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";s:4:"text";s:4134:"Allopurinol is metabolized by xanthine oxidase to alloxanthine, which also inhibits xanthine oxidase.This inhibition decreases the production of uric acid and reducing its concentration in extracellular fluid, thereby preventing precipitation of crystals in joints or elsewhere. It is also used in the prevention of increased uric acid levels in patients on It works by reducing total uric acid body burden by inhibiting xanthine oxidase.Allopurinol is used as long-term prophylaxis for patients with recurrent Chemically, Allopurinol is an isomer of hypoxanthine.The plasma uric acid concentration should be kept below 0.42 mmol/L. Allopurinol is often the first urate-lowering drug used prophylactically to treat chronic, tophaceous gout because it reduces the size of the established tophi; colchicine is administered concomitantly during the first week of therapy to prevent gouty arthritis. It may be titrated upward until serum uric acid is below 6 mg/dL; this level is commonly achieved at 300 mg/d but is not restricted to this dose.Colchicine or an NSAID should be given during the first weeks of allopurinol therapy to prevent gouty arthritis episodes that sometimes occur.Gout and hyperuricemia: 100–800 mg/day PO in divided doses, depending on the severity of the disease (200–300 mg/day is the usual dose).Prevention of acute gouty attacks: 100 mg/day PO; increase the dose by 100 mg at weekly intervals until uric acid levels are within normal limits.Prevention of uric acid nephropathy in certain malignancies: 600–800 mg/day PO for 2–3 days; maintenance dose should then be established as above.Recurrent calcium oxalate stones: 200–300 mg/day PO; adjust the dose up or down 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.Secondary hyperuricemia associated with various malignancies:< 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 infusion or at 6, 8, 12 hr intervals.For geriatric patient or patients with creatinine clearance 10–20 mL/min, 200 mg/day; for creatinine clearance < 10 mL/min, 100 mg/day; for creatinine clearance < 3 mL/min, extend intervals between doses based on patient's serum uric acid levels.Allopurinol is approximately 80% absorbed after oral administration and has a terminal serum half-life of 1-2 hours.Administer drug following meals to prevent stomach upsets.Encourage patient to drink 2.5 to 3 L/day to decrease the risk of renal stone development.On oral administration, it has a slow onset compared to parenteral administration with an onset of 10-15 minutesLike uric acid, allopurinol is itself metabolized by xanthine oxidase, but the resulting compound, alloxanthine, retains the capacity to inhibit xanthine oxidase and has a long enough duration of action so that allopurinol is given only once a day.The drug is dialyzable by both hemodialysis and peritoneal dialysis.Dietary purines are not an important source of uric acid. Apart from this agent, chronic gout is treated with the uricosuric agent probenecid or sulfinpyrazone, which increases the elimination of uric acid, or febuxostat. Administer within 10 hr of reconstitution.Administer as a continuous infusion or infused q 6, 8, or 12 hr with rate dependent on the volume used.Incompatible with many other drugs; do not mix with any other drug in the same solution.There is an increased risk of hypersensitivity reaction with Increased risk of bone marrow suppression with cyclophosphamide, other cytotoxic agents.Increased risk of toxic effects with thiopurines, 6-MP (azathioprine dose and the dose of 6-MP should be reduced to one-third to one-fourth the usual dose)When chemotherapeutic mercaptopurines (eg, azathioprine) are given concomitantly with allopurinol, their dosage must be reduced by about 75%.Allopurinol may also increase the effect of cyclophosphamide.Allopurinol inhibits the metabolism of probenecid and oral anticoagulants and may increase hepatic iron concentration. 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