Gout: initially 100mg once daily. Increase by 100mg/day every 2 to 4 weeks - titrated to desired uric acid level (~ <6 mg/dL).
Usual range: (Mild gout): 200-300mg/day. Moderate-severe: 400-600mg/day. Maximum dose/day: 800mg
Renal Dosing
Since allopurinol and its metabolites are primarily eliminated only by the kidney, accumulation of the drug can occur in renal failure, and the dose of allopurinol tablets USP should consequently be reduced. With a creatinine clearance of 10 to 20 mL/min, a daily dosage of 200 mg of allopurinol tablet USP is suitable. When the creatinine clearance is less than 10 mL/min, the daily dosage should not exceed 100 mg. With extreme renal impairment (creatinine clearance less than 3 mL/min) the interval between doses may also need to be lengthened
Package insert summarized: [10-20]: 200mg q24h. [<10 mL/min]: Do not exceed 100mg/day. [<3 ml/min]: Administer 100 mg at extended intervals.
[Titrate to desired uric acid level]
-----Severe impairment-------- In patients with severely impaired renal function or decreased urate clearance, the half-life of oxipurinol in the plasma is greatly prolonged. Therefore, a dose of 100 mg per day or 300 mg twice a week, or perhaps less, may be sufficient to maintain adequate xanthine oxidase inhibition to reduce serum urate levels.
Hemodialysis
100mg q24-48h (give dose after dialysis on dialysis days.) Titrate to desired uric acid level.
Reference(s)
National Institutes of Health, U.S. National Library of Medicine, DailyMed Database. Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). Please review the latest applicable package insert for additional information and possible updates. A local search option of this data can be found here.
