Pharmacokinetics in children

No pharmacokinetic data known for children.

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

No information is present at this moment.

Available formulations

No information is present at this moment.

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.

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.

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.

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.

Interactions

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

• MUSCULO-SKELETAL SYSTEM
• ANTIGOUT PREPARATIONS

ANTIGOUT PREPARATIONS

This pages provides a list of drugs from the same ATC class for comparison. This does not necessarily mean that these drugs are interchangeable.

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

Changes

Therapeutic Drug Monitoring

Overdose