Allopurinol Oral Tablet Use With Other Drugs
Its common for doctors to prescribe other medications in combination with allopurinol oral tablets. This is because allopurinol doesnt provide immediate results. It can take days to begin working and weeks to lower your uric acid levels within a normal range.
The other drugs that you may take with allopurinol can vary with your condition. Below are a few examples for each condition that allopurinol oral tablets are approved to treat.
Allopurinol oral tablets may be used with other drugs for gout, including:
Allopurinol oral tablets may be used with other drugs for kidney stones that keep coming back, including:
- potassium citrate
Allopurinol may be used with other drugs to reduce uric acid levels due to certain cancer treatments , including:
Who Can Take Allopurinol
Allopurinol is often recommended as the first choice of treatment to control gout. If your doctor prescribes it as soon as you are diagnosed, it may prevent future attacks and joint damage.
You will usually be offered allopurinol if blood tests show that your urate level is high enough for urate crystals to form, especially if one or more of the following applies:
- you are having frequent attacks of gout.
- your joints have been damaged by gout.
- your skin has visible deposits of urate crystals. These are firm white lumps, which are called tophi.
You may not be offered allopurinol, or you may be given a lower dose, if you:
- have ever had an allergic reaction to allopurinol.
- are currently having an attack of gout.
- have problems with your liver or kidneys.
- are of Han Chinese, Thai or Korean origin.
- have thyroid problems.
Cardiovascular Events Hospitalizations And Death
There were two deaths in the control group and two patients required dialysis .
After a mean follow-up time of 23.4 ± 7.8 months, 22 patients suffered a cardiovascular event: 15 in the control group and seven in allopurinol group. Cardiovascular events were: 8 congestive heart failures, 7 ischemic coronary events, 5 cerebrovascular accidents, 1 peripheric arteriopathy, and 1 arrythmia. Kaplan-Meier survival showed that patients in the allopurinol group had lower cardiovascular risk than patients in the control group .
Effect of allopurinol treatment in cardiovascular events. Log rank: 4.25 P = 0.039.
Regression cox analysis adjusted for age, eGFR change, and UA levels showed that diabetes , CRP levels , and previous coronary arteriopathy increased the risk of cardiovascular events. Allopurinol treatment decreased the risk of cardiovascular events in 71% .
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Enhancing Healthcare Team Outcomes
Allopurinol is a relatively safe drug that has been used for over half a century. Still, recent studies in gout have shown significant underutilization of this agent and suboptimal dose use, insufficient to reach target serum uric acid concentrations in a considerable proportion of gout patients. A problem with allopurinol treatment for gout is therapy adherence. Emad Y. et al. found that the most common reason for lack of patient adherence to pharmacotherapy is: “patients wanting to lead a normal life.” This is an opportunity for healthcare professionals to improve pharmacotherapy adherence.
Contrary to the common belief, recent studies have shown that allopurinol is safe in severe chronic kidney disease and can impede the progression of renal disease in patients with gout and chronic kidney disease. Using allopurinol in patients with gout is also associated with lower all-cause mortality and other adverse cardiovascular events, including readmissions due to congestive heart failure. American College of Rheumatology recommends allopurinol as one of the first-line agents of urate-lowering therapy for gout management. Several studies report that allopurinol reduced cardiovascular events. However, research by Suissa S. et al. concludes that these studies contained time-related biases and, thus, allopurinol does not provide cardiovascular protection.
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Allopurinol Treatment And Progression Of Renal Disease
An elevated UA level has been associated with a greater incidence of end-stage renal disease. Hyperuricemia induces high BP, renal afferent arteriopathy, increased glomerular hydrostatic pressure, and renal scarring. Kang et al. found that hyperuricemic rats showed greater proteinuria, greater BP, and greater serum creatinine levels than controls that were treated with allopurinol to decrease serum UA levels.
In our study, we demonstrated that allopurinol is able to slow the progression of renal disease after a mean time of 23.4 ± 7.8 months. No changes in BP or in albuminuria induced by allopurinol have been observed. Although, there is a relationship between hypertension and hyperuricemia, it is not known whether lowering UA levels with allopurinol will be effective in people with longstanding hypertension. The only study that showed that allopurinol treatment reduces BP was performed in adolescent subjects with initial hypertension .
Recent studies suggest that lowering levels of UA may slow progression of renal disease, especially in patients with hyperuricemia. Kanbay et al. reported that treatment of asymptomatic hyperuricemia improved renal function . Likewise, Siu et al. reported that the treatment of asymptomatic hyeruricemia delayed disease progression . The results of our study are similar, but with more patients and a longer follow-up time.
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Drugs Used For Flares And Prophylaxis
For drugs used in the management of gout flares or flare prophylaxis when starting ULT , the efficacy outcomes of interest are resolution or prevention of gout flares, respectively. For this G-CAN Consensus Statement, safety outcomes for each drug were individualized. The specific issues identified with medications used for the management of gout flares and prophylaxis in people with CKD are discussed below, and the G-CAN-proposed research priorities are outlined in Box .
Should I Stop Taking Allopurinol During A Gout Attack
You should not stop taking allopurinol oral tablets during a gout attack. If you suddenly stop taking the drug, the uric acid level in your blood can rise. When your uric acid level is high, your gout symptoms may become worse.
If you have gout attacks during your treatment, talk with your doctor. They may be able to recommend other medications that could help. Keep in mind that you should not stop taking allopurinol oral tablets without first talking with your doctor.
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Allopurinol In Kidney Transplant Recipients
Hyperuricemia is common in kidney transplant recipients , with prevalence as high as 40% .The vast majority of KTRs, despite working allografts, have reduced kidney function, and immunosuppressive medications used to maintain KTRs, specifically calcineurin inhibitors, are associated with hyperuricemia, making KTRs a population at particularly high risk . In a recent meta-analysis, Huang et al. showed that hyperuricemia was a risk factor of chronic allograft nephropathy and graft loss . In an experimental rat study, Mazali et al. showed that increased serum uric acid exacerbated cyclosporine nephropathy, and these changes could be reversed or, if administered early, prevented with allopurinol or uricosuric drug administration. To the best of our knowledge, there is no clinical trial assessing safety and efficacy of allopurinol in KTRs to date. Critically, concerns do exist regarding the use of allopurinol in KTRs. These include appropriate dose reduction for reduced GFR and a potentially very serious drug interaction with azathioprine. Once the backbone of kidney transplant immunosuppression protocols, azathioprine is seldom used for this purpose nowadays. Moreover, recent studies have shown that the low-dose combination of azathioprine and allopurinol in patients with inflammatory bowel disease, who have an unfavorable tioguanine metabolite profile, is safe .
Dosage For Treating Gout
Your doctor will start you on a low dosage of allopurinol oral tablets for gout. This is typically 100 mg once daily.
After a week, your doctor may order a blood test to check your uric acid level. If its still high, theyll usually increase your dosage to 200 mg per day.
Your doctor will continue this pattern of checking your uric acid level and increasing your dosage once per week. When you reach the dosage that manages your uric acid level effectively, youll likely continue taking this dosage long term. You should keep taking your usual dosage during gout attacks.
For most people, the usual long-term dosage for gout is 200 mg to 600 mg per day. Your doctor will advise you on whether to take your dose once daily or split it up into two doses per day. The maximum daily dose of allopurinol is 800 mg.
Adjusted dosage for kidney disease
Your doctor may recommend a different dosage depending on several factors. This includes whether you have renal disease and the severity of it. Theyll typically prescribe a lower dosage of allopurinol than usual if you have kidney disease. This is called renal dosing.
If you have questions about the dosage thats right for you, talk with your doctor.
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How Does Allopurinol Prevent Tumor Lysis Syndrome
Following the initiation of chemotherapy, medications can be modified in response to the extent of tumor lysis and/or metabolic abnormalities. Allopurinol, a xanthine oxidase inhibitor, prevents urate nephropathy and eventual oliguric renal failure by reducing the conversion of nucleic acid byproducts to uric acid. Allopurinol is used for the prevention of tumor lysis syndrome in patients with cancer who are about to receive cytotoxic chemotherapy.
Tumor lysis syndrome is a life-threatening complication of cancer therapy. It occurs when the body destroys large numbers of cancer cells with drugs such as cisplatin or etoposide. The death of these cancer cells causes chemicals to be released into the blood. These chemicals can damage other parts of the body, especially the kidneys. TLS can occur without treatment but is more likely to happen if you have an existing kidney problem or are older than 60 years old.
Tumor lysis syndrome results from the release of DNA fragments and other toxic substances from dying tumors. Healthy bone marrow produces new red blood cells, white blood cells, and platelets to replace those destroyed by chemotherapy. However, it cannot produce enough new cells to replace all those lost due to cancer or chemotherapy. When this happens, patient’s blood counts become low which can lead to serious infections or even death.
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Does Ibuprofen Interact With Allopurinol
Theres no interaction between allopurinol oral tablets and ibuprofen. Its safe to take ibuprofen with allopurinol.
Ibuprofen is a nonsteroidal anti-inflammatory drug . Its commonly prescribed to ease the swelling and pain that occurs with gout, usually in your big toe. Your doctor may recommend that you take ibuprofen if youre also using allopurinol.
Keep in mind that if you take allopurinol, you should not use aspirin because it can prevent allopurinol from working as well as usual.
For more about allopurinol interactions, see the Allopurinol oral tablet interactions section above.
If you have other questions about what drugs you can take during your treatment with allopurinol oral tablets, talk with your doctor or pharmacist.
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Allopurinol And Other Medications
Below are examples of medications that can interact with allopurinol oral tablets. This section does not contain all drugs that may interact with allopurinol.
Before taking allopurinol oral tablets, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.
If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.
Drugs that can affect how allopurinol oral tablets work include:
- Salicylates, which can cause the opposite effect of allopurinol and prevent it from lowering uric acid levels. Examples of these drugs include:
- bismuth subsalicylate
Allopurinol oral tablets can affect how other drugs work. If you take one of the following drugs, you may need a lower dose than usual if you also take allopurinol:
Some medications can increase your risk for certain side effects.* These drugs include:
- Amoxicillin , which has been reported to increase the risk of skin rash when used in combination with allopurinol.
- Thiazide diuretics, which can increase the risk of kidney problems, especially in people with kidney disease. Examples of thiazide diuretics include:
* For more information about side effects, see the Allopurinol oral tablet side effects section above.
Alternatives To Allopurinol Oral Tablets
Other drugs are available that can treat your condition. Some may be a better fit for you than others. If youre interested in finding an alternative to allopurinol oral tablets, talk with your doctor. They can tell you about other medications that may work well for you.
Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label drug use means using a drug for a purpose other than what its been approved for by the FDA.
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Allopurinol Tablets & Kidney Disease
Allopurinol tablets are the most important weapon in any gout patients arsenal.
Also, they could be more important, if you also suffer from kidney disease.
Because, gout related research from Y P Siu and colleagues investigates allopurinol tablets and kidney disease. Specifically, it looks at in patients with high uric acid levels and impaired kidney function.
They recognized that high uric acid is associated strongly with the development of high blood pressure and kidney disease. So, they thought allopurinol might benefit gout patients with chronic kidney disease.
First, they conducted a randomized controlled trial with 54 patients. All had high uric acid levels and chronic kidney disease. Half were treated with allopurinol tablets . While the other half continued with normal treatment.
Next, patients were assessed after 12 months. Then, 46% of normal patients had significant kidney deterioration or started dialysis. But, only 16% of those treated with allopurinol got worse.
Finally, the authors conclude:
Allopurinol therapy significantly decreases serum uric acid levels in hyperuricemic patients with mild to moderate chronic kidney disease. Its use is safe and helps preserve kidney function during 12 months of therapy compared with controls. Results of this study need to be confirmed with an additional prospective trial involving a larger cohort of patients to determine the long-term efficacy of allopurinol therapy and in specific chronic kidney disease subpopulations.
Identification Of Research Areas
Data from the literature were thematically analysed by the leaders and fellows of each literature review team to identify general issues with the currently available data with regard to gout and gout studies in people with concomitant CKD as well as specific issues with individual medications.
The research areas and general requirements for studies identified were agreed on by the leaders and fellows of each literature review team and then circulated to all authors of this Consensus Statement. Agreement was reached by consensus of all authors via e-mail, and final approval was granted by the G-CAN Board. No effort was made to prioritize the research areas.
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Selection Of Cases And Non
We selected ADRs recorded in VigiBase® between January 1, 2008, and December 31, 2018, and excluded ADRs occurring in patients under the age of 18 and in those whose age or gender was not specified.
For cases, the primary analysis included all VigiBase® ICSRs detected with an SMQ of acute renal failure and for which febuxostat or allopurinol was the suspected drug. This broad SMQ was chosen so as not to exclude cases of ARF coded with another MedDRA term . The SMQ notably includes the MedDRA term acute kidney injury, which is the new consensus term for ARF . It focuses on the acute potentially reversible failure of kidney function, and MedDRA terms for prolonged renal failure were excluded. In addition, we previously demonstrated that this SMQ identifies correctly cases of AKI .
Does Allopurinol Treatment Worsen Acute Gout
Its possible that using allopurinol oral tablets can trigger acute gout .
Gout attacks occur when theres too much uric acid in your blood. Gout attacks are temporary flare-ups of severe pain and swelling. They start suddenly and keep coming back over time.
Experts dont fully understand why some people who take allopurinol have gout attacks. But the risk seems to lessen if your doctor starts you on a low dose of allopurinol.
To learn more, see Gout attacks in the Allopurinol oral tablet side effects section above. You can also talk with your doctor.
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How Should I Use Allopurinol
Take allopurinol exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.
Take allopurinol oral with a full glass of water. To reduce your risk of kidney stones forming, drink 8 to 10 full glasses of fluid every day, unless your doctor tells you otherwise.
If this medicine upsets your stomach, take allopurinol oral after a meal.
Allopurinol injection is given as an infusion into a vein if you are unable to take the medicine by mouth. A healthcare provider will give your first dose and may teach you how to properly use the medication by yourself.
You may need to mix the injection with a liquid in an IV bag. When using injections by yourself, be sure you understand how to properly mix and store the medicine. Ask your doctor or pharmacist if you don’t understand all instructions.
Prepare an injection only when you are ready to give it. Do not use if the medicine has changed colors or has particles in it. Call your pharmacist for new medicine.
You may need frequent medical tests. Even if you have no symptoms, tests can help your doctor determine if allopurinol is effective.
You may have gout attacks more often when you first start taking this medicine oral. Your doctor may recommend other gout medication to take with allopurinol. Keep taking the medicine as directed.
Store at room temperature away from moisture and heat.