This has been confirmed in human trials, where thioguanine has proven to be safe but efficacious for coeliac disease when used at doses below those commonly prescribed. This has led to a revival of interest in thioguanine because of its higher efficacy and faster action compared to other thiopurines and immunosuppressants such as mycophenylate. Contraindications
Pregnancy
Lactation: The safety warning against breastfeeding may have been a conservative assessment, but research evidence suggests that thiopurines do not enter breastmilk. Interactions
Cancers that do not respond to treatment with mercaptopurine do not respond to thioguanine. On the other hand, some cases of IBD that are resistant to mercaptopurine (or its pro-drug azathioprine) may be responsive to thioguanine. Pharmacogenetics
The enzyme thiopurine S-methyltransferase (TPMT) is responsible for the direct inactivation of thioguanine to its methylthioguanine base – this methylation prevents thioguanine from further conversion into active, cytotoxic thioguanine nucleotide (TGN) metabolites. Certain genetic variations within the TPMT gene can lead to decreased or absent TPMT enzyme activity, and individuals who are homozygous or heterozygous for these types of genetic variations may have increased levels of TGN metabolites and an increased risk of severe bone marrow suppression (myelosuppression) when receiving thioguanine. In many ethnicities, TPMT polymorphisms that result in decreased or absent TPMT activity occur with a frequency of approximately 5%, meaning that about 0.25% of patients are homozygous for these variants.
Examples
Stephen Akinmurele
Juana Barraza
Kenneth Erskine
Dana Sue Gray
Delroy Grant
Reta Mays
Thierry Paulin
Kaspars Petrovs
Dorothea Puente
Irina Gaidamachuk
John Wayne Glover
Charles Rogers (murder suspect)
Murder of Esther Brown
Murder of Valerie Graves
Murder of Patricia OConnor
Murder of Janie Perrin
Murders of William and Patricia Wycherley
Sereni Orizzonti

See also
References
Further reading
Nerenberg, Lisa Elder Abuse Prevention: Emerging Trends and Promising Strategies (2007)

External links
World Health Organization website
https://ncea.acl.gov/whatwedo/research/statistics.html
National Center on Elder Abuse (NCEA)
Senior Abuse Awareness & Prevention Infographic
End of Life Care – Dying with Dignity at Home
Elder abuse Centers for Disease Control and Prevention