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Published in: BMC Gastroenterology 1/2013

Open Access 01-12-2013 | Case report

Allopurinol use in pregnancy in three women with inflammatory bowel disease: safety and outcomes: a case series

Authors: Muhammad W Fazal, Matt P Doogue, Rupert W Leong, Peter A Bampton, Jane M Andrews

Published in: BMC Gastroenterology | Issue 1/2013

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Abstract

Background

Allopurinol is a frequently prescribed drug. In inflammatory bowel disease patients who shunt thiopurine metabolism towards more toxic and less desirable pathways, allopurinol is proving to be an effective add on therapy with good resultant disease control and less treatment side effects. As many such patients are young, the potential for pregnant women to be exposed to allopurinol is increasing. The safety of allopurinol in pregnancy is not known however.

Case presentation

We report three cases of safe use of allopurinol in pregnancy for women with inflammatory bowel disease. This included 2 patients with ulcerative colitis and 1 patient with fistulising Crohn’s disease. Allopurinol was used throughout pregnancy in all patients. All 3 pregnancies resulted in normal healthy babies born at term by Caesarean section.

Conclusion

It is important to evaluate and document the safety of allopurinol during pregnancy, as it is finding new roles in young patients. These three cases add significantly to the very limited data on allopurinol use in pregnancy. We encourage reporting of all cases of allopurinol use in pregnant patients and suggest an allopurinol pregnancy registry to document drug exposures and outcomes.
Literature
1.
2.
go back to reference Sparrow MP, Hande SA, Friedman S, Lim WC, Reddy SI, Cao D, Hanauer SB: Allopurinol safely and effectively optimizes thioguanine metabolites in inflammatory bowel disease patients not responding to azathioprine and mercaptopurine. Aliment Pharmacol Ther. 2005, 22 (5): 441-446. 10.1111/j.1365-2036.2005.02583.x.CrossRefPubMed Sparrow MP, Hande SA, Friedman S, Lim WC, Reddy SI, Cao D, Hanauer SB: Allopurinol safely and effectively optimizes thioguanine metabolites in inflammatory bowel disease patients not responding to azathioprine and mercaptopurine. Aliment Pharmacol Ther. 2005, 22 (5): 441-446. 10.1111/j.1365-2036.2005.02583.x.CrossRefPubMed
3.
go back to reference Sparrow MP: Use of allopurinol to optimize thiopurine immunomodulator efficacy in inflammatory bowel disease. Gastroenterol Hepatol (NY). 2008, 4 (7): 505-511. Sparrow MP: Use of allopurinol to optimize thiopurine immunomodulator efficacy in inflammatory bowel disease. Gastroenterol Hepatol (NY). 2008, 4 (7): 505-511.
4.
go back to reference Dubinsky MC, Yang H, Hassard PV, Seidman EG, Kam LY, Abreu MT, Targan SR, Vasiliauskas EA: 6-MP metabolite profiles provide a biochemical explanation for 6-MP resistance in patients with inflammatory bowel disease. Gastroenterology. 2002, 122 (4): 904-10.1053/gast.2002.32420.CrossRefPubMed Dubinsky MC, Yang H, Hassard PV, Seidman EG, Kam LY, Abreu MT, Targan SR, Vasiliauskas EA: 6-MP metabolite profiles provide a biochemical explanation for 6-MP resistance in patients with inflammatory bowel disease. Gastroenterology. 2002, 122 (4): 904-10.1053/gast.2002.32420.CrossRefPubMed
5.
go back to reference Fujii T, Nishimura H: Comparison of teratogenic action of substances related to purine metabolism in mouse embryos. Jpn J Pharmacol. 1972, 22 (2): 201-206. 10.1254/jjp.22.201.CrossRefPubMed Fujii T, Nishimura H: Comparison of teratogenic action of substances related to purine metabolism in mouse embryos. Jpn J Pharmacol. 1972, 22 (2): 201-206. 10.1254/jjp.22.201.CrossRefPubMed
6.
go back to reference Product information. Zyloprim. 1990, Burroughs Wellcome Product information. Zyloprim. 1990, Burroughs Wellcome
7.
go back to reference Hoeltzenbein M, Stieler K, Panse M, Wacker E, Schaefer C: Allopurinol use during pregnancy - outcome of 31 prospectively ascertained cases and a phenotype possibly indicative for teratogenicity. PLoS ONE. 2013, 8 (6): e66637-10.1371/journal.pone.0066637.CrossRefPubMedPubMedCentral Hoeltzenbein M, Stieler K, Panse M, Wacker E, Schaefer C: Allopurinol use during pregnancy - outcome of 31 prospectively ascertained cases and a phenotype possibly indicative for teratogenicity. PLoS ONE. 2013, 8 (6): e66637-10.1371/journal.pone.0066637.CrossRefPubMedPubMedCentral
8.
go back to reference Kozenko M, Grynspan D, Oluyomi-Obi T, Sitar D, Elliott AM, Chodirker BN: Potential teratogenic effects of allopurinol: a case report. Am J Med Genet. 2011, 155A (9): 2247-2252.CrossRefPubMed Kozenko M, Grynspan D, Oluyomi-Obi T, Sitar D, Elliott AM, Chodirker BN: Potential teratogenic effects of allopurinol: a case report. Am J Med Genet. 2011, 155A (9): 2247-2252.CrossRefPubMed
9.
go back to reference Seinen ML, de Boer NK, van Hoorn ME, van Bodegraven AA, Bouma G: Safe use of allopurinol and low-dose mercaptopurine therapy during pregnancy in an ulcerative colitis patient. Inflamm Bowel Dis. 2013, 19 (3): E37-10.1002/ibd.22945.CrossRefPubMed Seinen ML, de Boer NK, van Hoorn ME, van Bodegraven AA, Bouma G: Safe use of allopurinol and low-dose mercaptopurine therapy during pregnancy in an ulcerative colitis patient. Inflamm Bowel Dis. 2013, 19 (3): E37-10.1002/ibd.22945.CrossRefPubMed
10.
go back to reference Awidi AS, Tarawneh MS, Shubair KS, Issa AA, Dajani YF: Acute leukemia in pregnancy: report of five cases treated with a combination which included a low dose of Adriamycin. Eur J Cancer Clin Oncol. 1983, 19 (7): 881-884. 10.1016/0277-5379(83)90051-2.CrossRefPubMed Awidi AS, Tarawneh MS, Shubair KS, Issa AA, Dajani YF: Acute leukemia in pregnancy: report of five cases treated with a combination which included a low dose of Adriamycin. Eur J Cancer Clin Oncol. 1983, 19 (7): 881-884. 10.1016/0277-5379(83)90051-2.CrossRefPubMed
11.
go back to reference O’Donnell R, Costigan C, O’Connell LG: Two cases of acute leukaemia in pregnancy. Acta Haematol. 1979, 61 (5): 298-300. 10.1159/000207676.CrossRefPubMed O’Donnell R, Costigan C, O’Connell LG: Two cases of acute leukaemia in pregnancy. Acta Haematol. 1979, 61 (5): 298-300. 10.1159/000207676.CrossRefPubMed
12.
go back to reference Boros SJ, Reynolds JW: Intrauterine growth retardation following third-trimester exposure to busulfan. Am J Obstet Gynecol. 1977, 129 (1): 111-112.CrossRefPubMed Boros SJ, Reynolds JW: Intrauterine growth retardation following third-trimester exposure to busulfan. Am J Obstet Gynecol. 1977, 129 (1): 111-112.CrossRefPubMed
13.
go back to reference Chocair P, Duley J, Simmonds HA, Cameron JS, Ianhez L, Arap S, Sabbaga E: Low-dose allopurinol plus azathioprine/cyclosporin/prednisolone, a novel immunosuppressive regimen. Lancet. 1993, 342: 83-84. 10.1016/0140-6736(93)91287-V.CrossRefPubMed Chocair P, Duley J, Simmonds HA, Cameron JS, Ianhez L, Arap S, Sabbaga E: Low-dose allopurinol plus azathioprine/cyclosporin/prednisolone, a novel immunosuppressive regimen. Lancet. 1993, 342: 83-84. 10.1016/0140-6736(93)91287-V.CrossRefPubMed
14.
go back to reference Sparrow MP, Hande SA, Friedman S, Cao D, Hanauer SB: Effect of allopurinol on clinical outcomes in inflammatory bowel disease nonresponders to azathioprine or 6-mercaptopurine. Clin Gastroenterol Hepatol. 2007, 5 (2): 209-214. 10.1016/j.cgh.2006.11.020.CrossRefPubMed Sparrow MP, Hande SA, Friedman S, Cao D, Hanauer SB: Effect of allopurinol on clinical outcomes in inflammatory bowel disease nonresponders to azathioprine or 6-mercaptopurine. Clin Gastroenterol Hepatol. 2007, 5 (2): 209-214. 10.1016/j.cgh.2006.11.020.CrossRefPubMed
15.
go back to reference Gearry RB, Day AS, Barclay ML, Leong RW, Sparrow MP: Azathioprine and Allopurinol: a two-edged interaction. J Gastroenterol Hepatol. 2010, 25 (4): 653-655. 10.1111/j.1440-1746.2010.06254.x.CrossRefPubMed Gearry RB, Day AS, Barclay ML, Leong RW, Sparrow MP: Azathioprine and Allopurinol: a two-edged interaction. J Gastroenterol Hepatol. 2010, 25 (4): 653-655. 10.1111/j.1440-1746.2010.06254.x.CrossRefPubMed
16.
go back to reference Cornish J, Tan E, Teare J, Teoh TG, Rai R, Clark SK, Tekkis PP: A meta-analysis on the influence of inflammatory bowel disease on pregnancy. Gut. 2007, 56 (6): 830-837. 10.1136/gut.2006.108324.CrossRefPubMed Cornish J, Tan E, Teare J, Teoh TG, Rai R, Clark SK, Tekkis PP: A meta-analysis on the influence of inflammatory bowel disease on pregnancy. Gut. 2007, 56 (6): 830-837. 10.1136/gut.2006.108324.CrossRefPubMed
17.
go back to reference Mahadevan U, Sandborn WJ, Li DK, Hakimian S, Kane S, Corley DA: Pregnancy outcomes in women with inflammatory bowel disease: a large community-based study from Northern California. Gastroenterology. 2007, 133 (4): 1106-1112. 10.1053/j.gastro.2007.07.019.CrossRefPubMed Mahadevan U, Sandborn WJ, Li DK, Hakimian S, Kane S, Corley DA: Pregnancy outcomes in women with inflammatory bowel disease: a large community-based study from Northern California. Gastroenterology. 2007, 133 (4): 1106-1112. 10.1053/j.gastro.2007.07.019.CrossRefPubMed
18.
go back to reference Hanan IM, Kirsner JB: Inflammatory bowel disease in the pregnant woman. Clin Perinatol. 1985, 12 (3): 669-682.PubMed Hanan IM, Kirsner JB: Inflammatory bowel disease in the pregnant woman. Clin Perinatol. 1985, 12 (3): 669-682.PubMed
19.
go back to reference Akbari M, Shah S, Velayos FS, Mahadevan U, Cheifetz AS: Systematic review and meta-analysis on the effects of thiopurines on birth outcomes from female and male patients with inflammatory bowel disease. Inflamm Bowel Dis. 2013, 19 (1): 15-22. 10.1002/ibd.22948.CrossRefPubMed Akbari M, Shah S, Velayos FS, Mahadevan U, Cheifetz AS: Systematic review and meta-analysis on the effects of thiopurines on birth outcomes from female and male patients with inflammatory bowel disease. Inflamm Bowel Dis. 2013, 19 (1): 15-22. 10.1002/ibd.22948.CrossRefPubMed
20.
go back to reference Francella A, Dyan A, Bodian C, Rubin P, Chapman M, Present DH: The safety of 6-mercaptopurine for childbearing patients with inflammatory bowel disease: a retrospective cohort study. Gastroenterology. 2003, 124 (1): 9-17. 10.1053/gast.2003.50014.CrossRefPubMed Francella A, Dyan A, Bodian C, Rubin P, Chapman M, Present DH: The safety of 6-mercaptopurine for childbearing patients with inflammatory bowel disease: a retrospective cohort study. Gastroenterology. 2003, 124 (1): 9-17. 10.1053/gast.2003.50014.CrossRefPubMed
21.
go back to reference Alstead EM, Ritchie JK, Lennard-Jones JE, Farthing MJ, Clark ML: Safety of azathioprine in pregnancy in inflammatory bowel disease. Gastroenterology. 1990, 99 (2): 443-446.CrossRefPubMed Alstead EM, Ritchie JK, Lennard-Jones JE, Farthing MJ, Clark ML: Safety of azathioprine in pregnancy in inflammatory bowel disease. Gastroenterology. 1990, 99 (2): 443-446.CrossRefPubMed
22.
go back to reference Jharap B, de Boer NK, Stokkers P, Hommes DW, Oldenburg B, Dijkstra G, van der Woude CJ, de Jong DJ, Mulder CJ, van Elburg RM, van Bodegraven AA: Intrauterine exposure and pharmacology of conventional thiopurine therapy in pregnant patients with inflammatory bowel disease. Gut. 2013, Published Online First: February 19. doi:10.1136/gutjnl-2012-303615 Jharap B, de Boer NK, Stokkers P, Hommes DW, Oldenburg B, Dijkstra G, van der Woude CJ, de Jong DJ, Mulder CJ, van Elburg RM, van Bodegraven AA: Intrauterine exposure and pharmacology of conventional thiopurine therapy in pregnant patients with inflammatory bowel disease. Gut. 2013, Published Online First: February 19. doi:10.1136/gutjnl-2012-303615
Metadata
Title
Allopurinol use in pregnancy in three women with inflammatory bowel disease: safety and outcomes: a case series
Authors
Muhammad W Fazal
Matt P Doogue
Rupert W Leong
Peter A Bampton
Jane M Andrews
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Gastroenterology / Issue 1/2013
Electronic ISSN: 1471-230X
DOI
https://doi.org/10.1186/1471-230X-13-172

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