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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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Allopurinol 300 mg daily probably does not reduce the incidence of acute gout attacks when compared with placebo over 30 days, and allopurinol 100 to 600 mg daily may not reduce acute gout attacks compared with benzbromarone 100 to 200 mg daily or febuxostat 80 mg daily over 16 to 24 weeks.
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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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The dose of oral mercaptopurine (Purinethol) and azathioprine (Imuran) should be reduced as Allopurinol increases their blood levels.
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It is used to treat high uric acid levels in the blood or urine caused by certain types of cancer chemotherapy.
The treatment of acute gout attacks is aimed at controlling the inflammatory response and alleviating pain, and the drugs commonly used for this are nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and glucocorticoids ().
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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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In the presence of small-sample bias, the random-effects estimate of the intervention was more beneficial than the fixed-effect estimate ().
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Oxipurinol, however, has a longer plasma half-life (approximately 15 hours) and therefore effective xanthine oxidase inhibition is maintained over a 24 hour period with single daily doses of Allopurinol.
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Patients with acute gout and tophi (uric acid crystals in the tissues mostly around joints) should be treated with 300-400 mg of Allopuionol daily.
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Our review found low- to moderate-quality evidence indicating similar effects on withdrawals due to AEs and SAEs and incidence of acute gout attacks when allopurinol (100 to 600 mg daily) was compared with placebo, benzbromarone (100 to 200 mg daily) or febuxostat (80 mg daily).
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In contrast to our review, included two trials with mixed populations of people with hyperuricaemia and chronic gout ( (S13-18); (S44-S49); and excluded from their review due to methodological limitations.
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RCT (the Febuxostat versus Allopurinol Controlled Trial (FACT) trial) including 762 participants with gout (as per ARA criteria) that compared allopurinol 300 mg daily with febuxostat 80 or 120 mg daily.
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