Starting from scratch: Allopurinol prescribing for the non-adherent

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In print

Pharmacotherapy

Starting from scratch: Allopurinol prescribing for the non-adherent

1 March 2023

Leanne Te Karu

Wednesday 1 March 2023, 12:30 AM

Gout flares when initiating allopurinol are a common reason for people to fall into a stop-start cycle of administration [Asm Arif on Pexels]

Pharmacist prescriber Leanne Te Karu explains that repeat prescriptions for allopurinol sometimes require the same approach as for allopurinol naive people

Key points, In a person who has become non-adherent to allopurinol (even for one month), do not automatically restart at a previous dose – re-titration is require, Pract Green w Pale Yellow

Rheumatology

References

Yue TF, Gutman AB. Effect of allopurinol (4-hydroxypyrazolo-(3,4-d)pyrimidine) on serum and urinary uric acid in primary and secondary gout. Am J Med 1964;37:885–98.
Borstad GC, Bryant LR, Abel MP, et al. Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis. J Rheumatol 2004;31(12):2429–32.
Stamp LK, Taylor WJ, Jones PB, et al. Starting dose is a risk factor for allopurinol hypersensitivity syndrome: a proposed safe starting dose of allopurinol. Arthritis Rheum 2012;64(8):2529–36.
Medsafe. Re-ad-DRESS-ing the risk of DRESS with cautious titration. Prescriber Update 2022;43(3):38–40.

How to Treat

+How to treat

For older people and frail people, the long-term benefit of medicines reduces and the potential for harm from adverse effects increases. When the benefit–risk balance changes in this way, medicine review and optimisation are important to simplify the therapeutic regimen, reduce inappropriate medicines and minimise risks. In this article, pharmacist prescriber Linda Bryant uses two case studies to illustrate important considerations during medicine reviews

Wednesday 28 May 2025, 12:50 AM