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allopurinol
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MODEL LIST INFORMATION
SECTION FORMULATION DISEASE/INDICATION RATIONALE FOR INCLUSION
02.03.00.00 Medicines used to treat gout Dosage form and strength

Tablet: 100 mg.



ATC Code
M04AA01

Type of List
Core List

Maintenance prophylaxis for recurrent attacks of acute gout: administer 2-3 weeks after acute episode has subsided. Commence at low dose and increase slowly. Continuous treatment is better than intermittent. Preferably give with colchicine at start of treatment (up to 6 months) to prevent acute attack. Caution re renal failure, requires dose adjustment.

First-line treatment for gout - reduces uric acid levels.

1998: allopurinol and colchicine were moved from section 2.1 (Non-opioid analgesics and nonsteroidal anti-inflammatory drugs) to section 2.3 (drugs used to treat gout).

Date added: 1977.

MODEL FORMULARY INFORMATION
GENERAL INFORMATION

Uses: prophylaxis of gout; prophylaxis of hyperuricaemia associated with cancer chemotherapy

 

Contraindications: acute gout; if an acute attack occurs while receiving allopurinol, continue prophylaxis and treat attack separately

 

Precautions: ensure adequate fluid intake of 2–3 litres daily; pregnancy (Appendix 2); breastfeeding (Appendix 3); renal impairment (Appendix 4); hepatic impairment (Appendix 5); withdraw treatment if rash occurs, reintroduce if rash is mild but discontinue immediately if it recurs; interactions: Appendix 1

 

Dose:

Prophylaxis of gout, by mouth, ADULT initially 100 mg daily as a single dose, preferably after food, then adjusted according to plasma or urinary uric acid concentration; usual maintenance dose in mild conditions 100–200 mg daily, in moderately severe conditions 300–600 mg daily, in severe conditions 700–900 mg daily; doses over 300 mg daily given in divided doses

 

NOTE. Initiate 2–3 weeks after acute attack has subsided and administer a suitable NSAID (not ibuprofen or a salicylate) or colchicine from the start of allopurinol treatment and continue for at least 1 month after hyperuricaemia corrected

 

Prophylaxis of hyperuricaemia, by mouth, ADULT maintenance doses as for acute gout, adjusted according to response, started 24 hours before cancer treatment and continued for 7–10 days afterwards; CHILD under 15 years 10–20 mg/kg daily (maximum 400 mg daily)

 

Adverse effects: rash (see Precautions above), hypersensitivity reactions occur rarely and include fever, lymphadenopathy, arthralgia, eosinophilia, erythema multiforme (Stevens-Johnson syndrome) or toxic epidermal necrolysis, vasculitis, hepatitis, renal impairment and, very rarely, seizures; gastrointestinal disorders; rarely malaise, headache, vertigo, drowsiness, visual and taste disturbance, hypertension, alopecia, hepatotoxicity, paraesthesia, neuropathy, gynaecomastia, blood disorders (including leukopenia, thrombocytopenia, haemolytic anaemia and aplastic anaemia)

 



MEDICINE REFERENCES
WHO Technical Report Series 882: The use of essential drugs.
http://whqlibdoc.who.int/trs/WHO_TRS_882.pdf
EULAR Evidence based recommendations for gout - part ii management: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT).
http://ard.bmjjournals.com/cgi/content/abstract/ard.2006.055269v2
Cochrane review: Intermittent control of hyperuricemia in the treatment of gout.
http://www.mrw.interscience.wiley.com/cochrane/clcentral/articles/446/CN-00063446/frame.html
A cost effectiveness analysis of urate lowering drugs in nontophaceous recurrent gouty arthritis.
http://144.32.150.197/scripts/WEBC.EXE/nhscrd/expand?saan=0000129497
Febuxostat compared with allopurinol in patients with hyperuricemia and gout.
http://www.mrw.interscience.wiley.com/cochrane/clcentral/articles/399/CN-00532399/frame.html
Oxidized low-density lipoprotein autoantibodies in patients with primary gout: effect of urate-lowering therapy.
http://www.mrw.interscience.wiley.com/cochrane/clcentral/articles/317/CN-00472317/frame.html