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Drug Name allopurinol (al oh pure' i nole) Aloprim, ApoAllopurinol (CAN), Purinol (CAN), Zyloprim Pregnancy Category C Drug class • Antigout drug •

Dosages ADULTS • Gout and hyperuricemia: 100–800 mg/day PO in divided doses, depending on the severity of the disease (200–300 mg/day is usual dose). Maintenance: Establish dose that maintains serum uric acid levels within normal limits. Prevention of acute gouty attacks: 100 mg/day PO; increase the dose by 100 mg at weekly intervals until uric acid levels are < 6 mg/dL. Prevention of uric acid nephropathy in certain malignancies: 600–800 mg/day PO for 2–3 days with a high fluid intake; maintenance dose should

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 5-FU; as

Adverse effects • CNS: Headache , drowsines s, peripheral neuropath y, neuritis, paresthesi as Dermatolo gic: Rashes— maculopa pular, scaly or exfoliative — sometime s fatal GI: Nausea, vomiting, diarrhea, abdominal pain, gastritis, hepatome galy, hyperbiliru binemia, cholestati c jaundice GU: Exacerbat ion of gout and renal calculi, renal failure Hematolo gic:

Contraindications • Contraindic ated with allergy to allopurinol, blood dyscrasias. Use cautiously with liver disease, renal failure, lactation, pregnancy.

Nursing considerations Assessment • History: Allergy to allopurinol, blood dyscrasias, liver disease, renal failure, lactation Physical: Skin lesions, color; orientation, reflexes; liver evaluation, normal urinary output; normal output; CBC, LFTs, renal function tests, urinalysis

Interventions • • Administer drug following meals. Encourage patient to drink 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. WARNING: Discontinue drug

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then be established as above. Recurrent calcium oxalate stones: 200– 300 mg/day PO; adjust dose based on 24-hr urinary urate determinations. Parenteral: 200–400 mg/m2/day IV to maximum of 600 mg/day as continuous infusion or at 6, 8, 12 hr intervals.

a mouthwash to prevent 5FU-induced stomatitis

Anemia, leukopeni a, agranuloc ytosis, thrombocy topenia, aplastic anemia, bone marrow depressio n

at first sign of skin rash; severe to fatal skin reactions have occurred. Arrange for regular medical follow-up and blood tests.

Teaching points • • Take the drug after meals. Avoid over-thecounter medications. Many of these preparations contain vitamin C or other agents that might increase the likelihood of kidney stone formation. If you need an overthe-counter preparation, check with your health care provider. You may experience these side effects: Exacerbation of gouty attack or renal stones (drink 2.5–3 liters of fluids per day while on this drug); nausea, vomiting, loss of

PEDIATRIC PATIENTS • Secondary hyperuricemia associated with various malignancies: o 6–10 yr: 300 mg/day PO. o < 6 yr: 150 mg/day; adjust dosage after 48 hr of treatment based on serum uric acid levels. Parenteral: 200 mg/m2/day IV as continuous

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infusion or at 6-, 8-, 12-hr intervals.

appetite (takes after meals or eat frequent small meals); drowsiness (use caution while driving or performing hazardous tasks). Report unusual bleeding or bruising; fever, chills; gout attack; numbness or tingling; flank pain, skin rash.

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