পুরিনেথল খাওয়ার নিয়ম কি?

Crohn's disease:

• Adult: Initially 1.5 mg/kg daily, may increase to 125 mg daily.
• Child: Initially 1.5 mg/kg daily increased to a max of 75 mg daily

Acute lymphocytic leukemia:

• Adult: Usual maintenance dose: Initially, 1.5.5 mg/kg daily as a single dose, usually used in combination with methotrexate. Dose may vary individually based on response and tolerance. Monitor blood counts at least once wkly. Withdraw treatment immedietely if there is a sharp drop in the white cell count or severe bone-marrow depression. May resume treatment slowly and carefully if white cell count remains constant for 2 days or rises. Reduce dose when used with allopurinol.
• Child: Usual maintenance dose: Initially, 1.5.5 mg/kg daily as a single dose, usually used in combination with methotrexate. Dose may vary individually based on response and tolerance. Monitor blood counts at least once wkly. Withdraw treatment immedietely if there is a sharp drop in the white cell count or severe bone-marrow depression. May resume treatment slowly and carefully if white cell count remains constant for 2 days or rises. Reduce dose when used with allopurinol.

Should be taken on an empty stomach. Best taken on an empty stomach 1 hr before or 2 hr after meals. Ensure adequate fluid intake.

Renal Impairment: Dosage may need to be reduced.

Hepatic Impairment: 

• Crohn's disease: Dosage may need to be reduced.
• Acute lymphocytic leukemia: Dosage may need to be reduced

Dosage adjustment in patients with thiopurine-S-methyl transferase (TPMT) deficiency to prevent life-threatening myelotoxicity. 

For patients with homozygous TPMT deficiency: Substantial reduction is required. 

For patients with heterozygous TPMT deficiency: Some may require reduction but most will tolerate the usual dosages.

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