Allopurinol

0 Views • 08/17/25

Side Effects

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Generally prescribed as a treatment for gout, Zyloprim sold generically as allopurinol should not be routinely used to lower asymptomatic levels of serum uric acid. Even more than 50 years since its introduction to our medicine cabinets, no other compound surpasses allopurinol in preventing acute gouty attacks or accumulations of excess uric acid in the skin, joints, or kidney.

Controversy surrounds when to begin therapy. Traditional recommendations suggest withholding treatment until 4-6 weeks after an attack of gout subsides. Current statements from the American College of Rheumatology find no justification to delay instituting therapy. This contrasts to the British Society of Rheumatology that adheres to the more conservative approach.

Not to be outdone, the American College of Physicians does not believe an occasional attack of gout necessarily warrants treatment with a drug with so many potential adverse effects. They propose shared decision making in the presence of two or more attacks a year.

Allopurinol also helps prevent uric acid kidney stones and at times also assists in minimizing the recurrence of mixed calcium oxalate stones. The drug may reduce complications from massive release of uric acid associated with the treatment of certain blood cancers.

Basically the goal in gout involves maintaining the uric acid concentration at less than 6 mg/dl. Unfortunately the recommended dose of allopurinol often fails to achieve this standard. Doctors seem hesitant to increase the amount beyond 300 mg even though rheumatology guidelines suggest up to 900 mg/day in divided doses may be necessary and appropriate.

During the first months after beginning a course of allopurinol, gout actually tends to flare. To minimize this, most patients are advised to add a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen or naproxen. In the past colchicine was popular, but has recently fallen out of favor due to its dramatic price escalation.

Side effects due to allopurinol occur more frequently than with most other medicines. An accompanying skin rash may be benign but also may herald the onset of a hypersensitivity reaction capable of damaging the liver, kidneys and marrow and at times resulting in death. Severe reactions occur more frequently in those of Chinese or Thai descent.

Any skin eruption while on the drug must promptly be brought to the attention of a health care practitioner.

Allopurinol interacts with a large number of other prescription medicines. In those receiving allopurinol the dose of Imuran or azathioprine - a drug for Crohn’s disease, ulcerative colitis, rheumatoid arthritis and psoriasis - must be reduced by about 75%. When combined with ampicillin or amoxicillin a widespread but relatively harmless skin rash typically develops.

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