Buy Allopurinol Online

Aloprim (allopurinol sodium)

THERAPEUTIC CLASS

Xanthine oxidase inhibitor

DEA CLASS

RX

INDICATIONS

Management of patients with leukemia, lymphoma, and solid tumor malignancies who are receiving cancer therapy which causes elevations of serum and urinary uric acid levels and who cannot tolerate oral therapy.

ADULT DOSAGE

Chemotherapy-Induced Hyperuricemia

Management of patients w/ leukemia, lymphoma, and solid tumor malignancies who are receiving cancer therapy that causes elevations of serum and urinary uric acid levels and who cannot tolerate oral therapy

Usual: 200-400mg/m2/day, as a single infusion or in equally divided infusions at 6-, 8-, or 12-hr intervals
Max: 600mg/day

Whenever possible, initiate therapy 24-48 hrs before the start of chemotherapy known to cause tumor cell lysis (including adrenocortical steroids)

PEDIATRIC DOSAGE

Chemotherapy-Induced Hyperuricemia

Management of patients w/ leukemia, lymphoma, and solid tumor malignancies who are receiving cancer therapy that causes elevations of serum and urinary uric acid levels and who cannot tolerate oral therapy

Initial: 200mg/m2/day, as a single infusion or in equally divided infusions at 6-, 8-, or 12-hr intervals

Whenever possible, initiate therapy 24-48 hrs before the start of chemotherapy known to cause tumor cell lysis (including adrenocortical steroids)

DOSING CONSIDERATIONS

Renal Impairment
CrCl 10-20mL/min: 200mg/day
CrCl 3-10mL/min: 100mg/day
CrCl <3mL/min: 100mg/day at extended intervals

Elderly
Start at lower end of dosing range

ADMINISTRATION

IV route

Hydration
Fluid intake sufficient to yield a daily urinary output of ≥2L in adults and the maint of a neutral or, preferably, slightly alkaline urine are desirable

Preparation of Sol
1. Dissolve the contents of each 30mL vial w/ 25mL of sterile water for inj; reconstitution yields a concentrated sol w/ a pH of 11.1-11.8
2. Dilute the sol to the desired concentration w/ 0.9% NaCl inj or D5 for inj; refer to PI for drugs that are physically incompatible in sol w/ allopurinol
3. A final concentration of ≤6mg/mL is recommended

Administration
Begin administration w/in 10 hrs after reconstitution
The rate of infusion depends on the volume of infusate
Do not mix w/ or administer through the same IV port w/ agents that are incompatible in sol w/ allopurinol

HOW SUPPLIED

Inj: 500mg

WARNINGS/PRECAUTIONS

D/C at 1st appearance of skin rash or other signs of an allergic reaction. Hepatotoxicity and elevated serum alkaline phosphatase/transaminase reported with PO allopurinol. Bone marrow suppression reported. Evaluate liver function if anorexia, weight loss, or pruritus develops. Periodically monitor LFTs during early stages of therapy in patients with preexisting liver disease. May impair mental/physical abilities. Maintain sufficient fluid intake to yield a daily urinary output in adults of at least 2L and maintain neutral or slightly alkaline urine. Caution with renal impairment or concurrent illnesses affecting renal function (eg, HTN, diabetes mellitus); periodically monitor renal function. Caution in elderly.

ADVERSE REACTIONS

Rash, eosinophilia, local inj-site reaction, diarrhea, nausea, decreased renal function, generalized seizure.

DRUG INTERACTIONS

Inhibits oxidation of mercaptopurine and azathioprine; reduce mercaptopurine or azathioprine dose to 1/3-1/4 of usual dose when given with 300-600mg of allopurinol. May prolong T1/2 of dicumarol; monitor PT with concomitant use. Inhibition of xanthine oxidase by oxypurinol may be decreased and urinary excretion of uric acid may be increased with concomitant uricosuric agents. May increase toxicity and occurrence of hypersensitivity reactions with concomitant thiazide diuretics in patients with decreased renal function; monitor renal function. May increase frequency of skin rash when used with ampicillin or amoxicillin. Bone marrow suppression may be enhanced with cyclophosphamide and other cytotoxic agents among patients with neoplastic disease, except leukemia. May increase risk of hypoglycemia in the presence of renal insufficiency with concomitant chlorpropamide. May increase cyclosporine levels; monitor cyclosporine levels and consider possible adjustment of cyclosporine dose.

PREGNANCY AND LACTATION

Category C, caution in nursing.

MECHANISM OF ACTION

Xanthine oxidase inhibitor; reduces production of uric acid by inhibiting the biochemical reactions immediately preceding its formation.

PHARMACOKINETICS

Absorption: Allopurinol: Cmax=1.58mcg/mL (100mg), 5.12mcg/mL (300mg); Tmax=0.5 hr; AUC=1.99 hr•mcg/mL (100mg), 7.1 hr•mcg/mL (300mg). Oxypurinol: Cmax=2.2mcg/mL (100mg), 6.18mcg/mL (300mg); Tmax=3.89 hrs (100mg), 4.16 hrs (300mg); AUC=80 hr•mcg/mL (100mg), 231 hr•mcg/mL (300mg). Distribution: Found in breast milk. Allopurinol: Vd=0.84L/kg (100mg), 0.87L/kg (300mg). Metabolism: Oxidation; oxypurinol (active metabolite). Elimination: Urine (12% unchanged, 76% oxypurinol). Allopurinol: T1/2=1 hr (100mg), 1.21 hrs (300mg). Oxypurinol: T1/2=24.1 hrs (100mg), 23.5 hrs (300mg).

ASSESSMENT

Assess for renal/hepatic disease, concurrent illnesses affecting renal function, previous severe reaction to the drug, pregnancy/nursing status, and possible drug interactions. Obtain serum uric acid level to provide correct dosage and schedule.

MONITORING

Monitor for signs/symptoms of hypersensitivity/allergic reactions, drowsiness, bone marrow suppression, and other adverse reactions. Monitor fluid intake, LFTs, renal function (BUN, SrCr, CrCl), and serum uric acid level.

PATIENT COUNSELING

Inform of risks and benefits of therapy. Counsel that drug may impair mental/physical abilities. Advise to take sufficient fluid to yield urinary output of at least 2L/day in adults and inform of the need to maintain a neutral or, preferably, slightly alkaline urine. Instruct to report any adverse events to physician.

STORAGE

20-25°C (68-77°F). Do not refrigerate reconstituted/diluted sol.

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