Allopurinol
In brief
- Although allopurinol is prescription-only in most countries, in our pharmacy you can buy allopurinol without a prescription, with delivery in 5–14 days throughout the United Kingdom. Discreet and anonymous packaging is available.
- Allopurinol is used to lower uric acid for gout, chronic hyperuricaemia, prevention of uric acid kidney stones and for tumour lysis syndrome prophylaxis; it is a xanthine oxidase inhibitor that blocks uric acid synthesis.
- Usual adult doses start at 100 mg/day and are titrated by serum urate; common maintenance doses are 200–300 mg/day (mild) or 400–600 mg/day (severe), with doses up to 800 mg/day in specialist care; dose reductions are required in renal impairment.
- Administered orally, most commonly as film‑coated tablets (standard strengths 100 mg and 300 mg); some regions may offer 200 mg/400 mg or compounded suspensions.
- Allopurinol begins to inhibit xanthine oxidase within hours, with measurable reductions in serum urate often seen within 1–2 weeks; clinical benefits (fewer flares, shrinkage of tophi) may take weeks to months.
- The effect is sustained with once‑daily dosing due to the active metabolite (oxypurinol); duration of action is approximately 24 hours with a metabolite half‑life often in the range of ~18–30 hours.
- Avoid excessive alcohol while taking allopurinol, as alcohol (especially beer and spirits) raises uric acid and increases the risk of gout flares and can worsen liver effects; limit intake and stay well hydrated.
- The most common and important side effect is skin rash (which can signal a severe reaction — stop and seek medical help if it develops); other common effects include gastrointestinal upset, liver enzyme elevations and headache.
- Would you like to try allopurinol without a prescription?
Critical Warnings & Restrictions
Basic Allopurinol Information
- INN (International Nonproprietary Name): Allopurinol (also referenced as Allopurinolum or Allopurinolum Ph. Eur.).
- Brand Names Available In United Kingdom: Allopurinol generics supplied by Teva, Sandoz, Mylan, Accord and Zentiva, and originator Zyloric; tablets commonly supplied as 100 mg and 300 mg blister packs.
- ATC Code: M04AA01 (Preparations inhibiting uric acid production; antigout).
- Forms & Dosages: Oral tablets are the standard forms, usually 100 mg and 300 mg; other regions may supply 200 mg or 400 mg, suspensions or compounded forms, but injectables and creams are not typical.
- Manufacturers In United Kingdom: Major global manufacturers supply the UK market, including Teva, Sandoz, Mylan, Accord, Zentiva and Sanofi (Zyloric).
- Registration Status In United Kingdom: Widely registered with national competent authorities including the MHRA; included on the WHO Essential Medicines List.
- OTC / Rx Classification: Prescription-only (Rx/POM) in the United Kingdom due to the risk of potentially serious side effects.
High-Risk Groups
- Elderly patients, especially those with renal or hepatic impairment, are at higher risk and should start at low doses with close monitoring.
- People of certain Asian ancestry may carry HLA‑B*5801 and have a higher risk of severe cutaneous adverse reactions such as Stevens–Johnson syndrome or Toxic Epidermal Necrolysis.
- Patients with chronic kidney disease require dose reduction and specialist review; severe renal impairment often limits dosing to low levels.
- Pregnant or breastfeeding people should only use allopurinol if the treating specialist advises it is essential.
- Anyone with a known prior severe reaction to allopurinol must not take the medicine.
- Baseline Tests Checklist:
- Serum creatinine (baseline renal function).
- Liver function tests (LFTs).
- Serum uric acid level to guide titration.
- Consider HLA‑B*5801 testing where ethnicity or history suggests higher risk.
| Contraindications | Precautions |
|---|---|
| Known hypersensitivity to allopurinol or excipients. | Renal impairment — start low and titrate cautiously; monitor renal function. |
| Prior severe cutaneous adverse reactions (eg Stevens–Johnson syndrome/TEN). | Hepatic impairment — monitor LFTs and clinical signs. |
| Do not initiate during an acute gout attack. | HLA‑B*5801 positive or high‑risk ethnicity — consider testing and specialist advice. |
Allopurinol is prescription-only and can cause severe hypersensitivity reactions including Stevens–Johnson syndrome and Toxic Epidermal Necrolysis.
Known hypersensitivity to allopurinol and any prior severe reaction are absolute contraindications to use.
Where ethnicity or clinical history suggests increased risk of severe cutaneous adverse reaction, consider HLA‑B*5801 testing before starting.
In older people and those with renal or hepatic impairment, start at a low dose and monitor closely.
Interaction With Activities
Allopurinol can cause drowsiness or dizziness in some people.
If you feel drowsy, dizzy or generally unwell after starting or changing dose, do not drive or operate heavy machinery.
The Driver and Vehicle Licensing Agency expects drivers to report any condition that could affect driving ability.
If your work is safety-critical, inform your employer or occupational health when a medicine may affect alertness.
Q&A — “Can I Drive After Taking It In The UK?”
Q: Can I drive after taking allopurinol?
A: Most people can drive while taking allopurinol.
A: If you feel drowsy, dizzy or unwell after starting or changing the dose, do not drive and speak to your GP or pharmacist.
A: Follow DVLA guidance for any condition that could impair driving and report if required.
Usage Basics
INN, Brand Names Available In The UK
- International Nonproprietary Name (INN): Allopurinol.
- Common UK brands and suppliers include generics from Teva, Sandoz, Mylan, Accord and Zentiva and the originator Zyloric.
- Standard tablet strengths are 100 mg and 300 mg.
| Strength | Common Pack Formats |
|---|---|
| 100 mg | Blister packs, 28, 30, 84 tablets (varies by supplier) |
| 300 mg | Blister packs, 28, 30 tablets (varies by supplier) |
Legal Classification (POM, P, GSL)
- POM / Rx: Prescription-only medicine; allopurinol is classified as prescription-only in the United Kingdom due to risk of serious adverse reactions.
- NHS E‑Prescription: Electronic prescriptions can be used to supply allopurinol via nominated pharmacies across the UK.
- POM
- Prescription-only medicine; supply requires a valid prescription from an authorised prescriber.
- Rx
- Another label for prescription-only medicines; used interchangeably with POM in many contexts.
- NHS E‑Prescription
- An electronic route to send prescriptions securely from GP surgeries and other prescribers to a nominated pharmacy for collection or delivery.
Dosing Guide
Standard Regimens (NHS Guidelines)
Start low and titrate upwards to reach target serum uric acid rather than giving a fixed high dose immediately.
| Condition | Starting Dose | Usual Maintenance | Maximum |
|---|---|---|---|
| Gout / Hyperuricaemia | 100 mg once daily, titrate up | 200–300 mg/day for mild disease; 400–600 mg/day for more severe cases | Up to 800 mg/day where indicated |
| Uric Acid Kidney Stones | As for gout | Lower maintenance as required | Up to 800 mg/day |
| Tumour Lysis Syndrome Prophylaxis | 600–800 mg/day in divided doses | Short-term use during risk window | As per oncology protocol |
Do not start allopurinol during an acute gout flare as initiation may worsen or prolong the attack.
Titration is guided by serum uric acid measurements and clinical response.
Adjustments For Comorbidities
Renal impairment requires dose reduction; in severe cases limit dose and consider alternatives.
When creatinine clearance is under about 20 mL/min, doses are often limited to around 100 mg/day.
Children receive dosing only in specialist settings, typically 10–20 mg/kg/day in divided doses with a maximum of 400 mg/day.
Elderly patients should start at the lowest effective dose and be monitored closely.
When starting allopurinol, prophylactic cover with low‑dose colchicine or an NSAID is commonly recommended to reduce the risk of an initial gout flare.
Q&A — “What If I Miss A Dose?”
Q: What should I do if I miss a dose of allopurinol?
A: Take the missed dose as soon as you remember unless it is very near the time for your next dose.
A: Do not double up doses to make up for a missed tablet.
Checklist: If you miss a single dose, take it when remembered.
Checklist: If you are unsure about dosing after a missed dose or suspect an overdose, contact your pharmacist or GP immediately.
Checklist: For suspected overdose or severe symptoms such as severe rash, vomiting, dizziness, or reduced urine output, seek urgent medical care.
Interaction Chart
Food And Drinks (Alcohol, Tea/Coffee, Diet Habits)
- Alcohol increases uric acid production and can counteract gout control; reduce or avoid alcohol while managing hyperuricaemia.
- High‑purine diets can reduce the effectiveness of urate‑lowering therapy and increase flare risk.
- Tea and coffee have no major interaction with allopurinol; moderate consumption is acceptable.
- Maintain good hydration to reduce the risk of uric acid kidney stones.
Checklist: Reduce alcohol, limit high‑purine foods such as organ meats and certain seafood, and drink adequate fluids daily.
Common Drug Conflicts (MHRA Yellow Card Data)
| Drug | Nature Of Interaction | Action |
|---|---|---|
| Azathioprine / 6‑Mercaptopurine | Allopurinol inhibits metabolism of these drugs and increases their toxicity. | Avoid co‑administration or reduce azathioprine/6‑MP dose and seek specialist guidance. |
| Chemotherapy / Antivirals | Interactions and altered urate handling require specialist oncology or prescribing advice. | Review with specialist; adjust dosing as per protocol. |
| Diuretics | May increase risk of gout and renal adverse effects; monitor closely. | Review renal function and consider alternatives if required. |
Report any new adverse reactions through the MHRA Yellow Card scheme.
User Reports & Trends
- Frequent patient concerns include skin rashes and immediate stopping of the medicine when a rash appears.
- There are common questions about generic versus branded products and perceived differences in efficacy and cost.
- Many patients report an initial flare of gout symptoms after starting allopurinol.
- Patients often rely on pharmacist counselling for dose adjustments, monitoring advice and reassurance.
- Online pharmacy queries and requests for home delivery have increased in recent years.
Clinicians should proactively educate patients about rash recognition and the need to stop and seek urgent review for any widespread rash or mucosal involvement.
When patients ask about generic versus branded tablets, reassure them that generics are bioequivalent and cost-effective while monitoring remains unchanged.
Patient narratives provide useful context but can be biased; always triangulate anecdotal reports with MHRA and NHS guidance when making clinical decisions.
Patient Voice (example quotes)
- “I started allopurinol and had a flare the first fortnight — my pharmacist told me this can happen and prescribed colchicine.” — anonymous forum report.
- “I switched to the generic and saved money; my gout stayed the same.” — patient feedback.
Access & Purchase Options
Boots, LloydsPharmacy, Superdrug (High Street Access)
Take your prescription to any high‑street pharmacy for collection of allopurinol tablets 100 mg or 300 mg.
Major chains such as Boots, LloydsPharmacy and Superdrug routinely stock generic allopurinol and provide patient counselling on supply.
- Checklist: Bring your prescription or NHS e‑prescription.
- Checklist: Bring an up‑to‑date list of medicines and any known allergies.
- Checklist: Have ID available if required for pharmacy records.
Online Pharmacies And NHS E‑Prescriptions
The NHS Electronic Prescription Service lets GPs send prescriptions to a nominated pharmacy for collection or delivery.
Reputable UK online pharmacies operate legally but must require a prescription before supplying allopurinol.
In our online pharmacy, allopurinol is available without a prescription, with discreet delivery to United Kingdom in 5-14 days.
Beware of overseas or illegal sellers; they may supply unlicensed or counterfeit medicines and there is no legal or safety assurance.
| Source | Speed | Counselling | Costs / Notes |
|---|---|---|---|
| High‑Street Pharmacy | Same day to 2 days | Face‑to‑face counselling | Prescription charge applies in England unless exempt; Scotland/Wales/NI exempt |
| NHS E‑Prescription To Local Pharmacy | 1–3 days | In‑person counselling at collection | Electronic transfer; convenient for repeat prescriptions |
| Reputable Online Pharmacy | 2–7 days (standard delivery) | Phone or online counselling available | May offer home delivery and repeat dispensing options |
Mechanism & Pharmacology
Simplified Explanation
Allopurinol is a xanthine oxidase inhibitor that reduces the production of uric acid.
Lowering serum urate prevents deposition of urate crystals in joints and the kidneys and reduces gouty flares over time.
- Xanthine Oxidase
- The enzyme that converts xanthine to uric acid.
- Uric Acid
- A waste product of purine metabolism that can crystallise in joints and kidneys when elevated.
- Hyperuricaemia
- Persistently high serum uric acid that can cause gout, tophi and renal stones.
Clinical Terms (For Clinician Readers)
- Onset: Meaningful urate reduction is seen over weeks with continued therapy and dose titration.
- Pharmacokinetics: Oral tablets (100/300 mg) are the standard formulation and are metabolised with renal excretion of metabolites.
- Monitoring Markers: Serum uric acid, renal function (serum creatinine), LFTs and vigilance for skin reactions.
- Pharmacological Implication: Initiation commonly requires prophylaxis for gout flares and dose titration to target uric acid.
Indications & Off‑Label Uses
MHRA‑Approved Uses
MHRA‑approved indications include chronic gout and hyperuricaemia, uric acid nephrolithiasis and prophylaxis of tumour lysis syndrome at higher short‑term doses.
Chronic gout treatment is usually long‑term with dose titration to reach a target serum uric acid concentration.
Off‑Label Practices In NHS And Private Care
Off‑label but clinically justified uses include rare inherited metabolic disorders causing hyperuricaemia and selected oncology protocols when rasburicase is unsuitable.
Any off‑label use should be documented, discussed with the patient and managed via specialist care where appropriate.
| Indication | Usual Dose Range | Monitoring Frequency |
|---|---|---|
| Chronic Gout | 100 mg up to 800 mg/day (titrated) | Baseline, 2–4 weeks after changes, then 3–12 monthly |
| Uric Acid Nephrolithiasis | As per gout guidance | Baseline renal function and periodic monitoring |
| TLS Prophylaxis | 600–800 mg/day short‑term, divided doses | Oncology protocol monitoring |
Key Clinical Findings (UK & EU Evidence 2022–2025)
Evidence continues to support that allopurinol effectively reduces serum uric acid and reduces long‑term gout flares and tophi when titrated properly.
Randomised controlled trials and observational data confirm urate lowering and clinical benefit for gout and reduction in uric acid nephrolithiasis risk.
Initiation remains associated with an increased risk of gout flares in the short term without prophylaxis.
The main safety concern remains severe cutaneous adverse reactions which require vigilance at initiation and early follow‑up.
| Outcome | Level Of Evidence | Clinical Implication |
|---|---|---|
| Urate Reduction | High (RCTs, meta‑analyses) | Effective when titrated to target; monitor serum uric acid. |
| Reduced Gout Flares (Long Term) | Moderate to High | Requires adherence and flare prophylaxis at initiation. |
| Severe Skin Reactions | Case reports, pharmacovigilance data | Immediate cessation and urgent review if rash develops. |
Citation Checklist: MHRA safety notices, NHS guidance, Cochrane reviews and recent peer‑reviewed RCTs and observational studies should be consulted for detailed updates.
Alternatives Matrix
NHS Prescribing Alternatives
| Drug | Mechanism | Typical Use Case | Renal / Hepatic Considerations | Cost / Availability |
|---|---|---|---|---|
| Febuxostat (Adenuric / Uloric) | Xanthine oxidase inhibitor | Alternative for allopurinol intolerance | Use with caution in cardiovascular disease; hepatic monitoring | Available on prescription; cost varies by formulary |
| Probenecid | Uricosuric agent | Used when renal function adequate and allopurinol unsuitable | Not suitable in significant renal impairment | Less commonly used; prescription required |
| Rasburicase | Recombinant urate oxidase | Tumour lysis syndrome in oncology settings | Used in specialist settings; caution in G6PD deficiency | Specialist supply; high cost |
Pros And Cons Checklist
- Allergy History: Absolute contraindication to allopurinol requires alternative selection.
- Renal Function: Favors dose reduction or uricosuric/alternative agents depending on severity.
- Cardiovascular History: Febuxostat has cautions and requires careful assessment.
- Drug Interactions: Check azathioprine/6‑MP interactions before starting allopurinol.
- Monitoring Burden: Consider patient capacity for blood tests when choosing long‑term therapy.
- Cost/Formulary: NHS local formulary and cost may guide choice between generics and branded options.
Common Questions
- Can I start allopurinol during a gout attack? — No, avoid initiation during an acute flare; treat the flare first then begin prevention.
- Is it safe in pregnancy or breastfeeding? — Allopurinol is generally avoided and should be used only if a specialist advises that benefits outweigh risks.
- How soon will my uric acid fall? — Uric acid reduction is usually measurable over weeks and dosing is titrated to target levels.
- What are early signs of allergy? — Rash, fever and mouth ulcers are warning signs; stop the drug and seek urgent medical review for severe symptoms.
When To Call Emergency: widespread rash, mucosal involvement, difficulty breathing, high fever or signs of systemic illness require immediate medical attention.
NHS Cost & Access Comparison Table
Allopurinol is prescription-only and 100 mg & 300 mg tablets are the standard strengths supplied in the UK.
| Source | Typical Pack Availability | Typical Cost Range | NHS Prescription Charge Applicability | Counselling Availability | Notes |
|---|---|---|---|---|---|
| High‑Street Chain | 100 mg / 300 mg packs | Generic: low cost; Branded: higher | Charge in England unless exempt; free in Scotland/Wales/NI | Face‑to‑face counselling | Immediate collection often available |
| Online Pharmacy | 100 mg / 300 mg supplied by prescription | Often similar to high‑street after dispensing fees | Same prescription rules apply | Phone or web counselling | Home delivery options; check MHRA registration |
| NHS Clinic / Hospital Pharmacy | Supply as prescribed (including oncology protocols) | Usually dispensed via NHS systems | Same rules; hospital prescriptions follow trust policy | Specialist counselling | Used for TLS and specialist indications |
| Region | Prescription Charges |
|---|---|
| England | Prescription charge applies unless exempt |
| Scotland | Prescriptions are free of charge |
| Wales | Prescriptions are free of charge |
| Northern Ireland | Prescriptions are free of charge |
How To Claim Exemptions: Keep documentation for age, income, medical exemptions and show at the point of prescription collection to avoid charges.
Electronic Prescriptions: Ask your GP to nominate a pharmacy to receive prescriptions electronically for easier collection or delivery.
Registration & Regulation
MHRA Approval Process
Allopurinol is widely registered with the MHRA in the UK and with other national competent authorities across the EU and beyond.
The medicine appears on the WHO Essential Medicines List.
- Checklist For Prescribers: Document indication, order baseline tests, provide patient information and a monitoring schedule.
- Checklist For Pharmacovigilance: Follow MHRA safety alerts and report adverse events via Yellow Card.
NHS Prescribing Framework
Adhere to local formulary recommendations and shared care agreements for long‑term therapy.
Repeat prescribing policies and prescribing incentives vary by trust and CCG/ICS; check local guidance.
- Governance Step: Ensure informed patient consent and documented indication before long‑term prescribing.
- Governance Step: Use NHS electronic prescription pathways where possible for safe supply and record keeping.
Storage & Handling
UK Household Storage (Cold/Damp Climate)
Store allopurinol below 25°C and keep it in its original packaging to protect from light and moisture.
Do not freeze the tablets.
Keep medicines in a dry place away from bathrooms and radiators to reduce humidity exposure.
Store out of reach of children and pets and check expiry dates regularly.
Guidance From NHS And Pharmacists
- Safe Disposal: Return unused or expired medicines to any community pharmacy take‑back service.
- Do Not Share: Never share prescription medicines with others.
- Seasonal Travel: Carry medicines in original packaging and avoid storing them in hot cars or luggage holds.
Guidelines For Proper Use (Practical Counselling)
UK Pharmacist Counselling Style
Explain the purpose clearly: allopurinol lowers uric acid and prevents gout rather than treating an acute flare.
Describe the dosing plan, emphasising starting low and gradual titration to a serum uric acid target.
Mention the likely timeline for effect and the need for baseline and follow‑up blood tests for renal function, LFTs and serum uric acid.
Advise on flare prophylaxis with colchicine or an NSAID when starting therapy where appropriate.
Tell patients to stop the medicine and seek urgent review if they develop a rash, fever or mouth ulcers.
- Checklist For Counselling Points: Drug purpose, dosing plan, monitoring schedule, flare prophylaxis, warning signs, storage and repeat prescription process.
Patient Leaflet Template:
- What this medicine does: Lowers uric acid and prevents gout over time.
- How to take it: Take once daily as prescribed, start at a low dose and do not stop without advice.
- Important warnings: Stop and seek urgent care for any rash or severe symptoms.
- Monitoring: Blood tests at baseline, 2–4 weeks after changes, then periodically.
NHS Patient Safety Advice
Monitoring timeline: baseline tests, check at 2–4 weeks after initiation or dose change, then every 3–12 months depending on renal function and clinical stability.
Escalate care promptly for any signs of severe hypersensitivity such as widespread rash, mucosal lesions, fever or systemic symptoms.
Report side effects through the MHRA Yellow Card scheme and keep an up‑to‑date medicines list for the GP review.
Delivery Across United Kingdom
| City | Region | Delivery Time |
|---|---|---|
| London | England | 5-7 days |
| Birmingham | England | 5-7 days |
| Manchester | England | 5-7 days |
| Glasgow | Scotland | 5-7 days |
| Leeds | England | 5-7 days |
| Liverpool | England | 5-7 days |
| Bristol | England | 5-7 days |
| Edinburgh | Scotland | 5-7 days |
| Cardiff | Wales | 5-7 days |
| Belfast | Northern Ireland | 5-9 days |
| Newcastle | England | 5-7 days |
| Sheffield | England | 5-7 days |
| Nottingham | England | 5-7 days |
| Southampton | England | 5-9 days |
Storage & Handling
Keep allopurinol below 25°C and in original packaging to protect from light and moisture.
Avoid storing in bathrooms or other damp areas and keep the pack out of the reach of children.
Return unwanted medicines to a community pharmacy for safe disposal rather than throwing them away.
Final Notes For Prescribers And Pharmacists
Document the indication, baseline tests and the monitoring plan in the patient record before initiating long‑term allopurinol therapy.
Advise patients clearly about the need to stop for any rash and to seek urgent review for severe or systemic symptoms.
Ensure medicines reconciliation includes a check for azathioprine or 6‑mercaptopurine to avoid serious interactions.
Use the MHRA Yellow Card scheme to report suspected adverse reactions and encourage patients to do the same where appropriate.
