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Some patients with pre-existing renal disease or poor urate clearance have shown a rise in BUN during administration of ZYLOPRIM (allopurinol) . Although the mechanism responsible for this has not been established.patients with impaired renal function should be carefully observed during the early stages of administration of ZYLOPRIM (allopurinol) and the dosage decreased or the drug withdrawn if increased abnormalities in renal function appear and persist.

Early clinical experience with this drug found acute gouty attacks on therapy initiation to be one of the more commonly allopurinol generic adverse reactions. however.current use analyses suggests this incidence is now less than 1%. The reason for this change has not been determined.but it may be due to patients initiating therapy more gradually.

Gastrointestinal. Hepatic necrosis.granulomatous hepatitis.hepatomegaly.hyperbilirubinemia.cholestatic jaundice.vomiting.intermittent abdominal pain.gastritis.dyspepsia.

The reports that the concomitant use of allopurinol and thiazide diuretics may contribute to the enhancement of allopurinol toxicity in some patients have been reviewed in an attempt to establish a cause-and-effect relationship and a mechanism of causation. Review of these case reports indicates that the patients were mainly receiving thiazide diuretics for hypertension and that tests to rule out decreased renal function secondary to hypertensive nephropathy were not often performed. In those patients in whom renal insufficiency was documented.however.the recommendation to lower the dose of allopurinol was not followed. 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 thiazide diuretics and allopurinol even in the absence of renal failure.and dosage levels should be even more conservatively adjusted in those patients on such combined therapy if diminished renal function is detected.

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rarer side effects that are more severe if they do occur include the following numbness tingling of arms legs, itching and or swelling, hypersensitive reactions, easy bleeding and or bruising, unusual tiredness, blood in urine or pain when urinating, dark urine, signs of infection, vision changes, eye pain, loss of appetite, breathing problems allopurinol is one of the drugs commonly known to cause stevens johnson syndrome sjs and toxic epidermal necrolysis tens , two life-threatening dermatological conditions.

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