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Gout Care By Smith & Smith Est.1998


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Key Points About
Allopurinol (Zyloprim):

  • Allopurinol is prescribed
    for Gout and kidney stones

  • Allopurinol is prescribed
    to help reduce uric acid

  • It's use was not intended for
    Hyperuricemia without the
    presence of Gout attacks

  • Patients with liver or kidney
    disease, diabetes, HBP, or
    other serious health conditions
    should consider other
    Gout treatment options

  • Allopurinol can cause serious
    side effects that should be
    discussed with your doctor

  • Is Allopurinol (Zyloprim) a Safe and Effective Gout Treatment?


    ALLOPURINOL (Zyloprim), a medication commonly prescribed for gout, works by reducing the production of uric acid in the body. While it can be effective in managing gout symptoms and preventing future flare-ups, like any medication, it carries potential risks and side effects.

    One of the primary dangers associated with allopurinol is the risk of severe allergic reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis, which can be life-threatening. These reactions are rare but require immediate medical attention if they occur.

    Other potential side effects of allopurinol include:

    - Skin reactions: Mild to severe skin reactions, such as rash, itching, and hives, are common side effects of allopurinol. In some cases, these reactions may progress to more serious conditions, as mentioned above.

    - Liver and kidney problems: Allopurinol can affect liver function, leading to liver damage or liver failure in rare cases. It may also cause kidney problems, including kidney stones or impairment of kidney function.

    - Bone marrow suppression: Allopurinol has been associated with bone marrow suppression, which can lead to decreased production of blood cells and an increased risk of infections, anemia, and bleeding.

    - Gastrointestinal issues: Common side effects of allopurinol include gastrointestinal problems such as nausea, vomiting, diarrhea, and abdominal pain.

    - Drug interactions: Allopurinol may interact with other medications, including certain antibiotics, anticoagulants, and chemotherapy drugs, potentially leading to adverse effects or reduced effectiveness of either medication.

    ALLOPURINOL (Zyloprim) inhibits uric acid synthesis and has been linked to skin eruptions, inflammation of the blood vessels, and liver toxicity. Periodic liver enzymes, renal function tests and complete blood counts should be performed in all patients on allopurinol. Alterations in liver enzymes, including transient elevations of serum alkaline phosphatase, AST and ALT, have occurred in some patients. Reversible hepatomegaly, hepatocellular damage (including necrosis), granulomatous changes, hepatitis and jaundice have also occurred.

    It's essential for individuals taking allopurinol to be aware of these potential risks and to discuss them with their healthcare provider. Monitoring for any signs of allergic reactions, skin problems, or changes in liver or kidney function is crucial while taking this medication. In some cases, alternative treatments or adjustments to the dosage may be necessary to minimize the risks associated with allopurinol therapy.

    This report claims that 54 cases, out of 211 people, is "RARE"..... Rare or disturbing? You be the judge:

    Allopurinol Hypersensitivity Syndrome

    The allopurinol hypersensitivity syndrome (AHS) consists of severe rash, fever, eosinophilia, and hepatitis and renal failure. It is a feared, albeit rare (see below), complication of therapy and is sometimes fatal.

    Reported risk factors for AHS include renal impairment and diuretic use. Furthermore, although controversial, some data suggest that a higher dose of allopurinol in patients with renal impairment increases the risk for hypersensitivity. The effect of a creatinine clearance-based initial dosing regimen on risk for hypersensitivity is not well understood.

    Stamp and colleagues performed a case/control study in New Zealand to evaluate factors that were associated with the development of AHS.

    Study Summary Fifty-four patients who were treated for gout with allopurinol and developed AHS were identified. These patients were compared with 157 patients with gout who received allopurinol therapy but did not develop AHS.

    The median onset of AHS was 30 days after starting allopurinol therapy, and 90% of cases occurred within the first 6 months; 43 cases required hospitalization, and 3 patients (6%) died of AHS.

    NCBI- US National Library of Medicine Studies:

    1. Drug Intell Clin Pharm. 1985 Jun;19(6):431-3. Hepatitis associated with allopurinol.

    Ohsawa T, Ohtsubo M.

    When adverse reactions occur, it is important to identify the etiologic drug. We describe a case of hepatitis associated with allopurinol. A 66-year-old female was admitted for rehabilitation of a cerebral hemorrhage on September 11, 1981. Allopurinol, clofibrate, and baclofen were administered. Severe hepatitis developed on November 13. The clinical laboratory data returned to normal on November 30. Challenge tests were conducted on clofibrate, allopurinol, and baclofen. The challenge test was positive after the administration of allopurinol. Allopurinol hepatitis is most likely a hypersensitivity reaction, as is suggested by the symptoms of eosinophilia and rash. Renal dysfunction may predispose one to develop hepatitis associated with allopurinol.

    2. Arch Intern Med. 1978 Jun;138(6):997-8. Allopurinol-induced granulomatous hepatitis with cholangitis and a sarcoid-like reaction.

    Swank LA, Chejfec G, Nemchausky BA.

    A 36-year-old man had pain in both knees and an elevated uric acid concentration; his liver function was normal. Allopurinol therapy was started, 100 mg twice daily. After one month fever, lethargy, and severe polyarthralgia developed. On admission to our hospital liver function was abnormal, and a liver biopsy specimen showed granulomas with cholangitis and pericholangitis. He also had lymphopenia with a reduced number of T cells and granulomas in the bone marrow. One month after discontinuation of allopurinol therapy the patient was clinically well with normal liver function and a normal lymphocyte count. A repeated liver biopsy specimen showed normal liver tissue with no granulomas. The onset of the symptoms and findings shortly after the initiation of allopurinol therapy, and their disappearance after the discontinuation of therapy suggest a drug-induced hypersensitivity.

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