title: Dose adjustment of allopurinol according to creatinine clearance does not provide adequate control of hyperuricemia in patients with gout.
abstract: OBJECTIVE
  Published guidelines state that allopurinol doses should be adjusted according to creatinine clearance. We investigated whether such dosing provides adequate control of hyperuricemia.
  
  
  METHODS
  We studied 250 patients with gout attending rheumatology clinics in South Auckland from 2001 to 2004. Allopurinol dose, creatinine clearance, and serum uric acid (SUA) level were recorded. We analyzed the relationship between recommended allopurinol dose and SUA lowering to <or= 0.36 mmol/l.
  
  
  RESULTS
  For patients taking allopurinol, 70.9% were taking recommended doses, based on published allopurinol dosing guidelines. There were 4 (1.6%) patients with cutaneous hypersensitivity reactions to allopurinol, but none of these patients were taking higher than recommended allopurinol doses. The proportion of patients achieving SUA <or= 0.36 mmol/l was lower in those taking recommended doses, compared with those taking higher than recommended doses (19% vs 38.1%; p < 0.01).
  
  
  CONCLUSIONS
  Adherence to published allopurinol dosing guidelines led to suboptimal control of hyperuricemia in this population of patients with gout. Further work is required to clarify the safety and efficacy of allopurinol dose escalation, particularly in patients with renal impairment.
authors.affiliation: Department of Medicine, University of Auckland, Auckland, New Zealand. n.dalbeth@auckland.ac.nz
authors.forename: Nicola
authors.initials: N
authors.lastname: Dalbeth
authors.forename: Sunil
authors.initials: S
authors.lastname: Kumar
authors.forename: Lisa
authors.initials: L
authors.lastname: Stamp
authors.forename: Peter
authors.initials: P
authors.lastname: Gow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000493:Allopurinol / Q000008:administration & dosage / Q000627:therapeutic use*; D003404:Creatinine / Q000378:metabolism*; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D005260:Female; D006073:Gout / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D006074:Gout Suppressants / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D033461:Hyperuricemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood
chemical_list: D006074:Gout Suppressants; D014527:Uric Acid; D000493:Allopurinol; D003404:Creatinine