allopurinol

Adult Dosing .

Dosage forms:  TAB: 100 mg, 200 mg, 300 mg; INJ: various

gout prophylaxis

[200-600 mg/day PO divided qd-tid]

Start: 100 mg PO qd, incr. 100 mg/day qwk until uric acid <6 mg/dL; Max: 800 mg/day; Info: maintain urine output >2 L/day, neutral/slightly alkaline urine pH; for doses >300 mg/day divide bid-tid; give w/ food

hyperuricemia, chemo-related

[PO route]

Dose: 300-800 mg/day PO divided qd-tid x3-5 days; Start: 24-48h before chemo; Info: maintain urine output >2 L/day, neutral/slightly alkaline urine pH; give w/ food; cont. until TLS risk abated, 2-3 days after chemo tx start

[IV route]

Dose: 200-400 mg/m^2/day IV divided q6-24h; Start: 24-48h before chemo; Max: 600 mg/day; Info: maintain urine output >2 L/day, neutral/slightly alkaline urine pH; cont. until able to tolerate PO tx or TLS risk abated

calcium oxalate calculi, recurrent

[200-300 mg/day PO divided qd-tid]

Info: for pts w/ uric acid excret. >800 mg/24h (males) or >750 mg/24h (females) despite lifestyle changes; maintain urine output >2 L/day, neutral/slightly alkaline urine pH; give w/ food

renal dosing

[gout prophylaxis]

eGFR 30-60: start 50 mg qd; eGFR 15-30: start 50 mg qod; eGFR 5-15: start 50 mg 2x/wk; eGFR <5: start 50 mg qwk; Info: incr. by 50 mg/day q2-4wk until uric acid <6 mg/dL

HD/PD: not defined

[hyperuricemia, chemo-related, PO route]

eGFR 10-20: 200 mg q24h; eGFR <10: 100 mg q24h

HD: 50 mg q12h or 100 mg q24h; no supplement after dialysis; PD: not defined

[hyperuricemia, chemo-related, IV route]

CrCl 10-20: 200 mg q24h; CrCl <10: 100 mg q24h

HD: 50 mg q12h or 100 mg q24h; no supplement after dialysis; PD: not defined

[calcium oxalate calculi, recurrent]

renal impairment: not defined

HD/PD: not defined

hepatic dosing

[see below]

hepatic dz: not defined, caution advised

Peds Dosing .

Dosage forms:  TAB: 100 mg, 200 mg, 300 mg; INJ: various

hyperuricemia, chemo-related

[PO route]

Dose: 100 mg/m^2/dose PO q8-12h x3-5 days; Start: 24-48h before chemo; Max: 800 mg/day; Alt: 10 mg/kg/day PO divided bid-tid x3-5 days; Info: maintain urine output >100 mL/m^2/h, neutral/slightly alkaline urine pH; give w/ food; cont. until TLS risk abated, 2-3 days after chemo tx start

[IV route]

Dose: 200 mg/m^2/day IV divided q6-24h; Start: 24-48h before chemo; Max: 400 mg/day; Info: maintain adequate urine output, neutral/slightly alkaline urine pH; cont. until able to tolerate PO tx or TLS risk abated

renal dosing

[not defined]

renal impairment: not defined, consider adult renal dosing for guidance

HD: not defined, consider adult renal dosing for guidance; PD: not defined

hepatic dosing

[see below]

hepatic dz: not defined, caution advised