Allopurinol Medication: Uses, Dosage, Side Effects & Interactions

Summary of Key Points

Allopurinol is a medication primarily used to lower uric acid levels in the body, helping to prevent conditions such as gout and kidney stones. It is also prescribed for managing hyperuricemia and tumor lysis syndrome. Patients should take Allopurinol exactly as directed by their healthcare provider, with regular monitoring as necessary. Side effects may occur, so it’s important to discuss any concerns with your doctor.

Names of Medication

US Brand Name: Zyloprim (Allopurinol)

The generic name refers to the active ingredient in the medication, listed in parentheses. Generic medications are often more affordable but work the same way as their brand-name counterparts.

Pharmacologic Category

Xanthine Oxidase Inhibitors

Allopurinol Dosage

Allopurinol is used to treat various conditions, and the dosage depends on the specific condition being treated. Always follow your healthcare provider’s instructions and consult them before making any changes to your dose. You can also consult one of our telemedicine providers for personalized advice.

Allopurinol for Gout Treatment

Initial dose: 100 mg once daily

Maintenance dose: 200-300 mg per day for mild gout, up to 800 mg per day for severe cases

Duration: Long-term treatment is typically required to prevent flare-ups

Hyperuricemia (High Uric Acid Levels)

Initial dose: 100 mg once daily

Maintenance dose: 200-600 mg per day, depending on uric acid levels

Duration: Treatment is generally long-term

Kidney Stones (Uric Acid Stones)

Initial dose: 200-300 mg per day

Duration: Long-term treatment to prevent recurrence

Tumor Lysis Syndrome

Initial dose: 600-800 mg per day, starting 2-3 days before chemotherapy

Duration: Continue during chemotherapy and adjust based on uric acid levels

Chronic Kidney Disease (CKD)

Initial dose: 100 mg once daily

Maintenance dose: Adjust based on kidney function and uric acid levels

Duration: Long-term treatment may be necessary

Psoriasis

Initial dose: 100 mg once daily

Maintenance dose: 300-600 mg per day, depending on response

Duration: Long-term treatment is often required

Rheumatoid Arthritis

Initial dose: 100 mg once daily

Maintenance dose: 200-300 mg per day, adjusted based on response

Duration: Long-term treatment is common

Systemic Lupus Erythematosus (SLE)

Initial dose: 100 mg once daily

Maintenance dose: 200-300 mg per day, adjusted based on response

Duration: Long-term treatment may be necessary

Hypertension

Initial dose: 100 mg once daily

Maintenance dose: 200-300 mg per day, depending on response

Duration: Long-term treatment may be required

Diabetes Mellitus

Initial dose: 100 mg once daily

Maintenance dose: 200-300 mg per day, adjusted based on response

Duration: Long-term treatment is often needed

Dosage Forms and Strengths

Tablets: 100 mg, 300 mg

Oral suspension: 200 mg/5 mL

Administration Instructions for Allopurinol

Allopurinol should be taken after meals to reduce the risk of stomach upset. It’s important to drink plenty of fluids while taking this medication to help prevent kidney stones. Do not crush or chew the tablets. If you miss a dose, take it as soon as you remember, but if it’s almost time for your next dose, skip the missed dose. Never double up on doses. Always follow your healthcare provider’s instructions carefully.

Contraindications for Allopurinol

A contraindication is a specific situation where a medication should not be used because it may cause harm. For Allopurinol, there are several conditions where taking the medication could be dangerous or lead to serious side effects.

1. Severe kidney disease: Allopurinol is processed by the kidneys. If your kidneys are not functioning well, the drug can accumulate in your body, leading to toxicity.
2. Hypersensitivity to Allopurinol: If you have had an allergic reaction to Allopurinol in the past, do not take it again, as this could lead to severe skin reactions or other allergic responses.
3. Acute gout attack: Allopurinol should not be started during an active gout flare. Starting it during a flare can worsen symptoms. It is typically used for long-term prevention of gout, not for treating acute attacks.
4. HLA-B*5801 positive patients: People with this genetic marker, often found in individuals of Asian descent, are at a higher risk of developing severe skin reactions to Allopurinol, such as Stevens-Johnson syndrome or toxic epidermal necrolysis.

Allopurinol Drug Interactions

Allopurinol can interact with other medications, potentially causing harmful effects or reducing the effectiveness of either drug. Here are some common medications that may interact with Allopurinol:

1. Azathioprine (Imuran): Allopurinol can increase azathioprine levels, leading to a higher risk of toxicity.
2. Mercaptopurine (Purinethol): Similar to azathioprine, Allopurinol can increase mercaptopurine levels, which may lead to bone marrow suppression.
3. Warfarin (Coumadin): Allopurinol may enhance the effects of warfarin, increasing the risk of bleeding.
4. Thiazide diuretics (Hydrochlorothiazide): These medications can increase the risk of hypersensitivity reactions to Allopurinol.
5. Ampicillin or Amoxicillin: Taking these antibiotics with Allopurinol may increase the risk of skin rashes.

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Allopurinol in Pregnancy

Is it safe to take Allopurinol when pregnant?

Allopurinol is classified as a Category C drug by the FDA, meaning there are not enough well-controlled studies in pregnant women to definitively determine its safety. While animal studies have shown some risk to the fetus, in certain situations, the potential benefits may outweigh the risks. If you are pregnant or planning to become pregnant, it’s essential to discuss with your healthcare provider whether Allopurinol is the right choice for you. Our telemedicine providers can help you evaluate the risks and benefits based on your individual circumstances.

Allopurinol while Breastfeeding

Is it safe to take Allopurinol while breastfeeding?

Allopurinol does pass into breast milk, but its effects on a nursing infant are not well understood. Some healthcare providers may consider it safe to continue breastfeeding while taking Allopurinol, while others may recommend switching to an alternative medication or discontinuing breastfeeding. If you are breastfeeding, it’s important to consult your healthcare provider to determine the best course of action for both you and your baby. Our telemedicine providers are available to help you explore your options.

Estimated Cost of Allopurinol Medication

The cost of Allopurinol can vary depending on the pharmacy and whether you have insurance. Without insurance, using a GoodRx coupon, the estimated cost for a 30-day supply of Allopurinol (100 mg tablets) typically ranges from $5 to $15. Prices may vary based on dosage and location, so it’s a good idea to check with your local pharmacy or use a coupon service like GoodRx for the most up-to-date pricing.

Possible Alternatives to Allopurinol

If Allopurinol is not the right medication for you, there are other treatment options and lifestyle changes that may help manage your condition. Always consult your healthcare provider before making any changes to your treatment plan. Our telemedicine providers can assist you in exploring these alternatives.

1. Gout: Alternatives include febuxostat (Uloric) or probenecid. Lifestyle modifications, such as reducing alcohol consumption, avoiding purine-rich foods (like red meat and seafood), and staying well-hydrated, can also help manage gout.
2. Hyperuricemia: In addition to febuxostat and probenecid, lifestyle changes such as weight loss, limiting sugary beverages, and increasing water intake can help lower uric acid levels.
3. Kidney stones: Potassium citrate or thiazide diuretics may be prescribed as alternatives. Drinking plenty of water and reducing salt intake can also help prevent kidney stones.
4. Tumor lysis syndrome: Rasburicase (Elitek) is another medication that can help manage uric acid levels in patients undergoing cancer treatment.
5. Chronic kidney disease: Managing blood pressure and blood sugar levels, along with reducing salt and protein intake, can help slow the progression of kidney disease. Medications like angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) may also be used.
6. Psoriasis: Alternatives include topical treatments, phototherapy, or systemic medications such as methotrexate or biologics.
7. Rheumatoid arthritis: Disease-modifying antirheumatic drugs (DMARDs) like methotrexate or biologics such as adalimumab (Humira) may be used instead of Allopurinol.
8. Systemic lupus erythematosus: Hydroxychloroquine (Plaquenil) or corticosteroids may be used to manage lupus symptoms. Lifestyle changes, such as avoiding sun exposure, can also be beneficial.
9. Hypertension: Medications like ACE inhibitors, ARBs, or calcium channel blockers may be used to manage high blood pressure. Reducing salt intake, exercising regularly, and maintaining a healthy weight are important lifestyle changes.
10. Diabetes mellitus: Managing blood sugar levels through diet, exercise, and medications like metformin or insulin is key. Weight loss and regular physical activity can also help improve blood sugar control.

Recent Updates on Allopurinol Research

Recent studies have explored potential benefits of Allopurinol beyond its traditional use for gout and hyperuricemia. Some research suggests that Allopurinol may help protect the kidneys in patients with chronic kidney disease, potentially slowing the progression of the disease. Additionally, ongoing research is investigating Allopurinol’s role in cardiovascular protection, as lowering uric acid levels may reduce the risk of heart disease in certain populations.

However, more large-scale clinical trials are needed to confirm these potential benefits. If you’re interested in learning more about how Allopurinol could impact your health, our telemedicine providers are available to discuss the latest research and how it may apply to your treatment plan.

James Kingsley

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