Dosages
Side effects in children
Warnings & precautions in children
Contra-indications in children

Interactions
PK
Renal impairment
References

Allopurinol

Generic name
Allopurinol
Brand name
ATC Code
M04AA01

Pharmacokinetics in children

No pharmacokinetic data known for children.

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dose recommendation of formulary compared to licensed use (on-label versus off-label)

No information is present at this moment.

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Available formulations

No information is present at this moment.

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Dosages

Glycogen storage disorder
  • Oral
    • 0 years up to 18 years
      • 10 - 20 mg/kg/day in 3 doses. Max: 600 mg/day.

      • Treatment by or after consultations with a paediatric specialist (metabolic disorders) who has experience with using allopurinol for this indication.
Hyperuricaemia, tumour lysis syndrome
  • Oral
    • 1 month up to 18 years
      [1] [2] [3] [4] [5] [6]
      • 300 mg/m²/day in 3 doses. Max: 600 mg/day.
        • Equivalent to 10-20 mg/kg/day
        • Start 24-48 hours before commencing chemotherapy
  • Intravenous
    • 1 month up to 18 years
      [1] [7]
      • 200 - 300 mg/m²/day in 3 doses. Max: 400 mg/day.
Lesch-Nyhan, HPRT deficiency
  • Oral
    • 0 years up to 18 years
      [6] [8] [9]
      • 4 - 10 mg/kg/day in 1 - 3 doses. Max: 600 mg/day.

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Renal impaiment in children > 3 months

Adjustment in renal impairment as specified:

GFR 50-80 ml/min/1.73 m2
Dose adjustment not needed
GFR 30-50 ml/min/1.73 m2
Dose adjustment not needed
GFR 10-30 ml/min/1.73 m2
Adjustment of the starting dose is not necessary, dose according to serum uric acid.
GFR < 10 ml/min/1.73 m2
A general recommendation is not provided
Clinical consequences

With impaired renal function, cumulation of allopurinol and its active metabolite oxipurinol may occur. This increases the risk of toxicity.

Clinical implications:
Possibly increases the risk of hypersensitivity reactions, such as severe skin reactions. Thrombocytopenia, agranulocytosis, and aplastic anemia have been reported. Symptoms of overdose include nausea, vomiting, diarrhea, and dizziness.

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The complete list of all undesirable drug reactions can be found in the national Summary of Product Characteristics (SmPC) – click here

Side effects in children

Risk of hypersensitivity.

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The complete list of all contra-indications can be found in the national Summary of Product Characteristics (SmPC) – click here

Contra-indications

No information available on specific contra indications in children.

The complete list of all warnings and precautions can be found in the national Summary of Product Characteristics (SmPC) – click here

Warnings & precautions in children

Allopurinol is tolerated better when administered after a meal. Sufficient fluid intake (2-3 l/m²/day) and neutral or slightly alkaline urine are desirable. Adjust dosage in cases of reduced renal function and/or impaired hepatic function.

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Interactions

The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here

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References

  1. Kamps WA et al, Werkboek ondersteundende behandeling kinderoncologie, VU Uitgeverij, 2005
  2. Goldman SC, et al, A randomized comparison between rasburicase and allopurinol in children with lymphoma or leukemia at high risk for tumor lysis, Blood, 2001, May 15;97(10), 2998-3003
  3. Krakoff IH, et al, Hyperuricemia in neoplastic disease in children: prevention with allopurinol, a xanthine oxidase inhibitor, Pediatrics, 1968, Jan;41(1), 52-6
  4. Masson E, et al, Allopurinol inhibits de novo purine synthesis in lymphoblasts of children with acute lymphoblastic leukemia, Leukemia, 1996, Jan;10(1), 56-60
  5. Pui CH, et al, Urate oxidase in prevention and treatment of hyperuricemia associated with lymphoid malignancies, Leukemia, 1997 , Nov;11(11), 1813-6
  6. Cochat P, et al, Nephrolithiasis related to inborn metabolic diseases, Pediatr Nephrol, 2010, Mar;25(3), 415-24
  7. Smalley RV, et al , Allopurinol: intravenous use for prevention and treatment of hyperuricemia, J Clin Oncol, 2000, Apr;18(8), 1758-63
  8. Torres RJ, et al, Efficacy and safety of allopurinol in patients with hypoxanthine-guanine phosphoribosyltransferase deficiency, Metabolism, 2007, Sep;56(9):, 1179-86
  9. Cameron JS, et al, Gout, uric acid and purine metabolism in paediatric nephrology, Pediatr Nephrol, 1993, Feb;7(1), 105-18
  10. College voor zorgverzekeringen (CVZ), Farmacotherapeutisch Kompas (Eigenschappen, Contra-Indicaties, Bijwerkingen, Waarschuwingen en Voorzorgen), Geraadpleegd 06 okt 2014
  11. NKFK Workinggroup Acute Kidney Impairment, Extrapolation of KNMP risk analysis "Impaired renal function" for adults to children, 20 Dec 2021

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Changes

Changes