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Allopurinol

METABOLISM

ANTIGOUT DRUGS - [ METABOLISM ]

Allopurinol inhibits xanthine oxidase and prevents the synthesis of urate from hypoxanthine and xanthine. Allopurinol facilitates the dissolution of tophi and prevents the development or progression of chronic gouty arthritis by lowering the uric acid concentration in plasma below the limit of its solubility. (1)

1. Primary or secondary gout (acute attacks, tophi, joint destruction, uric acid lithiasis, and/or nephropathy). 2. Leukemia, lymphoma and malignancies who are receiving cancer therapy. 3. Recurrent calcium oxalate calculi whose daily uric acid excretion exceeds 800 mg/day in male patients and 750 mg/day in female patients. (2)

Development of a severe reaction to allopurinol tablet Acute gout; If an acute attack occurs while receiving allopurinol, continue prophylaxis and treat attack separately. (2,3)

Rash Hepatitis Renal impairment. Hypersensitivity (rare): fever, lymphadenopathy¸ arthralgia, eosinophilia, erythema multiforme (Stevens-Johnson syndrome) or toxic epidermal necrolysis, vasculitis (2,3)

Mercaptopurine, azathioprine: Dose reduction of these drugs required as per therapeutic response and occurrence of side- effects Dicumarol: Increase in concentration with allopurinol Ampicillin and amoxicillin: Increase in the frequency of skin rashes Chlorpropamide: Increased half- life due to allopurinol (2)

Lower doses recommended in individuals with decreased renal fuction (2)

Adult: Initially 100 mg daily after food, thereafter adjust according to uric acid concentration. (Usual maintenance dose in mild conditions: 100 to 200 mg daily, in moderately severe condition: 300 mg daily given in divided doses). Children: Neoplastic conditions and enzyme disorders:10 to 20 mg/kg daily (max. 400 mg). (2,3)

1. Grosser T, Smyth E, FitzGerald G. Anti-inflammatory, Antipyretic, and Analgesic Agents; Pharmacotherapy of Gout. In: Brunton L, Chabner B, Knollmann B eds. Goodman & Gilman’s The Pharmacological basis of Therapeutics. 12th ed. USA: McGraw Hill; 2011: 959- 1004 2. Allopurinol (allopurinol tablet) [Internet]. [cited 2013 Oct 20]. Available from: http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=682dd8b8-fc6e-47c5-95b7-82d7ad96b750#nlm34068-7 3. National Formulary of India. 4th ed. Government of India, Ministry of Health and Family Welfare. India: Indian Pharmacopoeia Commission; 2011.