Allopurinol: Intravenous use for prevention and treatment of hyperuricemia

Purpose: To tabulate data obtained over a 21-year period to determine the e fficacy and safety of an intravenous (IV) allopurinol preparation. Patients and Methods: IV allopurinol was provided on a compassionate plea b asis to patients of any age in whom xanthine oxidase inhibitor therapy was indicated as an adjunct to chemotherapy and for whom oral intake was restri cted. Three hundred twenty-seven investigators at multiple hospitals in the United States created 1,172 patients with IV allopurinol. The vast majorit y of these patients herd a malignancy and were in danger of developing tumo r lysis syndrome (TLS) and subsequent acute uric acid nephropathy (AUAN) an d were unable to take oral allopurinol. Data referable to the time period o f IV allopurinol administration were collected, collated, and analyzed retr ospectively. There was no randomization. Results: In patients initiating treatment for an elevated serum uric acid ( SUA), the SUA normalized or improved in 87% of adult patients and normalize d or improved in 95% of pediatric patients. IV allopurinol, administered pr ophylactically to patients at high risk of developing hyperuricemia and TLS , prevented an increase in SUA levels in 93% of adults and 92% of children. Toxicities caused by IV allopurinol were minimal and consisted of 10 insta nces of mild to moderate skin or allergic reactions. Conclusion: IV allopurinol is as efficacious and safe as oral allopurinol a nd will be of significant benefit to patients at risk of TLS and AUAN and u nable to take oral medication. J Clin Oncol 18:1758-1763. (C) 2000 by American Society of Clinical Oncolog y.