Allopurinol

• Allopurinol works by lowering urate levels in the blood. Over time, as urate levels are reduced, new gout crystals will stop forming and existing crystals can slowly dissolve. 
• On starting allopurinol, gout flares may be more common in the short term. Please discuss measures to reduce this with your doctor.
• Allopurinol should be taken continuously, even during an attack of gout. If ceased, the urate level in the blood will rise and crystals will reform.
• Rarely, allopurinol can cause a ‘hypersensitivity reaction’. If you develop a rash after starting this medication, you should cease it immediately and contact your doctor.

Allopurinol is taken on a long-term basis to prevent attacks of gout. The treatment also helps to prevent permanent damage to the joints such as gouty tophi and erosions. It does not treat the pain or inflammation of an ‘attack’ of gout. It does not generally reverse damage already caused to the joints.

Allopurinol does not work straight away. It may take several weeks to reduce the level of uric acid so you may continue to have gout attacks for some time.

Sometimes starting allopurinol or increasing the dose can actually cause an attack of gout. This does not mean the medicine is not working, so keep taking it during such attacks together with any other medicine your doctor may recommend to manage pain.

To reduce the risk of a gout attack, medicines such as colchicine or anti-inflammatory drugs may be recommended before or at the same time allopurinol is started. Your doctor will advise you about how these medicines should be taken.

What happens if you have a gout attack?

Allopurinol is not a pain reliever. You should continue to take allopurinol during an attack, but your doctor will also recommend medicines to treat pain and inflammation. These may include paracetamol, colchicine, anti-inflammatory drugs such as naproxen (Naprosyn), ibuprofen (Brufen/Nurofen), indomethacin (Indocid) or steroids such as prednisolone.

It is a good idea to plan with your doctor what to do if a gout attack occurs and to have symptom controlling medicine ready to use if needed. It is also important that you tell your doctor if your condition persists or worsens.

Allopurinol is taken by mouth as a tablet. It is usually taken once a day.

It should be taken after food to reduce stomach upset. It should also be taken with plenty of water.

For best results, take allopurinol regularly. To help you remember, take it at the same time(s) each day.

If you forget to take a dose, there is no need to double the dose at the next scheduled dose time.

What is the dosage?

Tablets come in 100mg or 300mg strengths. Treatment should start with a low dose, increasing over time to between 100mg and 300mg per day by your doctor. Higher doses (up to 900mg per day) are needed in some cases. If you have kidney problems the dose may need to be lower. The dose is modified according to the urate level in the blood.

Can other medicines be taken with allopurinol?

Allopurinol may be taken in combination with other arthritis medicines, including:

• steroid medicines such as prednisolone or cortisone injections into the joint
• anti-inflammatory medicines (NSAIDs) such as naproxen (Naprosyn) or ibuprofen (Brufen/Nurofen)
• colchicine (Colgout)
• pain relieving medicines such as paracetamol.

Treatment with allopurinol may be continued as long as it is effective and that no serious side effects occur.

If you stop allopurinol treatment there is a high risk that your gout may recur. It is very important not to stop your treatment unless advised by your doctor or unless side effects develop.

Most people do not experience side effects from allopurinol. Tell your doctor if you are concerned about any possible side effects.

If you do experience side effects, a reduction in dose may minimise these so that you can continue to take the medicine. Your doctor will advise on any dose changes that are necessary.

Although rare, some people can have a serious reaction called allopurinol ‘hypersensitivity’ reaction which usually presents as a rash. If this occurs, allopurinol should be ceased immediately, and you should contact your doctor.

Most common possible side effects

• The most common side effects are nausea or vomiting. These can be reduced if you eat little and often. If you are sick, drink plenty of liquid.

Less common or rare possible side effects

There are some rare but potentially serious side effects with allopurinol.

• Skin problems: Allopurinol can cause a rash or flaking skin. Very rarely, severe skin rash and mouth ulceration can occur. If any of these occur, contact your doctor straight away.
• Tiredness: Drowsiness can occur. If it makes you feel sleepy, avoid driving or operating machinery.
• Liver: Allopurinol can inflame the liver. Blood tests can pick this up if it occurs. The dose of allopurinol may need to be reduced or it may need to be stopped if problems occur. Contact your doctor immediately if you notice yellowing of the skin and/or whites of the eyes.
• Other: Headache, dizziness, taste disturbances, high blood pressure, feeling generally unwell, and hair loss can occur.

Long term side effects

Allopurinol can be taken for long periods to manage gout. There seems to be no long-term side effects.

Allopurinol does not affect a person’s ability to have children in the long term. See also Precautions.

Blood tests

• Blood tests will be required after starting allopurinol to check the urate level in the blood so that the dose can be adjusted if required. Even if all signs of gout have disappeared, it is still important to keep the blood urate level at a certain target so that symptoms will not return.
• It is important to see your general practitioner (GP) regularly as they have an important role in monitoring your condition.

Use with other medicines

• Allopurinol interact with themedicine azathioprine (Imuran) and mercaptopurine (Allmercap). If you are taking either of these medications, please let your doctor know as combined use with allopurinol can be very dangerous. 
• Other medicines that may interfere with allopurinol include: warfarin, ampicillin, amoxicillin, thiazide diuretics and sulfinpyrazone.
• You should tell your doctor (including your GP, rheumatologist and others) about all medicines you are taking or plan to take. This includes over the counter or herbal/naturopathic medicines. You should also mention your treatment when you see other health professionals.
• Aspirin can be used safely in the low doses taken for prevention of heart attack and stroke. You should avoid taking aspirin in all other circumstance as at higher doses it can raise the blood urate level.
• Allopurinol can be taken safely with anti-inflammatory drugs (NSAIDs) provided your kidney function is normal and you have discussed this with your doctor.
• The pain reliever paracetamol and combined medicines such as Panadeine and Panadeine Forte can be used while taking allopurinol provided you take them as directed.

Use with alcohol

• Alcohol can trigger a flare of gout. When taking allopurinol, keep your alcohol intake to a safe amount, 1 to 2 standard drinks, several times a week.
• In addition to alcohol, other things that may trigger a gout flare include dehydration, diuretics (fluid tablets) and stopping allopurinol treatment.

Use in pregnancy and when breastfeeding

• The effects of allopurinol during pregnancy have not been well studied, so it is not clear if it causes birth defects.
• Gout in women of child-bearing age is uncommon.
• If you are pregnant or are considering having a child you should discuss this with your doctor before beginning this medication.
• Allopurinol may be taken when breastfeeding.

• Store allopurinol in a cool, dry place, away from direct heat and light.
• Keep all medicines out of reach of children.