Severe Allopurinol Toxicity. Description and Guidelines for Prevention in Patients With Renal Insufficiency

Hande, Kenneth R.; Noone, Richard M.; Stone, William J.

doi:10.1016/s0022-5347(17)50916-7

Cited by 259 publications

(451 citation statements)

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“…With allopurinol standard dosage 200-300 mg/day, comparable effectiveness cannot be achieved for this group. The average allopurinol dosage (mean 243 mg/day) might be considered relatively low; however, (1) no efficacy data on allopurinol ≥600 mg/day are available in the literature; (2) dosages >300 mg/day are generally not advised because of increased risk of adverse drug reactions [22]; (3) benzbromarone (mean 138 mg/day) and probenecid (1,000 mg/day) could also be dosed higher.…”

Section: Discussionmentioning

confidence: 99%

Biochemical effectiveness of allopurinol and allopurinol-probenecid in previously benzbromarone-treated gout patients

et al. 2007

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Section: Discussionmentioning

confidence: 99%

Biochemical effectiveness of allopurinol and allopurinol-probenecid in previously benzbromarone-treated gout patients

et al. 2007

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“…(10) Hande et al's algorithm for the dosing of allopurinol based on creatinine clearance is deeply ingrained in many physicians' practices. (24) However, limiting the dose of allopurinol results in suboptimal control of gout, particularly since many patients with gout have renal impairment. (25) Studies show that administering an allopurinol dosage that is above the 'cap' does not increase toxicity in patients with renal impairment and results in a significant reduction in SUA levels.…”

Section: Physician Factorsmentioning

confidence: 99%

Poorly controlled gout: who is doing poorly?

Chia¹

2016

smedj

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Gout, an inflammatory arthritis caused by the deposition of monosodium urate crystals, is commonly seen in primary care and specialist clinics. In recent years, there has been a resurgence of interest in gout due to advances in therapies and the understanding of pathophysiology, with new guidelines being published by international bodies. However, there is still a gap between the goals of treatment and actual day-to-day practice. Barriers that result in poorly controlled gout include patient factors such as lack of understanding of the disease, stigma and nonadherence to treatment, as well as physician factors such as knowledge gaps, inadequate use of allopurinol and lack of ownership of the disease. The medical profession needs to do more to bridge the gap through physician and patient education, identification of treatment targets with appropriate use of drugs, and dissemination of guidelines.

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“…Oxipurinol is a potent inhibitor of xanthine oxidase and the longer residence of oxipurinol in the body means that it accounts for the majority of the effect of allopurinol (Spector, 1977). Oxipurinol is cleared from the body through the kidneys and accordingly, the dosage of oxipurinol should be reduced in patients with renal impairment (Elion et al, 1968;Hande et al, 1984). Severe toxic reactions to allopurinol are observed uncommonly but can be fatal (Hande et al, 1984;Singer & Wallace, 1986).…”

Section: Introductionmentioning

confidence: 99%

“…Oxipurinol is cleared from the body through the kidneys and accordingly, the dosage of oxipurinol should be reduced in patients with renal impairment (Elion et al, 1968;Hande et al, 1984). Severe toxic reactions to allopurinol are observed uncommonly but can be fatal (Hande et al, 1984;Singer & Wallace, 1986). Exfoliative dermatitis, hepatitis and progressive renal failure are features of the toxic reaction to this drug.…”

Section: Introductionmentioning

confidence: 99%

Allopurinol dosage selection: relationships between dose and plasma oxipurinol and urate concentrations and urinary urate excretion.

Day

Miners

Birkett

et al. 1988

Brit J Clinical Pharma

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1 Allopurinol usage in 50 patients of a city teaching hospital was surveyed. 2 The plasma concentrations of oxipurinol and uric acid and the urinary production of uric acid were examined. 3 The daily doses of allopurinol ranged from 50 to 1200 mg but 83% of patients were taking 300 mg daily. 4 A wide range of plasma oxipurinol concentrations was observed from 2.8 to 55.8mg 11 with a mean ± s.d. of 15.2 ± 11.7 mg l-1. 5 The population studied included a high proportion of patients with renal impairment and creatinine clearance was a significant determinant of oxipurinol concentrations (P < 0.005). 6 There was no significant correlation between plasma urate and plasma oxipurinol concentrations and only a few plasma urates were above the upper limit of the reference range of the laboratory. 7 It was apparent that many patients were taking unnecessarily high daily doses of allopurinol and that renal status was not always considered when deciding dosage regimens of allopurinol.

show abstract

Severe Allopurinol Toxicity. Description and Guidelines for Prevention in Patients With Renal Insufficiency

Cited by 259 publications

References 0 publications

Biochemical effectiveness of allopurinol and allopurinol-probenecid in previously benzbromarone-treated gout patients

Biochemical effectiveness of allopurinol and allopurinol-probenecid in previously benzbromarone-treated gout patients

Poorly controlled gout: who is doing poorly?

Allopurinol dosage selection: relationships between dose and plasma oxipurinol and urate concentrations and urinary urate excretion.

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