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How I treat my inflammatory bowel disease-patients with thiopurines?

Berrie Meijer1, Chris Jj Mulder1, Adriaan A van Bodegraven1

  • 1Berrie Meijer, Chris JJ Mulder, Nanne KH de Boer, Department of Gastroenterology and Hepatology, VU University Medical Center, 1007 MB, Amsterdam, The Netherlands.

World Journal of Gastrointestinal Pharmacology and Therapeutics
|November 22, 2016
PubMed

Thiopurines are essential drugs to maintain remission in patients with inflammatory bowel disease (IBD). Thiopurines used in IBD are azathioprine (2.0-2.5 mg/kg), mercaptopurine (1.0-1.5 mg/kg) and thioguanine (0.2-0.3 mg/kg). However, mainly due to numerous adverse events associated with thiopurine use, almost 50% of the patients have to discontinue conventional thiopurine treatment. Extensive monitoring and the application of several treatment strategies, such as split-dose administration, co-administration with allopurinol or dose reduction/increase, may increase the chance of successful therapy. With this review, we provide practical information on how thiopurines are initiated and maintained in two thiopurine research centers in The Netherlands. We provide clinical information concerning safety issues, indications and management of therapy that may serve as a guide for the administration of thiopurines in IBD patients in daily practice.

Keywords:
AzathioprineInflammatory bowel diseaseMercaptopurineMetabolitesPregnancyTherapeutic drug monitoringThioguanineThiopurines

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