Adult Dosing
Notes- Dose of allopurinol varies with severity of the disease
- May be administered in divided doses or as a single equivalent dose with the 300 mg tablet
- Administer dosage in divided doses if dosage requirements exceed 300 mg
- Minimum effective dose: 100-200 mg/day PO
- Max dose: 800 mg/day
Primary or secondary gout
Mild gout
Moderately severe tophaceous gout
Flare-up of acute gouty attacks
- Initial dose: 100 mg/day PO, increase qwk by 100 mg until a serum uric acid level of <6 mg/dL is achieved, do not exceed maximum recommended dose
Chemo-related hyperuricemia
- 600-800 mg/day PO for 2-3 days, consume high levels of fluid
Recurrent calcium oxalate calculi
- 200-300 mg/day PO in divided doses/as single equivalent, adjust dose based on resultant control of the hyperuricosuria determined by assessing 24 hr urinary urate
- Note: Advice patients to reduce consumption of animal protein, sodium, refined sugars, oxalate rich foods, excessive calcium intake, also advice them to increase intake of oral fluids and dietary fiber
Pediatric Dosing
Chemo-related hyperuricemia
6-10 yrs
- 300 mg/day PO in 2-3 divided doses; alt 10 mg/kg/day PO in 2-3 divided doses, Max dose: 800 mg/day
- Note Evaluate response after approximately 48 hrs of therapy and adjust dose if necessary
<6 yrs
- 150 mg/day PO in 3 divided doses; alt 10 mg/kg/day in 2-3 divided doses, Max dose: 800 mg/day
- Note: Evaluate response after approximately 48 hrs of therapy and adjust dose if necessary
>10 yrs
- 600-800 PO mg/day in 2-3 divided doses; Max dose: 800 mg/day; start 1-2 days before chemotherapy or radiation
- Note: Allopurinol is rarely indicated in children for gout and recurrent calcium oxalate calculi
[Outline]
Renal Dose Adjustment (Based on CrCl)
- 10-20 mL/min: 200 mg/day PO
- 3-10 mL/min 100 mg/day PO
- < 3 mL/min: 100 mg/day at extended intervals PO
Hepatic Dose adjustment
- Hepatic impairment: Dose adjustments not defined; start with lower dose
See Supplemental Patient Information
- Discontinue at first appearance of skin rash or symptom suggestive of an allergic reaction
- Severe hypersensitivity like exfoliative, urticarial, purpuric lesions as well as Stevens-Johnson Syndrome, generalized vasculitis, irreversible hepatotoxicity may occur, rare fatal death may occur
- Reduce dose of azathioprine and mercaptopurine to one-third to one-fourth if given concomitantly with therapy
- Reversible clinical hepatotoxicity, asymptomatic rise in serum alkaline phosphatase and serum transaminase may occur
- Monitor LFTs if hepatic impairment or if anorexia, weight loss, or pruritus develop during therapy
- Periodically perform liver function tests during the early stages of therapy in patients with pre-existing liver disease
- May cause drowsiness hence advice patients to undertake precaution during performing high alert activities
- Concomitant use of thiazides and allopurinol may cause hypersensitivity reactions
- Acute attacks of gout may occur during the early stages of allopurinol administration even with normal or subnormal serum uric acid levels
- Administer maintenance doses of colchicine during commencing of therapy
- Start with a lower dose of PO 100 mg/day and increase qwk by PO 100mg until a serum uric acid level of <6 mg/dL is achieved, Max dose: PO 800mg/day
- May require several months to deplete the uric acid levels even with adequate therapy
- Ensure adequate hydration yielding urine output 2L/day to avoid xanthine calculi and renal precipitation of urates in patients using concomitant uricosuric agents
- BUN levels may rise in patients with pre-existing renal disease or poor urate clearance
- Carefully observe patients with impaired renal function during the early stages of therapy to ensure that the dosage can be appropriately adjusted or drug can be withdrawn if abnormalities in renal function is increased
- Renal failure may occur on administration of drug in patients with hyperuricemia secondary to neoplastic diseases
- Renal dysfunction may increase in patients with concurrent disease condition such as multiple myeloma and congestive myocardial disease on commencing of therapy
- Renal failure associated with gouty nephropathy and rarely associated with hypersensitivity reactions may occur
- Albuminuria associated with chronic glomerulonephritis and chronic pyelonephritis may occur
- Use lower dose in patients with decreased renal function and closely monitor the patients
- Bone marrow depression may occur in patients who received concomitant drugs with the potential for causing this reaction
- Determine serum uric acid level as an index for using correct dosage and schedule for maintaining the serum uric acid within the normal range
- Monitor BUN/serum creatinine or creatinine clearance at baseline in patients with decreased renal function or having concurrent illness such as hypertension and diabetes mellitus
- Periodically reassess prothrombin time in patients with concurrent use of dicumarol
Cautions: Use cautiously in
- Renal impairment (refer dose adjustment section)
- Hepatic impairment
- Concomitant thiazide diuretics (monitor renal function)
- Concomitant uricosuric agents (may increase excretion of uric acid)
- Concurrent cytotoxic agents
- Bone marrow suppression
- Chemotherapy
- Dehydration
- Geriatric population
- Ampicillin/Amoxicillin administration
Supplemental Patient Information
- Caution patients to discontinue allopurinol and to consult their physician immediately at the first sign of a skin rash, painful urination, blood in the urine, irritation of the eyes, or swelling of the lips or mouth
- Continue drug therapy prescribed for gouty attacks since optimal benefit of allopurinol may be delayed for 2 to 6 weeks
- Patients may wish to take allopurinol after meals to minimize gastric irritation
Lopurin, Zyloprim interacts with :
Pregnancy Category:C
Breastfeeding: This drug is compatible and considered safe with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776. Allopurinol and its active metabolite oxypurinol are excreted in breast milk. Maternal doses of 300 mg/day provide near therapeutic dose and plasma levels in an exclusively breastfed infant. If allopurinol is required by the mother, it is not a reason to discontinue breastfeeding, but exclusively breastfed infants should be monitored including observation for allergic reactions (rash) and periodic CBC and differential blood counts. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 03 December 2010). Manufacturer advises caution
Pricing data from www.DrugStore.com in U.S.A.
- Zyloprim 100 MG TABS [Bottle] (PROMETHEUS)
30 mg = $69.98
90 mg = $139.94 - Zyloprim 300 MG TABS [Bottle] (PROMETHEUS)
30 mg = $103.99
90 mg = $279.96
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
