Allopurinol

By: Esraa Sahim Salim

Allopurinol is a first-line agent for gout prevention, which is a type of

arthritis caused by a build up of uric acid crystals in the joints.
Allopurinol works by reducing the amount of uric acid made by cells.
This helps prevent uric acid crystals building up in the joints and
therefore helps prevent joints becoming swollen and painful.

Allopurinol Tablets are used to treat the following conditions:

Gout (increased uric acid quantity in the body). The uric acid builds
up in your joints and tendons as crystals causing an inflammatory
reaction. The inflammation causes the skin around certain joints to
become swollen, tender and sore when only slightly touched. You may
also get severe pain when the joint is moved.

Kidney stones formation and certain other types of kidney diseases due
to increase in the

amount of uric acid in the body

Some types of Cancer due to increase in the amount of uric acid in the
body

Enzyme disorders due to increase in the amount of uric acid in the

body

What are the benefits can be expected from allopurinol treatment?

Allopurinol is taken on a long-term basis to prevent attacks of gout. The

treatment also helps to prevent permanent damage to the joints. It does
not treat the pain or inflammation of an 'attack' of gout and it is not
normally started during a sudden attack. Allopurinol does not work
straight away. It may take several weeks to reduce the level of uric acid
so the patient may continue to have gout attacks for some time.

Dose
Adults: The initial dose is usually 100mg daily, after food, but this can be
gradually increased over one to three weeks according to the levels of
uric acid in your blood and urine. The following dosages are
administered depending on the severity of the disease.

100 mg to 200mg average daily dose for mild gout

033 to 600mg daily for moderately severe gout

033to 900mg daily for severe gout

Patients with liver disease: The dose may need to be reduced.

Patients with kidney disease: The dose may be reduced to less than
100mg daily. After dialysis single dose of 300 to 400mg may be given.

Elderly: need a reduced dose.

Treatment of high uric acid levels in chemotherapy: Treatment

commences from one to two days before chemotherapy and take 600 to
800mg daily in divided doses for 2 to 3 days. The maintenance dose is
then decided depending on the response to treatment.

Note: Allopurinol should not be started during an acute gout attack.

Initiating urate- lowering therapy can mobilize urate deposits, which
may precipitate an attack. Thus most clinicians advocate a prophylactic
dose of colchicine (0.6 mg/day) during initiation of antihyperuricemic
therapy. NSAIDS can be used at a low dose if colchicine is
contraindicated. Combined treatment is continued until uric acid levels
return to normal or a maximum of 3 to 6 months.

Adverse effects: Mild adverse effects of allopurinol include skin rash,

GI problems, headache, and urticaria ).

More severe adverse reactions include severe rash and an allopurinol

hypersensitivity syndrome characterized by fever, vasculitis, renal and
hepatic dysfunction that occurs' rarely but is associated with a 20%
mortality rate.