Prolonged allopurinol therapy in a patient with gout is NOT indicated for:
Allopurinol is the drug of choice in- Severe tophaceous deposits Uric acid nephropathy/nephrolithiasis. Sudden increase or decrease in serum levels of uric acid can trigger acute gout attack. Allopurinol initially mobilizes uric acid stored in the tissues and increases serum uric acid level, which can make the situation worse in an acute gouty attack When we sta allopurinol in chronic hyperuricemic patients, we should warn the patient and also give colchicine or NSAIDs with allopurinol for the first few weeks to avoid a flare of it. Dose should be lowered based on the serum creatinine concentration in patients with chronic renal disease. Doses can be increased gradually to reach the target urate level of <6 mg/dL.
Acute gouty ahritis
Tophi
Urate nephropathy
Evidence of bone/joint damage
Crystal Ahropathy