Food and Drug Administration (FDA) (n.d.) Allopurinol package insert. Retrieved June 30th, 2018 from Food and Drug Administration (FDA) (n.d.b) Colcrys package insert. Retrieved June 30, 2018 from Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby. Mayo Clinic (n.d.) Colchicine. Retrieved from - supplements/colchicine-oral-route/proper-use/drg-20067653 Spieker, L., Ruschitzka, F., Luscher, T., Noll, G. (2002). The managment of hyperuricemia and gout in patients with heart failure. The European Journal of Heart Failure. 403-410. Retrieved from (02)00086-7 Yancy, C., Jessup, M., Bozkurt, B., Butler, J., Casey, D., Drazner, M., . . . Wilkoff, B. (2013). 2013 ACCF/AHA guideline for the management of heart failure. Circulation, 2013(128), e240-e327. Retrieved from I would start the patient on allopurinol 100mg PO once a day, and check renal function (BUN, Cr, and CrCl) in one week. If renal function allowed I would titrate the medication to 200mg daily, and continue to monitor labs closely. At a CrCl of 30mL/min it may be possible to titrate the allopurinol to 300mg/day, IF the patient’s serum uric acid remained greater than 6, but again renal function labs would have to be closely monitored. I would anticipate the patient
needing a maintenance dose of 100-200mg a day. Allopurinol is cleared by the kidneys therefore patients with decreased kidney function will have increased accumulation of the drug and require a lower dose of the medication. Generally, the lower the creatinine clearance, the lower the dose of allopurinol “a creatinine clearance of 10 to 20 mL/min, a daily dosage of 200 mg of ZYLOPRIM is suitable. When the creatinine clearance is less than 10 mL/min, the daily dosage should not exceed 100 mg” (Drugs.com, n.d.). Patients may require just 100mg a day, but the dose can be decreased further by having the patient take it fewer days a week. In addition, because the patient has T2DM that has already resulted in decreased renal function, further decreased renal function is possible through the disease course and periodic monitoring of renal function and allopurinol dose adjustments may be necessary. Reference Drugs.com (n.d.) Retrieved from
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- Fall '17
- Dr. Funda Tiryaki
- Uric acid, colchicine, Allopurinol