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Low-purine foods Refined cereals and cereal products, cornflakes, white bread, pasta, flour, arrowroot, sago, tapioca, cakes Milk, milk products, and eggs Sugar, sweets, and gelatin Butter, polyunsaturated margarine, and all other fats Fruit, nuts, and peanut butter Lettuce, tomatoes, and green vegetables (except those listed below) Cream soups made with low-purine vegetables but without meat or meat stock Water, fruit juice, cordials, and carbonated drinks High-purine foods All meats, including organ meats, and seafood Meat extracts and gravies Yeast and yeast extracts, beer, and other alcoholic beverages Beans, peas, lentils, oatmeal, spinach, asparagus, cauliflower, and mushrooms
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The purine content of a food reflects its nucleoprotein content and turnover Foods containing many nuclei (eg, liver) have many purines, as do rapidly growing foods such as asparagus The consumption of large amounts of a food containing a small concentration of purines may provide a greater purine load than consumption of a small amount of a food containing a large concentration of purines Reproduced, with permission, from Emmerson BT The management of gout N Engl J Med 1996 Feb 15;334(7):445 51
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The drug is of special value in uric acid overproducers; in tophaceous gout; in patients unresponsive to the uricosuric regimen; and in gouty patients with uric acid renal stones It should be used in low doses in patients with renal insufficiency and is not indicated in asymptomatic hyperuricemia The most frequent adverse effect is the precipitation of an acute gouty attack However, the most common sign of hypersensitivity to allopurinol (occurring in 2% of cases) is a pruritic rash that may progress to toxic epidermal necrolysis Vasculitis and hepatitis are other rare complications The initial daily dose of allopurinol is 300 mg/d for patients who have normal renal function and who are taking prophylactic colchicine In the absence of prophylactic colchicine, the initial dose should be 100 mg/d orally The dose of allopurinol can be increased in a week if needed to achieve the desired serum uric acid level of 50 mg/dL Successful treatment usually requires a dose of 300 400 mg of allopurinol daily The maximum daily dose is 800 mg Allopurinol can be used in renal disease, but the dose must be reduced to decrease the chance of side effects Allopurinol interacts with other drugs The combined use of allopurinol and ampicillin causes a drug rash in 20% of patients Allopurinol can increase the half-life of probenecid, while probenecid increases the excretion of allopurinol Thus, a patient taking both drugs may need to use slightly higher than usual doses of allopurinol and lower doses of probenecid
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Without treatment, the acute attack may last from a few days to several weeks The intervals between acute attacks vary up to years, but the asymptomatic periods often become shorter if the disease progresses Chronic gouty arthritis occurs after repeated attacks of acute gout, but only after inadequate treatment The younger the patient at the onset of disease, the greater the tendency to a progressive course Destructive arthropathy is rarely seen in patients whose first attack is after age 50 Patients with gout are anecdotally thought to have an increased incidence of hypertension, renal disease (eg, nephrosclerosis, interstitial nephritis, pyelonephritis), diabetes mellitus, hypertriglyceridemia, and atherosclerosis
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Zhang W et al; EULAR Standing Committee for International Clinical Studies Including Therapeutics EULAR evidence based recommendations for gout Part I: Diagnosis Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT) Ann Rheum Dis 2006 Oct;65(10):1301 11 [PMID: 16707533] Zhang w et al; EULAR Standing Committee for International Clinical Studies Including Therapeutics EULAR evidence based recommendations for gout Part II: Management Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT) Ann Rheum Dis 2006 Oct;65(10):1312 24 [PMID: 16707532]
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