Thioguanine (LANVIS)

Send in Email Print Collapse All Expand All

Indication

Acute lymphoblastic leukemia

Dose

Acute lymphoblastic leukemia

Oral: Both weight-based and body surface area-based dosing exists. Please refer to local protocol for dosing details.

Supplied

Available as 40mg tablets. Contains lactose. Suspension may be prepared for those who cannot swallow tablets, please discuss with your pharmacy team. Store at room temperature and protect from light.

Pharmacological Category

Antimetabolite

Administration

Take on empty stomach

Missed Dose

If a dose is missed, patients should be instructed to take it as soon as they can if it is within 12 hours of the missed dose. If it is over 12 hours since the missed dose, patients should skip the missed dose and resume with the next scheduled dose.

Adverse Effects

Common: Anemia, Thrombocytopenia, Leukopenia.

Less Common: Hepatotoxicity.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Monitoring Parameters

Baseline before treatment: CBC & differential, platelets, SCr, AST, ALT, ALP, bilirubin.

During treatment: CBC & differential, platelets, SCr, AST, ALT, ALP, bilirubin. Frequency dependent on protocol and physician discretion. Consider performing TPMT phenotype/genotype to assess for TPMT activity level in patients who are experiencing a high level of myelosuppression. Please be advised that this testing is not currently readily accessible in Canada and may need to be sourced elsewhere.

Drug Interactions

Current drug interaction databases should be consulted for more information.

Clinical Pearls

Avoid in pregnancy and lactation.
Hepatotoxicity is more prevalent in males.

References

BC Cancer. BC Cancer Drug Manual. Thioguanine. Vancouver, British Columbia: BC Cancer Agency. Available at: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Thioguanine_monograph_1Mar07.pdf. Updated March 2007. Accessed February 2, 2024.

Lexicomp. Thioguanine Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at: https://online-lexi-com.qe2a-proxy.mun.ca/lco/action/doc/retrieve/docid/patch_f/7757?cesid=9YQf2fVvRgg&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dthioguanine%26t%3Dname%26acs%3Dfalse%26acq%3Dthioguanine. Updated December 5, 2023. Accessed February 2, 2024.

Cancer Care Ontario. Methotrexate Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/44146. Updated June 2019. Accessed January 22, 2024.

GlaxoSmithKline Inc. LANVIS Thioguanine Tablet Product Monograph. Mississauga, Ontario. Updated April 5, 2019.