Practical aspects of using allopurinol

Severe adverse reactions seem to be related to poor renal function:

• check creatinine before initiating therapy
• obtain consultant advice if creatinine is raised
• monitor uric acid and creatinine 4 weekly as allopurinol is increased
• check uric acid and creatinine yearly
• start with 100mg daily, increase dose over 2-3 months
• if minor side effects such as rash occur, stop therapy and consider reintroducing at a lower dose and increasing slowly
• initiation of prophylactic therapy may provoke an acute gout attack and so an NSAID or colchicine should be given concomitantly for at least the first 3 months
• prophylactic therapy should not be started during an acute attack because it can prolong symptoms
• if an acute attack occurs during prophylactic treatment, this should be continued at the same dose while the acute attack is treated with an NSAID or colchicine

The summary of product characteristics should be consulted before prescribing this drug.

Reference:

1. Drug and Therapeutics Bulletin (2004); 42(5):37-40.
2. BMJ (1987); 294: 1504-1505