Allopurinol
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
Drug Interactions:
· 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.