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Table 1 Major limitations of allopurinol therapy

From: Recent developments in our understanding of the renal basis of hyperuricemia and the development of novel antihyperuricemic therapeutics

Rash in about 2% of treated patients
Additional intolerance in up to 10% of patients (includes hepatic enzyme, gastrointestinal, and central nervous system effects)
Allopurinol hypersensitivity syndrome: <1/1000 treated patients, but 20% fatality rate
Prolonged renal elimination of active oxypurinol metabolite necessitates reduced dose in renal disease with impaired function
Contraindicated in patients receiving azathioprine or 6-mercaptopurine