenty of water.
  • If the mixture accidentally gets into your eyes, wash with plenty of running water for five to 10 minutes.
• Used paper towels, masks, vomit and dirty disposable nappies should be placed inside two rubbish bags and disposed of along with your normal rubbish.
• If your doctor decides to stop treatment with tioguanine or the medicine passes its expiry date, return any remaining medicine to the pharmacist. Do not flush it down the toilet or throw it away.

Last reviewed by Great Ormond Street Hospital: May 2010

Ref: 2010F0668 © GOSH Trust May 2010
Compiled by the Pharmacy department in collaboration with the Child and Family Information Group

Please read this information in conjunction with any patient information leaflet provided by the manufacturer. However, please note that this information explains about the use of medicines in children and young people so may differ from the manufacturer’s information.

Each person reacts differently to medicines so your child will not necessarily suffer every side effect mentioned. This information does not constitute health or medical advice and will not necessarily reflect treatment at other hospitals. If you have any questions, please ask your doctor. No liability can be taken as a result of using this information.