Allopurinol

31/03/2009 11:05

Allopurinol

Brand name: Apo-Allopurinol (CAN), Purinol (CAN), Zyloprim

Pregnancy Category C

Drug class: Antigout drug

 

Therapeutic actions

Inhibits the enzyme responsible for the conversion of purines to uric acid, thus reducing the production of uric acid with a decrease in serum and sometimes in urinary uric acid levels, relieving the signs and symptoms of gout

 

 

Indications

· Management of the signs and symptoms of primary and secondary gout

· Management of patients with malignancies that result in elevations of serum and urinary uric acid

· Management of patients with recurrent calcium oxalate calculi whose daily uric acid excretion exceeds 800 mg/day (males) or 750 mg/day (females)

· Orphan drug use: treatment of Chagas' disease; cutaneous and visceral leishmaniasis

· Unlabeled uses: amelioration of granulocyte suppression with fluorouracil; as a mouthwash to prevent fluorouracil-induced stomatitis


Contraindications

· Contraindicated with allergy to allopurinol, blood dyscrasias.

 

 

Adverse effects

Headache, drowsiness, peripheral neuropathy, neuritis, paresthesias, Rashes--maculopapular, scaly or exfoliative--sometimes fatal, Nausea, vomiting, diarrhea, abdominal pain, gastritis, hepatomegaly, hyperbilirubinemia, cholestatic jaundice, Exacerbation of gout and renal calculi, renal failure, Anemia, leukopenia, agranulocytosis, thrombocytopenia, aplastic anemia, bone marrow depression

 

· Increased risk of hypersensitivity reaction with ACE inhibitors

· Increased toxicity with thiazide diuretics

· Increased risk of rash with ampicillin

· Increased risk of bone marrow suppression with cyclophosphamide, other cytotoxic agents

· Increased half-life of oral anticoagulants

 

Nursing considerations

· Administer drug following meals.

· Force fluids--2.5 to 3 L/day to decrease the risk of renal stone development.

· Check urine alkalinity--urates crystallize in acid urine; sodium bicarbonate or potassium citrate may be ordered to alkalinize urine.

· Arrange for regular medical follow-up and blood tests.

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