Clinical Challenges in the Usage and Shortage of Mercaptopurine in Pediatric Oncology: Case Report

Abstract

Introduction: The shortage of pediatric medications is particularly concerning due to the lack of pediatric-specific labeling and limited alternatives, reducing the therapeutic options and increasing the risk of medication errors. Another significant challenge is the absence of appropriate pediatric dosage forms, leading to practices such as tablet splitting or dilution, which can result in toxic or subtherapeutic doses. This article presents two cases that exemplify these obstacles and underscore the critical role of pharmaceutical services, particularly Comprehensive Medication Management (CMM). Case report: 1-year-old boy with B-cell acute lymphoblastic leukemia (B-ALL) was prescribed 50 mg 6-mercaptopurine (6MP) tablets, but experienced difficulty swallowing the medication. In case two, the mother of a two-year-old child with B-ALL encountered difficulties obtaining 6MP due to medication shortages. In the first case, caregivers were advised to prepare an extemporaneous oral solution to accommodate the child’s inability to swallow tablets. In the second case, the mother was instructed not to use expired medications and was directed to promptly obtain compounded 6MP from the hospital pharmacy to counter the shortage of commercial formulation. Conclusion: These cases highlight significant challenges faced by pediatric leukemia patients within a CMM service. Two primary issues were identified: the need to adapt dosage forms for pediatric use and the shortage of 6MP, an orphan drug in Brazil. Children with cancer have unique medication needs, and services like CMM are vital in educating patients and caregivers on proper medication administration, while addressing challenges related to medication access and use effectively.