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Since the excretion of oxipurinol is similar to that of urate, uricosuric agents, which increase the excretion of urate, are also likely to increase the Online of oxipurinol and thus lower the degree Zyloprim inhibition of xanthine oxidase. Although clinical evidence to date has not demonstrated renal precipitation of oxypurines in patients either on ZYLO-PRIM alone or in combination with uricosuric agents, the possibility should be kept in mind. The reports that the concomitant use of ZYLOPRIM allopurinol Migliore thi-azide diuretics may contribute to the enhancement of allopuri-nol toxicity in some patients have been reviewed in an attempt to establish a cause-and-effect relationship and a mechanism of causation.
Although a causal mechanism and a cause-and-effect relationship have not been established, current evidence suggests that renal function should be monitored in patients on thi-azide diuretics and ZYLOPRIM allopurinol even in the absence of renal failure, Zyloprim Migliore Online, and dosage levels should be even more conservatively adjusted in those patients on such combined therapy if diminished renal function is detected.
The cause of the reported association has not been established. Enhanced bone marrow suppression by cyclophosphamide Migliore other cytotoxic agents has been reported among patients with neoplastic disease, except leukemia, in the Online of ZYLOPRIM allopurinol. Tolbutamide’s conversion to inactive metabolites has been shown to be catalyzed by xanthine oxidase from rat liver. The clinical significance, if any, of these observations is unknown.
The risk of hypoglycemia secondary to this mechanism may be increased if ZYLOPRIM allopurinol and chlorpropamide are Zyloprim concomitantly in the presence of renal insufficiency, Zyloprim Migliore Online. In patients with pre-existing liver disease, periodic liver function tests are recommended during the early stages of therapy. Due to the occasional occurrence of drowsiness, patients should be alerted to the need for due precaution when engaging in activities where alertness is mandatory.
The use of colchicine or anti-inflammatory agents may be required to suppress gouty attacks in some cases. The attacks usually become shorter and less severe after several months of therapy.
Even with adequate therapy with ZYLOPRIM allopurinol, it may require several months to deplete the uric acid pool sufficiently to achieve control of the acute attacks. A fluid intake sufficient to yield a daily urinary output of at least 2 liters and the Migliore of a neutral or, preferably, slightly alkaline urine are desirable Zyloprim 1 avoid the theoretical possibility of formation Online xanthine calculi under the influence of therapy with ZYLOPRIM allopurinol and 2 help prevent renal precipitation of urates in patients receiving concomitant uricosuric agents.
Concurrent conditions such as multiple myeloma and congestive myocardial disease were present among those patients whose renal dysfunction increased after ZYLOPRIM allopurinol was begun.
In patients with severely impaired renal function Zyloprim decreased urate clearance, the half-life of oxipurinol in the plasma is greatly prolonged. ZYLOPRIM allopurinol and its primary active metabolite, oxipurinol, are eliminated Online the kidneys; therefore, Zyloprim Migliore Online, changes in renal function have a profound effect on dosage. There Migliore increased numbers of external malformations in fetuses at both doses of allopurinol on gestation day 10 and increased numbers of skeletal malformations in fetuses at both doses on gestation day 13.
It cannot be determined whether this represented a fetal effect or an effect secondary to maternal toxicity. There are, however, Zyloprim Migliore Online, no adequate or well-controlled studies in pregnant women. There are two unpublished reports and one published paper of women giving birth to normal offspring after receiving ZYLOPRIM allopurinol during pregnancy.
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