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Allopurinol/lesinurad is a combination medication used to prevent gout attacks. It works by dissolving uric acid crystals slowly, over several months, by lowering uric acid in the blood. One part, Allopurinol, lowers the amount of uric acid that the body makes, while the other, lesinurad, causes the body to get rid of more uric acid in the urine. After several months of low uric acid levels, the uric acid crystals dissolve, reducing the risk of gout attacks. However, while uric acid crystals are dissolving, the risk of gout attacks is increased for a few months. To prevent gout attacks in the first few months of taking allopurinol/lesinurad, anti-inflammatory medications such as colchicine and NSAIDs may be added until the risk decreases.
Allopurinol/lesinurad is usually taken in the morning with food and water. Because it works by eliminating uric acid in the urine, it is important to stay hydrated while taking allopurinol/lesinurad.
Allopurinol/lesinurad lowers uric acid levels within a few days; however, it may take up to 6 months before crystallized uric acid dissolves, if uric acid levels are lowered enough (to less than 6 mg/dl). Some patients (Han Chinese, Thai, and Korean) have a genetic predisposition to allergic reactions to the allopurinol in this medication, and your provider may check this (HLA- B5801) marker before starting.
The most significant side effect for allopurinol is the risk of an allergic reaction. If you develop any skin itching, rashes, or hives, you should discontinue allopurinol/lesinurad immediately and inform your provider.
The lesinurad part of this medication may increase the risk of kidney/bladder stones. Other potential side effects of allopurinol/lesinurad include upset stomach, liver and kidney problems, and acute gout attacks while starting the medication.
You should notify your doctor if you have a history of liver or kidney disease. Also, tell your doctor if you have ever had or develop a reaction to allopurinol, particularly a skin rash or allergic reaction. Make sure to notify your other physicians while you are taking this drug, especially if you are taking azathioprine or 6-mercaptopurine. If you are pregnant or considering pregnancy, tell your doctor before starting this medication. Women should discuss birth control with their primary care physicians or gynecologists. Breast-feeding should be avoided while taking allopurinol/lesinurad. The risk in pregnancy and breastfeeding has not been determined.
Written June 2018 by Luke Barre, MD and reviewed by the American College of Rheumatology Committee on Communications and Marketing.
This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.