Allopurinol — Severe Drug Reactions and Potential Death Are More Frequent Among Users than Nonusers

Although incidence is rare, high mortality in those who do develop reactions is an important factor when making treatment decisions.

It has long been recognized that allopurinol, a xanthine oxidase inhibitor used to treat hyperuricemia and gout, is associated with increased risk for severe cutaneous adverse reactions (SCARs). In my practice, we have seen multiple cases of Stevens-Johnson syndrome or toxic epidermal necrolysis attributable to the initiation of allopurinol therapy.

Epidemiologists used Medicaid databases in five large U.S. states to compare incidence rates (IRs) of hospitalization for SCARs in 90,358 patients initiated on allopurinol and 90,358 controls without allopurinol exposure. They found an IR of 0.69 per 1000 person-years in allopurinol recipients versus 0.04 in nonusers. Twelve deaths occurred in the 45 patients with allopurinol-induced SCARs (26.7%…

Reviewing Author

Jeffrey P. Callen, MD

Disclosures

Consultant / Advisory board XOMA; Eli Lilly; Celgene

Equity Various trust accounts

Editorial boards JAMA Dermatology; UpToDate

Leadership positions in professional societies Association of Professors of Dermatology (President-Elect)