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Why it's used

Allopurinol is a prescription medicine that is used for the management of primary or secondary gout, patients receiving cancer therapy which increases uric acid level in the blood and urine. It can also be used for the management of recurrent calcium kidney stone, uric acid stones, kidney damage due to uric acid, and certain enzyme disorders that cause overproduction of urate. This medicine works by decreasing the formation of uric acid in the body.
When not to use
Allopurinol should not be used to treat high blood uric acid level with no symptoms.
Xanthine Oxidase Inhibitor
Allopurinol belongs to the Xanthine Oxidase Inhibitor class of medicines. Xanthine oxidase inhibitors are the drugs which are used to treat severe pain, tenderness and redness in the joints (gout) and abnormally high level of the uric acid in the blood. It blocks the activity of an enzyme (xanthine oxidase) which is responsible for the production of the uric acid.

How to use

Read the medicine guide provided by your pharmacist, your doctor, or the medicine company. If you have any questions related to Allopurinol, ask your doctor or pharmacist. Use Allopurinol as per the instructions provided by your doctor.
Allopurinol is eaten after food. Allopurinol may be taken after food to minimize stomach irritation. Allopurinol should be swallowed with a glass of water.

Typical Dosage

The typical dose of Allopurinol for adults is 100-600 mg daily based on patient's condition (not more than 800 mg daily). The usual dose for children is 10 to 20 mg/kg or 4.5 to 9.1 mg/lb daily (not more than 400 mg daily). The maximum dose for adult patients of Allopurinol is 800 mg daily per day. This medicine is not known to be addictive or habit-forming.
Allopurinol should be used as directed by the doctor even if you feel well, or even if you think that there is no need for you to use your medicine.

Talk to Your Doctor

Discuss with your doctor if you develop new symptoms. Discuss with your doctor if blood in the urine, skin rash, irritation of the eyes, swelling of the mouth, swelling of the lips, and painful urination. If you have any kidney disease, less than 100 mg daily dose of Allopurinol should be taken or take a single dose of 100 mg at longer periods than one day. If you have issues with the health of your liver, a low dose of Allopurinol should be used.
Your doctor may prescribe a lower starting dose of this medicine to understand the impact on the body. Please follow your doctor's recommendations. A lower dose of this medicine may be recommended to reduce the risk of side-effects.

Use in Children

If you are giving Allopurinol to a child, be sure to use a product that is for use in children. Use the child's weight or age to find the right dose from the product package or medicine label. You can also read the dosage section of this page to know the correct dose for your child. Else, consult with your doctor and follow their recommendation.

Lab Tests

Your doctor may request that specific lab tests be performed before you start using Allopurinol. Your doctor may ask you to undergo Uric Acid test. Blood uric acid test is needed before starting this medicine to calculate the dose of Allopurinol based on the blood uric acid level. Your doctor may request HLA-B58 test. The presence of HLA-B*5801 gene should be tested before starting treatment with Allopurinol because of the risk of allergic reactions such as Stevens-Johnson syndrome. This gene is mainly present in Han Chinese, Thai, Korean, Japanese or European origin population.
Medicines may be recommended for uses other than those listed in the medicine guide. You should not use Allopurinol for conditions or symptoms for which it was not prescribed. Do not give Allopurinol to other people, even if they have the same conditions or symptoms that you have. The use of this medicine without the advice of a doctor may cause harm.

Storage

Follow storage instructions on the product package if available. Store Allopurinol at 20° to 25°C (68° to 77°F), away from moisture, and away from light. Store this medicine away from children and pets.
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How to take Allopurinol

Your dose may depend on several personal factors. You should consult with your doctor to find out the dose that is best for you. The dose of Allopurinol depends on the following factors:
  • patient's age
  • patient's weight
  • patient's health
  • the health of the patient's liver
  • the health of the patient's kidneys
  • response to treatment

Allopurinol Dosage

Dosage for mild gout

Adult
  • Recommended: 200 to 300 mg daily in divided doses
  • Initial: 100 mg daily and an increase of 100 mg weekly until blood uric acid level of 6 mg/dL or less is achieved
  • Maximum: 800 mg daily

Dosage for severe tophaceous gout

Adult
  • Recommended: 400 to 600 mg daily in divided doses
  • Initial: 100 mg daily and an increase of 100 mg weekly until blood uric acid level of 6 mg/dL or less is achieved
  • Maximum: 800 mg daily

Dosage for kidney damage by uric acid

Adult (patients receiving cancer therapy)
  • Recommended: 600 to 800 mg daily is advisable for 2 to 3 days with intake of high fluid

Dosage for recurrent calcium kidney stone

Adult (patient with excessive uric acid in the urine)
  • Recommended: 200 to 300 mg daily in single or divided doses based on patient's response

Dosage for excessive uric acid in blood

Children (aged 6-10 years suffering from cancer)
  • Recommended: 300 mg daily
Children (aged under 6 years patients suffering from cancer)
  • Recommended: 150 mg daily

Dosage calculation for children

To calculate the dosage for children please use the weight based dose calculator to calculate the appropriate dosage as per the weight of your child.

Forms

Tablet
Strength: 100 mg, 200 mg, and 300 mg
Coated Tablet
Strength: 100 mg and 300 mg
Injection, Powder, Lyophilized, for Solution
Strength: 500 mg/25 ml

Special Instructions

Creatinine clearance of 10-20 ml/min
200 mg daily dose of Allopurinol should be given to such patients.
Creatinine clearance less than 10 ml/min
The daily dose of Allopurinol should not be more than 100 mg in such patients.
Creatinine clearance less than 3 ml/min
The gap between doses of Allopurinol should be increased in such patients.
Older people
The lowest dose of Allopurinol which produces a satisfactory reduction of uric acid should be given in such patients.

Missed Dose

Take the missed dose as soon as you remember. Skip the missed one if it's time for next dose. Avoid taking a double dose to make up for the missed dose.

Overdose

What to do if you overdose on Allopurinol?
In case of overdose, close supervision and supportive care should be provided. Also, provide adequate fluids to enhance the excretion of Allopurinol from the body in such patients. Allopurinol should be removed from the body by blood purifying technique (called as, hemodialysis).
Symptoms of an overdose of Allopurinol
If you use too much of this medicine, it could lead to dangerous levels of the medicine in your body. In such cases, symptoms of an overdose may include:
If you think you have overdosed on Allopurinol, call a poison control center immediately. You can look up the poison control center information from the Poison Center Finder at TabletWise.com.

Precautions while using Allopurinol

Before you use Allopurinol, tell your doctor of your medical and health history including the following:
  • Lapp lactase deficiency
  • abnormal absorption of glucose-galactose
  • galactose intolerance
  • gout
  • heart problems
  • high blood pressure
  • if you are of Han Chinese, Thai, Korean, African or Indian origin
  • kidney problems
  • liver problems
  • thyroid problems
In the case of liver and kidney problem, a low dose is given by the doctor.
Before you use Allopurinol, discuss with your doctor if you are allergic to it or its ingredients. Your doctor may prescribe an alternative medicine and update your medical records to record this information.
The use of this medicine may change thyroid stimulating hormone. This medicine may increase the thyroid stimulating hormone level.

Dizziness

Allopurinol can make you feel sleepy. Be careful when using any machinery, driving a vehicle, or doing any other activity that needs you to be fully alert. The consumption of alcohol with Allopurinol can worsen the sleepiness.

Use in Pregnancy

Consult with your doctor on the use of Allopurinol during pregnancy, or if you are planning to become pregnant. There is no evidence of the safety of this medicine in pregnancy. This medicine can only be used in pregnancy if the benefits outweigh the risk to the mother and baby.

Use while Breastfeeding

The use of Allopurinol is not safe for use in women who are breastfeeding. If you are breastfeeding a baby, discuss with your doctor if you should either discontinue breastfeeding or stop using this medicine while breastfeeding. This medicine may pass into breast milk. The patient should use caution while breastfeeding as the effect of Allopurinol on the baby is unknown.

Use while Conceiving

Consult with your doctor on the use of Allopurinol, if you are trying to conceive.

Increased Risks

This medicine may cause bleeding in the stomach. Regular use of tobacco or alcohol while using this medicine can increase your risk. Discuss with your doctor if you smoke and drink alcohol regularly.

Long-term Use

While using Allopurinol for the long term, there is a risk of a decrease in the production of blood cells (bone marrow depression).

Allopurinol Side-effects

The following side-effects may commonly occur when using Allopurinol. If any of these side-effects worsen or last for a long time, you should consult with your doctor:
  • acute attacks of gout
  • diarrhea
  • flat and raised skin lesions (maculopapular rash)
  • increase in the liver enzymes (alkaline phosphatase and SGOT/SGPT)
  • increased blood thyroid stimulating hormone
  • nausea
  • skin rash
Rarely, the use of Allopurinol may cause the following side-effects:
  • a feeling of discomfort
  • altered sense of taste
  • an increase in white blood cell count (lymphocytosis)
  • bleeding in the eyes, mouth, lips, nose or genitals
  • boil (furuncle)
  • breast enlargement in men
  • bruising (ecchymosis)
  • change of bowel habit
  • chest pain
  • chills
  • decrease in the sex drive (decrease in libido)
  • dilation of the blood vessels (vasodilation)
  • dizziness
  • excess fat in stools (steatorrhoea)
  • eye disease (macular retinitis)
  • eye disease related to the central part of the retina (maculopathy)
  • flu-like symptoms
  • hair color changes
  • hair loss
  • headache
  • hives
  • impotence
  • indigestion
  • infertility in males
  • inflamed and sore mouth
  • inflammation of nerves (neuritis)
  • inflammation of the middle layer of the eye (iritis)
  • inflammation of the optic nerve (optic neuritis)
  • inflammation of the skin (eczematoid dermatitis)
  • inflammation of the vein (thrombophlebitis)
  • insomnia
  • itching of the skin
  • joint pain (arthralgias)
  • lazy eye (amblyopia)
  • loss of muscle control and balance
  • memory loss (amnesia)
  • muscle diseases (myopathy)
  • muscle pain
  • nail separation from the nail bed (onycholysis)
  • nausea
  • nosebleed (epistaxis)
  • numbness, pain and weakness from nerve damage (peripheral neuropathy)
  • presence of albumin in the urine (albuminuria)
  • red or purple spots on the skin
  • red welts in ear, eyes and lips, hands, feet, and inside of the throat
  • reddening or scaling of the skin (scaly or exfoliative skin eruption)
  • reduced blood flow to the limbs due to narrowing of arteries (peripheral vascular disease)
  • ringing in the ear
  • signs of an infection
  • skin lesions with itching (pruritic skin eruption)
  • skin rash caused by the immune system (lichen planus)
  • sleepiness
  • sore lips and mouth
  • sore throat
  • stomach pain (intermittent abdominal pain)
  • stuffy nose (rhinitis)
  • sudden fall down (collapse)
  • sudden fluttering, tightness or wheeziness in the chest
  • sweating
  • swelling of the face, salivary gland and tongue
  • tingling or prickling sensation
  • trouble in getting or keeping an erection (erectile dysfunction)
  • ulcers of the mouth, nose, throat or genitals
  • vertigo
  • visual disturbances
  • weakness or paralysis of muscles of the foot (foot drop)
The following severe side-effects may also occur when using Allopurinol:
  • metabolism and nutrition disorders
    Symptoms: high blood sugar level, high level of fat in the blood increased calcium level in the blood
    If these symptoms occur, then contact your doctor immediately. Your doctor may keep a check on such condition by monitoring the blood glucose level.
  • heart and blood vessels disorders
    Symptoms: inflammation of heart membrane (pericarditis), slow heartbeat (bradycardia), high blood pressure inflammation of the blood vessels (vasculitis)
  • lymphatic system disorders
    Symptoms: abnormal increase in the lymph nodes mass of white blood cells that resembles cancer (pseudolymphoma)
  • nervous system disorders
    Symptoms: feeling unable to move muscles (paralysis)
  • eye disorders
    Symptoms: cataract red and swollen eyes (conjunctivitis)
  • immune system disorders
    Symptoms: cancer of lymphatic system caused by own immune system, swelling under the skin, adverse drug reactions of the skin (DRESS syndrome/drug eruption), severe skin allergic reactions, reddening of the skin (erythema multiforme) skin rash with vesicles and blisters (vesicular bullous dermatitis)
    If such symptoms occur, stop using this medicine permanently and contact the doctor immediately.
  • liver and bile tract diseases
    Symptoms: inflammation of the liver (hepatitis/granulomatous hepatitis), liver damage (hepatic necrosis), jaundice due to reduced bile flow (cholestatic jaundice), enlarged liver (hepatomegaly), abnormal liver function test, increased level of bilirubin in the blood (hyperbilirubinemia) injury of bile ducts or liver (vanishing bile duct syndrome)
    If such symptoms occur, stop using this medicine permanently and contact the doctor immediately.
  • blood diseases
    Symptoms: low platelets or white blood cell count, decreased production or abnormal breakdown of red blood cells, decreased number of all types of blood cells (pancytopenia), increased number of white blood cells (elevated eosinophil/leukocyte counts) abnormal blood tests
  • kidney disorders
    Symptoms: presence of blood in the urine (hematuria), high levels of nitrogen in the blood (azotaemia), kidney failure, high levels of waste products in the blood (uremia), increase in the number of immature red blood cells (reticulocytosis) inflammation of kidney's functional unit (nephritis)
  • stomach and intestinal disorders
    Symptoms: inflammation of stomach lining (gastritis), bleeding in the stomach and intestinal tract (gastrointestinal bleeding), vomiting of blood (haematemesis) inflammation of the pancreas (hemorrhagic pancreatitis)
    If such symptoms appear, contact the doctor immediately.
Your doctor has prescribed Allopurinol because they judge that the benefit is greater than the risk posed by side-effects. Many people using this medicine do not have serious side-effects. This page does not list all possible side-effects of Allopurinol.
If you experience side-effects or notice other side-effects not listed above, contact your doctor for medical advice. You may also report side-effects to your local food and drug administration authority. You can look up the drug authority contact information from the Drug Authority Finder at TabletWise.com.

Warnings

Mercaptopurine and azathioprine

Patients using mercaptopurine and azathioprine are at an increased risk when using Allopurinol. These patients may experience harmful effects. While using 300-600 mg Allopurinol, the dose adjustment of mercaptopurine and azathioprine is required and a low dose of these drugs should be used.

Liver disease

Patients with existing liver disease are at an increased risk when using this medicine. These patients may have reversible liver damage and level of some liver enzymes may also increase. They may develop symptoms like weight loss, itching, and an eating disorder (anorexia). In such cases, regular monitoring of liver function is recommended. The dose of Allopurinol should be reduced in such patients.

Allergic reactions

Patients receiving Allopurinol are at increased risk of allergic reactions. Such patients are at an increased risk of allergic reactions such as skin rash, shedding old skin, hives, red or purple discolored spots on the skin, severe skin reaction (Stevens-Johnson syndrome), drug-induced reactions (DRESS), inflammation of blood vessels, irreversible liver damage, and can be fatal. Allopurinol should be discontinued if these allergic reactions occur. Corticosteroids treatment may be given to such patients.

Decreased functioning of the kidney

Patients with kidney dysfunction taking treatment for heart failure or high blood pressure such as ACE inhibitors or diuretics are at an increased risk while taking Allopurinol. The incidence of allergic reactions is increased in such patients. The close monitoring and caution are advised in these patients. The dose of Allopurinol should be reduced in such patients.

Gout attack

Patients with gout attack are at an increased risk while taking Allopurinol. The occurrence of a gout attack may be increased while taking drugs that increase the excretion of uric acid in the urine with Allopurinol. Colchicine or anti-inflammatory agent are advised to use for one month as preventive therapy in such patients. If gout attack occurs during Allopurinol therapy, the treatment with this medicine should be continued with usual dose while gout attack is treated with an anti-inflammatory agent.

Xanthine deposition

Patients with cancer and Lesch-Nyhan syndrome are at an increased risk while taking Allopurinol. Patients with an increased formation of urate are at an increased risk of xanthine deposition in the urinary tract. Take adequate fluids to increase the production of urine to minimize the risk of xanthine deposition.

Uric acid kidney stones

The therapy with Allopurinol can dissolve uric acid kidney stones and may lead to an impact on the ureter.

Thyroid disorders

Patients on long-term therapy of Allopurinol are at an increased risk. There is a risk of an increase in thyroid stimulating hormone (TSH) in such patients. The patients should be cautious while taking Allopurinol.

Lactose intolerance

Patients with birth defects of lactose intolerance, abnormal absorption of glucose-galactose or the Lapp lactase deficiency are at an increased risk while taking Allopurinol. Allopurinol should not be given to such patients because it contains lactose.

Patients having HLA-B*5801 gene

Patients having HLA-B*5801 gene are at an increased risk while taking Allopurinol. This gene is mainly present in Han Chinese, Thai, Korean, Japanese or European origin population. There is a risk of developing allergic reactions in such patients. The presence of HLA-B*5801 gene should be tested before starting treatment with Allopurinol in such patients. Allopurinol should not be given to these patients unless there is no other treatment available or taking the benefits outweigh the risk in consideration. The close monitoring of symptoms of the allergic reactions advised in such patients.

Interactions with Allopurinol

When two or more medicines are taken together, it can change how the medicines work and increase the risk of side-effects. In medical terms, this is called as a Drug Interaction.
This page does not contain all the possible interactions of Allopurinol. Share a list of all medicines that you use with your doctor and pharmacist. Do not start, stop, or change the dose of any medicines without the approval of your doctor.

Immunosuppressive Drugs

Allopurinol may interact with azathioprine, mercaptopurine, and cyclosporine which are used to treat autoimmune disorders. The use of Allopurinol with azathioprine or 6-mercaptopurine may prolong the activity of azathioprine or 6-mercaptopurine due to inhibition of an enzyme (Xanthine oxidase) by Allopurinol. The use of Allopurinol with cyclosporine may increase the amount of cyclosporine in the blood. While using these medicines together, only one-quarter of the general dose of azathioprine or 6-mercaptopurine should be given. The close monitoring and dosage adjustment of cyclosporine are advised in patients using Allopurinol with cyclosporine. The possibility of occurrence of side effects must be considered before using Allopurinol with cyclosporine.

Anticoagulants

There may be an interaction of Allopurinol with coumarin anticoagulants (warfarin and dicumarol), which are used to prevent blood clots. The use of Allopurinol with an anticoagulant may increase the effectiveness of the anticoagulant. Such patients should be monitored carefully.

Uricosuric Agents

Allopurinol interacts with uricosuric agents (probenecid or salicylates), which are used to treat gout. The use of Allopurinol with uricosuric agents may decrease the effectiveness of Allopurinol by enhancing the excretion of the active metabolite (oxipurinol) of Allopurinol through kidneys. The possibility of the development of kidney disease should be kept in mind before using these medicines together.

Cytostatics

Special instructions need to be followed while taking this medicine along with cytostatics (cyclophosphamide, doxorubicin, bleomycin), which are used to treat cancer. The use of Allopurinol with cytostatics may increase the risk of development of a blood disorder in the patients. There are reports available on the decreased activity of production of cells by bone marrow in cancer patients using these drugs together but in a well-controlled clinical study, no such adverse effect was seen in patients with lymphatic cancer. The blood cell count should be monitored in such patients.

Antacid

Your doctor's guidelines may need to be followed while taking this medicine along with aluminium hydroxide, which is used to treat stomach acidity. The use of Allopurinol with aluminum hydroxide may decrease the effectiveness of Allopurinol. There should be at least 3 hours interval between intake of these medicines.

Antiviral Drug

Allopurinol may interact with vidarabine, which is used to treat viral infections. The use of Allopurinol with antiviral drugs may increase the amount of Allopurinol in the blood. The patients should be cautious while using these medicines together.

Antidiabetic

There may be an interaction of Allopurinol with chlorpropamide, which is used to treat diabetes. The use of Allopurinol with chlorpropamide may increase the risk of lowering of blood sugar level as both drugs will compete for there excretion through kidneys. The risk of such incidence is high in patients suffering from a kidney disorder.

Antibiotics

Allopurinol interacts with ampicillin and amoxicillin, which are used to treat bacterial infections. The use of Allopurinol with ampicillin or amoxicillin may increase the incidence of skin rash in the patients. The patients are advised to use an alternative of ampicillin and amoxicillin while using Allopurinol together.

Angiotensin-converting-enzyme (ACE) Inhibitors

Special instructions need to be followed while taking this medicine along with angiotensin-converting-enzyme (ACE) inhibitors, which is used to treat high blood pressure. The use of Allopurinol with angiotensin-converting-enzyme (ACE) inhibitors may increase the risk of occurrence of allergic reactions in patients with kidney disorders.

Antihypertensives

Your doctor's guidelines may need to be followed while taking this medicine along with diuretics (furosemide and thiazide diuretics), which are used to treat high blood pressure. The use of Allopurinol with furosemide and thiazide diuretics may increase the amount of uric acid and Allopurinol metabolite in the blood. The risk of occurrence of an allergic reaction also increases while using Allopurinol and thiazide diuretics together in patients with kidney disease. The monitoring of the functioning of the kidneys is advised in patients using thiazide diuretics and Allopurinol together. If any sign of kidney dysfunction is detected, an adjustment in dose is recommended.

Antiretroviral drugs

Allopurinol may interact with didanosine, which is used to treat HIV/AIDS. The use of Allopurinol with didanosine may increase the amount of didanosine in the blood. Allopurinol should not be used together with these medicines. If the combined use is unavoidable, a low dose of didanosine may be used with close monitoring.

Xanthines

There may be an interaction of Allopurinol with theophylline, which is used to treat lung diseases such as asthma. The use of Allopurinol with theophylline may cause an inhibition of the breakdown of theophylline. The patients should be monitored for theophylline level before starting treatment with Allopurinol or increasing its dose.

Traveling With Medication

  • Ensure that you carry enough doses of each of your prescription medicines to last the entire trip. The best place to store your medicines is in the carry on baggage. However, while flying, if carrying liquid medicines, make sure you do not go over the limits imposed for carry-on liquids.
  • While traveling overseas, make sure that you can carry each of your prescription medicines legally to your destination country. One way to ensure this is by checking with your destination country's embassy or website.
  • Make sure that you carry each of your medicines in their original packaging, which should typically include your name and address, and the details of the prescribing doctor.
  • If your travel involves crossing time zones, and you are required to take your medicine as per a fixed schedule, make sure that you adjust for the change in time.

Expired Medication

Taking a single dose of expired Allopurinol is unlikely to cause a side-effect. However, please discuss with your doctor or pharmacist, if you feel unwell or sick. An expired medicine may become ineffective in treating your prescribed conditions. To be on the safe side, it is important not to use an expired drug. You are much safer by always keeping a fresh supply of unexpired medicines.

Safe Disposal of Medication

  • If there are disposal instructions on the package, please follow the instructions.
  • If there are medicine take-back programs in your country, you should contact the respective authority to arrange for the disposal of the medicine. For example, in the USA, the Drug Enforcement Administration regularly hosts National Prescription Drug Take-Back events.
  • If there are no take-back programs, mix the medicine with dirt and place them in a sealed plastic bag. Throw the plastic bag in your household trash. Separately, remove all personal information including the prescription label from the medicine packaging and then dispose off the container.
  • If specifically indicated on the medicine package that it needs to be flushed down the toilet when no longer needed, perform the required step.

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