PHILADELPHIA — Increasing the dose of allopurinol above the recommended dose can lower serum urate to target levels in gout patients who do not respond to recommended doses, said Dr. Lisa Stamp, who presented her results at the annual meeting of the American College of Rheumatology.
“My current recommendation is to first get the patient to the current recommended dose for at least 1 month before a dose increase. If that does not work, consider increasing the dose,” said Dr. Stamp, a rheumatologist at the University of Otago, Dunedin, New Zealand.
Dr. Stamp and her colleagues enrolled 90 patients with gout who were on stable doses of allopurinol for at least 1 month (mean age, 58 years; 88% male). After the initial visit, 52 were found to have serum uric acid levels greater than 6 mg/dL. Of those, seven received lower-than-recommended allopurinol doses, as defined by the Hande criteria based on creatinine clearance.
Allopurinol dosage was increased above the recommended range for 45 patients in 50- to 100-mg increments per month until they reached target serum uric acid levels. Of 36 patients who completed the entire 12-month study period, 85% (31 patients) achieved serum uric acid levels less than or equal to 6 mg/dL at the 12 month end point. In all, 6 of the 45 patients were lost to follow-up, and 3 discontinued because they developed a rash. No other serious allopurinol-related adverse events were reported, including no reports of hypersensitivity syndrome, renal stones, or impaired liver function.
Dr. Stamp disclosed a relationship with Wyeth Pharmaceuticals.