Table of Contents
- Highlights
- Introduction
- Symptoms
- Causes and Risk Factors
- Triggers
- Diagnosis
- Treatment: Acute Gout Attack
- Treatment: Preventing Attacks
- Lifestyle Changes
- Complications
- Resources
- References
Allopurinol is taken by mouth once a day in doses of 100 - 600 mg, depending on the patient's response to treatment. When it is first used, allopurinol can trigger further attacks of gout. Therefore, during the first months (or longer) of therapy, the patient also takes an NSAID or colchicine to reduce that possibility.
Allopurinol has positive effects on "bad" cholesterol levels, so it may be better than other drugs for patients with both gout and coronary artery disease.
Side effects, which can be severe, include:
- Rash
- Diarrhea
- Headache
- Fever
- Leukopenia (a reduction in the number of white blood cells)
- Thrombocytopenia (a reduction in the number of platelets)
- Cataracts
In rare cases, the rash can become severe and widespread enough to be life threatening (this condition is called toxic epidermal necrolysis, or TEN). Allergic individuals who experience only a mild rash may be able to build up their tolerance for the drug by undergoing a desensitization process.
Allopurinol interacts with certain other drugs, such as azathioprine.
Febuxostat. Febuxostat is the first oral drug to emerge in many decades as a new treatment for chronic gout. Approved by the FDA, it will be particularly useful for patients who are allergic to allopurinol. It is structurally distinct from allopurinol, but, like the older drug, it reduces uric acid production by inhibiting xanthine oxidase. For some patients, gout may flare up after starting the medication, then begin to resolve. The FDA continues to assess its potential for hypersensitivity. It is much more expensive than allopurinol.
Krystexxa. The FDA approved Krystexxa (pegloticase) IV injections for the treatment of gout in September 2010. The injection is given every two weeks and reserved for patients with severe chronic gout who have not been helped by first line treatments. Krystexxa is an enzyme, or biologic, that targets uric acid directly by transforming it into a different molecule which is removed through the urine. In studies, up to 25% of patients experienced allergic reactions ranging from mild to severe. The FDA recommends that an antihistamine and corticosteroid be given prior to the injection to prevent reactions. Side effects, which can be severe, may include rash or hives, shortness of breath, nausea and vomiting, constipation, chest pain, redness and itching, wheezing, swelling of lips or tongue, blood pressure changes, or anaphylactic shock. It has not been tested in patients with heart failure.
Colchicine. colchicine is sometimes prescribed along with allopurinol or probenicid for its preventive and anti-inflammatory effects in cases of severe chronic gout.
Rasburicase. Rasburicase helps to convert uric acid into another molecule, allantoin. It is sometimes given to adults and children receiving cancer treatment to help prevent high uric acid levels from developing. It is given as a single course of intravenous treatment. Side effects may include confusion, dizziness, fatigue, blue lips, light-headedness, shortness of breath, mouth sores, seizures, pale/yellow skin, dark urine, or irregular heart rate.
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Review Date: 01/04/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School; Physician, Massachusetts General Hospital.
Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M.,
Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
