Lanvis (Tioguanine)

Lanvis (tioguanine) acts on rapidly dividing cells and is indicated for several hematologic and immune‑mediated conditions.

• Acute lymphoblastic leukemia: reduces leukemic blast proliferation and supports remission induction.
• Chronic myeloid leukemia: contributes to disease control in combination therapy regimens.
• Immunosuppression after organ transplantation: helps prevent graft rejection by inhibiting immune cell activation.
• Inflammatory bowel disease: provides therapeutic benefit in refractory cases by modulating inflammatory pathways.

• Tioguanine is a purine analog that is metabolized intracellularly to thioguanine nucleotides. These fraudulent nucleotides become incorporated into DNA and RNA, disrupting normal purine synthesis. The incorporation interferes with nucleic acid function, leading to inhibition of cell proliferation and induction of cytotoxicity in rapidly dividing cells, such as malignant lymphoblasts and activated immune cells. The resulting DNA damage triggers apoptosis, contributing to its antineoplastic and immunosuppressive effects.

Tioguanine may cause a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Nausea
• Vomiting
• Diarrhea
• Myelosuppression (low blood cell counts)

Serious or Rare Side Effects

• Hepatotoxicity (liver enzyme elevation)
• Pancreatitis
• Secondary malignancies (e.g., myelodysplastic syndrome)

Before initiating Lanvis, several safety considerations should be addressed.

• Blood count monitoring: perform baseline and regular CBC to detect myelosuppression.
• Liver function assessment: evaluate hepatic enzymes prior to therapy and periodically thereafter.
• Renal function evaluation: adjust use in patients with impaired kidney function.
• Infection risk management: avoid initiating therapy in the presence of active infections.
• Contraception use: advise patients of reproductive age to use effective contraception during treatment and for a defined period after discontinuation.
• Store at room temperature: keep in the original packaging, protect from moisture and direct sunlight.

Tioguanine can interact with other medicines, altering its efficacy or toxicity.

Major Interactions (Avoid)

• Allopurinol: co‑administration increases risk of severe bone marrow suppression.
• Azathioprine: combined use may result in additive myelosuppressive effects.
• Warfarin: tioguanine may potentiate anticoagulant activity, increasing bleeding risk.

Moderate Interactions (Monitor Closely)

• Xanthine oxidase inhibitors (e.g., febuxostat): may modestly raise thioguanine nucleotide levels.
• Non‑steroidal anti‑inflammatory drugs (NSAIDs): can affect renal function and platelet counts.
• Live vaccines: immunosuppression may reduce vaccine efficacy and increase infection risk.