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Allopurinol (Zyloprim) is a medication used to manage gout and other conditions associated with excess uric acid. However, its use comes with important safety considerations that both patients and healthcare providers should be aware of. Below are the key warnings to consider when using this medication:

• Severe Skin Reactions: Although uncommon, allopurinol can cause serious and potentially life-threatening skin reactions, such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS). These reactions are more likely to occur within the first few months of treatment, particularly in individuals with the HLA-B 58:01 gene, those of African or Asian descent, individuals with kidney issues using thiazide diuretics, and those taking medications like bendamustine, ampicillin, or amoxicillin.

• Increased Gout Attacks: Initiating allopurinol treatment can lead to an increase in gout flares during the initial months. This occurs as the medication rapidly reduces uric acid levels, which can sometimes irritate the joints and cause inflammation.

• Kidney Issues: There is a risk of developing kidney stones and potential kidney injury while taking allopurinol, especially for individuals with pre-existing kidney problems or a history of kidney stones. Dehydrated individuals may also be at increased risk.

• Liver Damage: Allopurinol has the potential to cause liver damage, although this is usually reversible upon discontinuation of the medication. Regular monitoring of liver enzyme levels is advised, particularly in individuals with existing liver conditions. Symptoms of potential liver damage include loss of appetite, weight loss, itching, and yellowing of the skin or eyes.

• Low Blood Cell Counts: Rarely, allopurinol may lead to reduced blood cell counts, affecting red blood cells, white blood cells, or platelets, thereby increasing the risk of anemia, infections, and easy bleeding or bruising. This can occur from one month to several years after starting the medication.

• Drowsiness and Dizziness: Some patients may experience significant drowsiness or dizziness, impacting their cognitive and motor functions. This risk is heightened when taking high doses of allopurinol or concurrently using other medications that induce sleepiness, such as benzodiazepines, muscle relaxants, and sleep aids.

In the event of an overdose or severe reactions, immediate medical attention is necessary. Always discuss any concerns or unusual symptoms with your healthcare provider to ensure safe and effective use of allopurinol.

Common side effects:

• stomach upset
• nausea
• diarrhea
• drowsiness

Less common but important to monitor:

• high liver enzyme levels
• muscle or joint pain
• headaches
• rash
• changes or loss in taste
• more frequent gout attacks

Serious side effects:

• severe skin reactions
• allergic reactions
• liver problems
• low blood cell counts
• nerve pain
• unusual tiredness

Interactions with high risk of serious adverse effects and should be avoided:

• Didanosine

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Acenocoumarol
• Azathioprine
• Capecitabine
• Captopril
• Enalapril
• Enalaprilat
• Fluorouracil
• Mercaptopurine
• Pegloticase
• Phenprocoumon
• Tegafur
• Warfarin

Interactions with low risk that usually do not require a change in therapy:

• Aluminum Hydroxide
• Cyclosporine
• Vidarabine