Allopurinol is a xanthine analogue that blocks the conversion of hypoxanthine to uric acid. It can help prevent the uric acid nephropathy in a patient at moderate to high risk for the tumor lysis syndrome.


Contraindication: history of anaphylaxis, hypersensitivity reaction or allergy to allopurinol


Timing: Therapy is started 12-24 hours prior to start of the induction chemotherapy. It is continued during the therapy while ongoing tumor lysis is occurring. It is discontinued after therapy has stopped and once the serum uric acid level has returned to normal.


Allopurinol does not increase the excretion of uric acid in hyperuricemia. Rasburicase is used to increase uric acid excretion once formed.


Pediatric Oral

Adult Oral

Adult Intravenous

maximum daily dose

300 mg

800 mg

600 mg

mg per square meter per day

150 - 300 mg

300 mg

200-400 mg

mg per kg per day


10 mg


dosing interval



q8h, q12h or q24h



• When the transition from pediatric to adult dosing occurs is not given. An older adolescent may tolerate adult dosing.


Allopurinol dosage reduction for renal failure: >=50%


Azathioprine or 6-mercaptopurine dosage reduction if taking allopurinol: 65-75%


Drugs which may interact with allopurinol:

(1) dicumarol (coumadin)

(2) thiazide diuretic

(3) chlorpropamide

(4) cyclosporine


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