Propylthiouracil Drug

A Drug Study Presented to

the Faculty of the Nursing Department
_______________________________, RN

In Partial Fulfilment of
the Requirements in NCM 212–RLE
IMMUNOLOGIC RESPONSE/CANCER NURSING ROTATION

By

_________________________, St. N
November 12, 2020
Generic Name Propylthiouracil

Brand Name PTU

Classification Pharmacologic classification: thyroid hormone antagonist

Therapeutic classification: antihyperthyroid

Mode of Action Propylthiouracil binds to thyroid peroxidase and thereby inhibits the
conversion of iodide to iodine. Thyroid peroxidase normally
converts iodide to iodine (via hydrogen peroxide as a cofactor) and
also catalyzes the incorporation of the resulting iodide molecule
onto both the 3 and/or 5 positions of the phenol rings of tyrosines
found in thyroglobulin. Thyroglobulin is degraded to produce
thyroxine (T4) and tri-iodothyronine (T3), which are the main
hormones produced by the thyroid gland. Therefore propylthiouracil
effectively inhibits the production of new thyroid hormones.

Dose / Route  PO (Adults): 100 mg every 8 hr; may be ↑ to 400 mg/day

(occasional patient may require 600–900 mg/day); usual
maintenance dose = 100–150 mg/day.
 PO (Children  >10 yr): 50–300 mg/day given once daily or in 2–4
divided doses.
 PO (Children  6–10 yr): 50–150 mg/day given once daily or in 2–
4 divided doses.

Indication Propylthiouracil is indicated:

 • To patients who have Graves’ disease with hyperthyroidism or
toxic multinodular goiter who are intolerant of methimazole and for
whom surgery or radioactive iodine therapy is not an appropriate
treatment option
• To ameliorate symptoms of hyperthyroidism in preparation for
thyroidectomy or radioactive iodine therapy in patients who are
intolerant of methimazole

Contraindication Contraindicated in:

 Hypersensitivity.
Use Cautiously in:
 ↓ bone marrow reserve;
 OB: May be used during 1st trimester (consider using
methimazole during 2nd and 3rd trimesters); however, fetus
may develop thyroid problems; mother and fetus may be at ↑
risk for hepatotoxicity;
 Lactation: Enters breast milk (safety not established);
 Geri: May have ↑ sensitivity; should initiate therapy with
lowest dose;
 Pedi: Children <6 yr (safety not established); not
recommended unless methimazole not tolerated and surgery
or radioactive iodine therapy not appropriate.

Side Effects Dermatologic: erythema nodosum, exfoliative dermatitis, urticaria,

skin ulcers, skin rash, alopecia, Stevens-Johnson syndrome, toxic
epidermal necrolysis
Renal: acute kidney injury, acute interstitial nephritis
Gastrointestinal: loss of taste, taste perversion, nausea, vomiting,
stomach pain, sialadenopathy
Neurological: neuritis, headache, paresthesia, drowsiness, vertigo
Hematological: lymphadenopathy, splenomegaly, leukopenia,
aplastic anemia, lymphadenopathy, hemorrhage,
hypoprothrombinemia
Respiratory: pulmonary alveolar hemorrhage, interstitial
pneumonitis
Drug fever
 Lupus-like syndrome

Adverse Effects  Earliest sign of toxicity (4–8 days after beginning therapy) is
stomatitis (dry mouth, burning sensation, mucosal erythema,
 Hypothyroidism: PTU can lead to hypothyroidism- weight
gain, constipation, or drowsiness. Hence, routine monitoring of
TSH and T4 is necessary to maintain the euthyroid state.

CNS: fever.
GU: nephritis.
Hematologic: agranulocytosis, thrombocytopenia, aplastic anemia,
leukopenia.
Hepatic: jaundice, hepatotoxicity, hepatitis.
Metabolic: altered selenomethionine levels and liothyronine
uptake, dose-related hypothyroidism (mental depression;
hypoprothrombinemia and bleeding; cold intolerance; hard,
nonpitting edema).
Skin: rash, urticaria, skin discoloration, pruritus, erythema
nodosum, exfoliative dermatitis, lupuslike syndrome.
Other: lymphadenopathy.

Drug  DRUG: May increase concentration of digoxin (As pt becomes

Interactions euthyroid). May increase effect of oral anticoagulants (e.g.,
apixaban, warfarin)
 HERBAL: None significant
 FOOD: None known.
 LAB VALUES: May increase LDH, serum alkaline
phosphatase, bilirubin, ALT, AST, prothrombin time.
 Additive bone marrow depression with  antineoplastics  or
radiation therapy.
 Additive antithyroid effects with lithium, or  potassium iodide.
 ↑ risk of agranulocytosis with  phenothiazines.
  Coumarins (oral): PTU inhibits vitamin K activity and hence
increases the effects of oral anticoagulants. Therefore, PT/INR
monitoring is necessary for such patients.
 Beta-blockers, digitalis, and theophylline: In a patient with
hyperthyroidism, there is an increased clearance of these
drugs. When the patient becomes euthyroid, a decrease in the
dose of beta-blockers and theophylline is required.

Nursing Assessment
Responsibilities  Obtain baseline weight, pulse. Obtain T3, T4, TSH level,
LFT.
 Monitor response of symptoms of hyperthyroidism or
thyrotoxicosis (tachycardia, palpitations, nervousness,
insomnia, fever, diaphoresis, heat intolerance, tremors,
weight loss, diarrhea).
 Assess patient for development of hypothyroidism
(intolerance to cold, constipation, dry skin, headache,
listlessness, tiredness, or weakness). Dose adjustment may
be required.
 Assess patient for skin rash or swelling of cervical lymph
nodes. Treatment may be discontinued if this occurs.

Interventions
 Monitor pulse, weight daily.
 Check for skin eruptions, pruritus, swollen lymph glands.
 Be alert for signs, symptoms of hepatic injury, hepatitis
(Nausea, vomiting, drowsiness, jaundice)
 Monitor hematology results for bone marrow suppression;
Observe for signs of infection, bleeding.
 Do not confuse propylthiouracil with Purinethol
(mercaptopurine).
 Can be compounded by pharmacist into enema or
suppository.
 PO Administer at same time in relation to meals every day.
Food may either increase or decrease absorption.
 Patient/Family teaching
 Space doses evenly around the clock
 Take resting pulse daily, report if pulse rate less than 60
beats/min.
 Seafood, iodine products may be restricted
 Report sudden or continuous weight gain, cold intolerance,
depression.
 Instruct patient to take medication exactly as directed,
around the clock. If a dose is missed, take as soon as
remembered; take both doses together if almost time for
next dose; check with health care professional if more than 1
dose is missed. Consult health care professional prior to
discontinuing medication.
 Instruct patient to monitor weight 2–3 times weekly. Report
significant changes.
 Caution patient to avoid driving or other activities requiring
alertness until response to medication is known. May cause
drowsiness.
 Advise patient to report sore throat, fever, chills, headache,
malaise, weakness, yellowing of eyes or skin, unusual
bleeding or bruising, symptoms of hyperthyroidism or
hypothyroidism, or rash to health care professional promptly.
 Advise patient to notify health care professional of all Rx or
OTC medications, vitamins, or herbal products being taken
and to consult with health care professional before taking
other medications.
 Advise patient to carry identification describing medication
regimen at all times and to notify health care professional of
medication regimen prior to treatment or surgery.
 Advise female patient to notify health care professional if
pregnancy is planned or suspected or if breast feeding.
 Emphasize the importance of routine exams to monitor
progress and to check for side effects.

References

Kozier, R.J., Hodgson, K.J., & EBSCO Publishing. (2019). Fluorouracil. Saunders
 nursing drug handbook 2019. St. Louis, Missouri: Elsevier.

RNpedia. (2020). Antineoplastic drugs nursing considerations & management.

Retrieved September 3, 2020 from https://www.rnpedia.com.

RxList. (2020). Adrucil. Retrieved September 3, 2020 from https://www.rxlist.com.

Wolters Kluwer. (2017). Fluorouracil. Nursing 2017 drug handbook (37th ed.).
Philadelphia, PA: Author.