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CCT (), comparing allopurinol up to 300 mg daily versus febuxostat 80 mg daily, that allopurinol 100 to 300 mg daily may not reduce the number of acute gout attacks, and may be less effective in achieving target serum urate levels compared with febuxostat 80 mg daily, without increasing withdrawals due to AEs or SAE rates.

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In cases where allopurinol (300 to 600 mg daily) is administered with mercaptopurine or azathioprine, a reduction in dose to approximately one-third to one-quarter of the usual dose of mercaptopurine or azathioprine should be made, and subsequent dose adjustment made on the basis of therapeutic response and the appearance of toxic effects.

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There was moderate-quality evidence based on the pooled data of two trials (453 participants) of no between-group difference in the number of participants who withdrew due to AEs or in the number of participants who had SAEs, when allopurinol was compared with placebo over a 28-week period ().

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