Allopurinol: Effective Uric Acid Control for Gout Management
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Synonyms
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Allopurinol is a xanthine oxidase inhibitor prescribed for the long-term management of hyperuricemia and its complications, most notably gout. It works by reducing the production of uric acid in the body, thereby preventing the formation of urate crystals that deposit in joints and tissues. This medication is a cornerstone therapy for chronic gout, tophi, and uric acid nephrolithiasis, and is also used as prophylaxis during chemotherapy to prevent tumor lysis syndrome. Proper dosing and monitoring are essential for efficacy and minimizing adverse effects.
Features
- Active ingredient: Allopurinol
- Drug class: Xanthine oxidase inhibitor
- Available forms: Oral tablets (100 mg, 300 mg)
- Prescription status: Requires medical prescription
- Mechanism: Inhibits xanthine oxidase, reducing uric acid synthesis
Benefits
- Prevents acute gout attacks by maintaining serum uric acid below saturation point
- Reduces formation and promotes resolution of gouty tophi
- Decreases risk of uric acid kidney stone formation
- Allows for long-term management of hyperuricemia with once-daily dosing
- May prevent uric acid nephropathy during cytotoxic therapy
- Reduces joint damage and disability from chronic gouty arthritis
Common use
Allopurinol is primarily indicated for the management of:
- Chronic gouty arthritis with frequent attacks, tophi, or radiographic evidence of joint involvement
- Hyperuricemia secondary to malignancies (prophylaxis of uric acid nephropathy during chemotherapy)
- Recurrent uric acid stone formation
- Hyperuricemia associated with Lesch-Nyhan syndrome
It is not indicated for the treatment of asymptomatic hyperuricemia unless the patient is undergoing cancer chemotherapy with a high risk of tumor lysis syndrome.
Dosage and direction
Initial dose: 100 mg once daily, increased weekly by 100 mg until target serum uric acid is achieved (typically <6 mg/dL) Maintenance dose: 200-600 mg daily for mild gout; 400-800 mg daily for severe gout Maximum dose: 800 mg daily (divided doses if >300 mg) Dosing consideration: Reduce dose in renal impairment (e.g., 100 mg daily or every other day for CrCl <20 mL/min) Administration: Take with food or milk to minimize gastric upset; maintain adequate hydration (2-3 L fluid daily)
Dose titration should be gradual to avoid precipitating acute gout attacks. Concomitant NSAID or colchicine prophylaxis is recommended during the first 3-6 months of therapy.
Precautions
- Initiate therapy only after acute gout attack has completely resolved
- Monitor serum uric acid levels regularly (target <6 mg/dL)
- Assess renal function and liver enzymes at baseline and periodically during treatment
- Use with caution in patients with hepatic impairment or history of alcohol abuse
- May cause drowsiness; caution when operating machinery
- Screen for HLA-B*5801 allele in patients of Asian descent (higher risk of severe hypersensitivity)
Contraindications
- Hypersensitivity to allopurinol or any component of the formulation
- Patients who have experienced previous severe allopurinol hypersensitivity reaction
- Asymptomatic hyperuricemia (except during chemotherapy)
- Concurrent use with didanosine
Possible side effect
Common (≥1%):
- Rash (maculopapular)
- Nausea, vomiting, diarrhea
- Elevated liver enzymes
- Drowsiness, headache
Serious (<1% but require immediate medical attention):
- Severe hypersensitivity reactions (DRESS syndrome, Stevens-Johnson syndrome, toxic epidermal necrolysis)
- Hepatitis, hepatotoxicity
- Eosinophilia, leukopenia, thrombocytopenia, agranulocytosis
- Acute renal failure
- Vasculitis
Drug interaction
- Azathioprine/6-mercaptopurine: Allopurinol inhibits metabolism, requiring 65-75% dose reduction
- Warfarin: Enhanced anticoagulant effect; monitor INR closely
- Diuretics: May decrease allopurinol efficacy and increase hypersensitivity risk
- Ampicillin/amoxicillin: Increased incidence of skin rash
- Theophylline: Increased serum levels; monitoring recommended
- Cyclosporine: Possible increased cyclosporine toxicity
Missed dose
If a dose is missed, take it as soon as remembered unless it is almost time for the next dose. Do not double the dose to make up for a missed one. Maintain regular dosing schedule to ensure consistent uric acid control.
Overdose
Symptoms may include nausea, vomiting, diarrhea, and dizziness. In massive overdose, hepatic toxicity, acute renal failure, and bone marrow suppression may occur. Management is supportive with gastric lavage if presented early. Hemodialysis may be effective due to allopurinol’s dialyzability. Contact poison control center immediately.
Storage
Store at room temperature (15-30°C/59-86°F) in original container. Protect from light and moisture. Keep out of reach of children. Do not use after expiration date.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Allopurinol requires prescription and medical supervision. Consult your healthcare provider for proper diagnosis, dosing, and monitoring. Do not initiate or discontinue therapy without professional guidance.
Reviews
“After six months of allopurinol therapy, my serum uric acid normalized from 9.2 to 5.1 mg/dL. No gout attacks in the past four months despite initial flare-ups during titration.” - Male, 52, chronic gout
“Effective for chemotherapy-associated hyperuricemia prevention. Required careful monitoring but prevented nephropathy during aggressive treatment.” - Oncologist
“Patient experienced severe hypersensitivity reaction requiring hospitalization. Genetic testing revealed HLA-B*5801 positivity. underscores need for pre-screening in high-risk populations.” - Rheumatologist