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Gout - Management
How should I prescribe allopurinol?
- In most people, allopurinol 100 mg once a day can be started (preferably taken after food) [Jordan et al, 2007]. The dose can then be increased by 50–100 mg increments approximately every 2–3 weeks until a dose of 300 mg is reached, then check the person's serum uric acid (SUA) level and renal function at 3 months.
- Increase doses further to achieve a SUA level below 300 micromol/L. The maintenance dose of allopurinol is often in the region of 300 mg a day but may vary between 100–900 mg.
- Allopurinol is usually given once a day. Doses over 300 mg per day should be taken in divided doses, which will help minimize any gastrointestinal adverse effects.
- Adjust the dose of allopurinol according to:
- SUA levels.
- Renal function.
- Clinical response and how well the allopurinol is tolerated.
- In elderly people, those with frequent attacks, those with renal impairment (glomerular filtration rate less than 60 mL/min), and in those with hepatic impairment, start allopurinol 50 mg once a day. See Managing renal impairment. Note: allopurinol 50 mg tablets are not available, so when providing a 50 mg dose, check that the 100 mg tablets are scored.
In depth
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