Allopurinol

Sounds like 'al-lo-pew-ri-nol'

Easy-to-read medicine information about allopurinol – what it is, how to take allopurinol safely and possible side effects.

Type of medicine Also called
  • Medicine to prevent gout
  • Belongs to a group of medicines known as urate lowering therapy
  • DP-Allopurinol
  • Apo-Allopurinol®
  • Allopurinol-Apotex®

What is allopurinol?

Allopurinol is used as a long-term treatment to prevent gout attacks or flares. It can also be used to prevent some types of kidney stones and may be used in people receiving cancer chemotherapy, to prevent high uric acid (measured as urate in the blood or 'serum urate') levels. In New Zealand allopurinol is available as 100 milligram and 300 milligram tablets.

Watch a video about allopurinol for gout

How does allopurinol work?

Allopurinol helps reduce urate levels in your blood (serum urate) and reduces gout attacks. 

Uric acid is a normal product of your metabolism and in the blood, uric acid becomes urate. When urate levels are high, crystals can form around joints causing inflammation, pain and damage. This is known as gout.

To reduce gout attacks, it is important to keep your serum urate level below 0.36 mmol/L. When the serum urate is below 0.36mmol/L no new crystals form and crystals that are in your joints or skin can dissolve. Read more about gout.

Dose 

  • The dose of allopurinol will be different for different people.
  • Your doctor will usually start you on a low dose (50 or 100 milligrams each day) and increase it very slowly over a few months. Your doctor  will test your serum urate with a blood test and increase the allopurinol dose as much as needed until a serum urate level of less than 0.36 mmol/L is reached.
  • The usual dose of allopurinol is 300 milligrams or more daily. Some people may need between 600 and 900 milligrams daily. 
  • Always take your allopurinol exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much to take, how often to take it, and any special instructions. Know what dose you should be taking - if you are unsure, talk to your pharmacist.

My dose is:

Week Dose
week beginning:   
week beginning:   
week beginning:   
week beginning: 
 
Notes:



How to take allopurinol

  • Take allopurinol once a day with a full glass of water. It is important to drink plenty of water while you are taking allopurinol because kidney stones can develop if you do not drink enough fluid.  
  • If you think allopurinol is causing stomach upset, try taking it with food.
  • Keep taking allopurinol every day, even during a gout attack. Allopurinol takes 2 to 3 months to become fully effective.
  • Limit or avoid alcohol while you are taking allopurinol. Alcohol can trigger an attack of gout. 
  • If you forget to take your dose of allopurinol, take it as soon as you remember. But, if it is nearly time for your next dose, just take the next dose at the right time. Do not take double the dose.
  • Do not stop taking allopurinol suddenly; speak to your doctor or nurse before stopping. Stopping allopurinol quickly can make your gout worse. Read more frequently asked questions about allopurinol.

Special instructions

  • Increased gout attacks: when you start taking allopurinol, gout attacks can still happen in the first few weeks or months, as you are increasing your dose. When you start allopurinol, your doctor will also prescribe a low-dose non-steroidal anti-inflammatory (NSAID) or colchicine to  reduce the chances of these attacks. Keep taking allopurinol every day, even during a gout attack.
  • Blood tests: when you first start taking allopurinol, you will need to have blood tests to monitor your serum urate levels every 4 weeks until the target level has been reached. Then you will need blood tests 3-6 monthly to check serum urate and your kidney function.

Precautions – before starting allopurinol

  • Are you pregnant or breastfeeding?
  • Do you have problems with your liver or kidneys?
  • Are you taking any other medicines? This includes any medicines you buy without a prescription, such as herbal and complementary medicines.

If so, it’s important that you tell your doctor or pharmacist before you start allopurinol or any new medicines. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

Possible side effects

Like all medicines, allopurinol can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Side effects What should I do?*
  • Skin rash or itching
    (about 2 in every 100 people who take allopurinol will have a skin rash)
  • Stop taking allopurinol
  • Contact your doctor immediately – even if the rash is mild. This can develop into a severe allergic reaction.
  • Stomach upset, nausea (feeling sick), or vomiting
  • This is quite common when you first start taking allopurinol.
  • Try taking allopurinol with food or milk.
  • If it gets worse, contact your doctor.  
  • Muscle pain
  • Dizziness, drowsiness
  • Tell your doctor if troublesome.
*Did you know that you can report a side effect to a medicine to CARM (Centre for Adverse Reactions Monitoring)? Report a side effect to a product

Interactions

Allopurinol may interact with a few medications and herbal supplements, so check with your doctor or pharmacist before starting allopurinol or before starting any new medicines. Do not take azathioprine with allopurinol except under specialist supervision.

Learn more

The following links have more information on allopurinol.

Allopurinol (Māori) New Zealand Formulary Patient Information
Medicines for gout Ministry of Health, NZ
A conversation about gout (includes dispelling common myths including gout is a bad drug)
 Best Practice Journal, April 2014 
Gout Pharmac

References

  1. allopurinol New Zealand Formulary
  2. A conversation about gout (includes dispelling common myths including gout is a bad drug) BPAC, 2014
  3. An update on the management of gout BPAC, 2013
  4. The medical management of gout revisited BPAC, 2011
Credits: Sandra Ponen, Pharmacist. Reviewed By: Assoc Professor Nicola Dalbeth. Last reviewed: 22 Jan 2018