ALLOPURINOL

Xanthine-oxidase inhibitor which reduces production of uric acid.

Dosage Forms

Tablet

100 mg

Uses

  • Prophylaxis of gout
  • Prophylaxis of hyperuricaemia associated with cancer chemotherapy
  • Prophylaxis of hyperuricaemic nephropathy
  • Enzyme disorders that lead to overproduction of urate e.g. Lesch-Nyhan syndrome

Dose and Duration

Prophylaxis of gout, hyperuricaemic nephropathy, over production of urate
Adult: initially 100 mg daily after food; then increase by 100 mg weekly according to plasma or urinary uric acid levels to a daily maintenance dose of 100–900 mg (mild conditions 100–200 mg daily, in moderate conditions 300–600 mg daily, in severe conditions 700–900 mg dai ly). Give doses above 300 mg in divided doses
Prophylaxis of hyperuricaemia associated with cancer
Adult: Maintenance doses same as above. Adjust dose according to response. Start treatment 24 hours before chemotherapy and continue for 7–10 days there after
Child 1 month–15 years: 10–20 mg/kg daily (max 400 mg per day) after food
Note: In moderate renal impairment, reduce dose to100 200 mg; in severe renal impairment, use maximum 100 mg daily

Contraindications

  • Known hypersensitivity to allopurinol
  • Treatment of an acute gout attack

Side Effects

  • Gastrointestinal disorders
  • Rash, Stevens-Johnson syndrome
  • Toxic epidermal necrolysis
  • Haemolytic anaemia

Interactions

  • Azathioprine (increased effects/toxicity of azathioprine)
  • Didanosine (increased plasma concentration of didanosine)
  • Mercaptopurine (increased toxicity of mercaptopurine)

Patient Instructions

  • Take at least 2–3 litres of water daily
  • Take medication after food
  • May impair ability to operate machinery or drive

Pregnancy

  • Can be used

Breastfeeding

  • Can be used

⚠️ Caution

  • Reduce dose in hepatic impairment
  • Withdraw treatment if rash occurs and reintroduce it if rash is mild: discontinue promptly if rash recurs
  • Delay treatment until an acute attack has completely subsided (i.e. 2–3 weeks after the acute attack)
  • Initiation of allopurinol may precipitate an acute attack of gout: use together with a suitable NSAID (not a salicylate or ibuprofen), or colchicine and continue for at least 1 month after correction of hyperuricaemia
  • Treat acute attacks that develop during treatment with out interrupting treatment with allopurinol