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Brand names: Zyloprim / Zyloric • Drug class: Xanthine oxidase inhibitor
Allopurinol is the standard urate-lowering drug for gout — and it's safe in CKD when started low and titrated slowly. Its metabolite oxypurinol accumulates with kidney disease, and dosing adjustments prevent both toxicity and the rare but serious hypersensitivity reaction.
Allopurinol is metabolized to oxypurinol, which is excreted by the kidneys — half-life extends from ~24h to ~60-70h in renal failure. Guidelines: start at 50-100 mg/day in CKD (vs 100 mg in normal function), titrate up to the serum urate target, and use lower maintenance caps in advanced CKD.
ACR 2020: allopurinol is first-line urate-lowering therapy, including in CKD, with slow titration
ACR Gout Guideline, 2020
Long half-life of oxypurinol in CKD requires reduced starting dose and slower titration
Pharmacokinetic studies (Hande KR et al., Am J Med 1984), 1984
Serious hypersensitivity (AHS) risk reduced by low-dose starts and avoiding co-prescribed azathioprine/6-MP
Clinical guidelines, 2020
Start: 50-100 mg/day (CKD) vs 100 mg/day (normal). Titrate every 2-5 weeks to target serum urate <6.0 mg/dL (or <5.0 with tophi). CrCl <10/dialysis: 100 mg/day, or 300 mg 2-3×/week post-dialysis. Cap doses conservatively in CKD.
Check your kidney functionThis page is educational. Medication decisions — especially dosing changes — must be made by your prescribing clinician.
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This content is a general reference, not medical advice, a diagnosis, or a treatment plan. Do not change your diet, fluids, medicines, or dialysis plan without your nephrologist or renal dietitian. Individual recommendations depend on your labs, medications, conditions, and care plan.