Allopurinol is great for gout patients, but what if you have other diseases?

Over the years, we have had several discussions about other diseases because many gout sufferers have other health problems.

One significant is the use of allopurinol for kidney transplant patients. Azathioprine (commonly sold as Imuran, or Azasan) is commonly used to control rejection of transplanted organs.

It has been said that allopurinol should be avoided for patients taking azathioprine, but there is no clear view.

I have not researched this much, as it is very specialist, but perhaps gout patients who are affected by this may share experiences or have better information.

There are 2 recent studies that suggest allopurinol and azathioprine could work together. They are:

Title Authors Published Note
Long-term outcome of using allopurinol co-therapy as a strategy for overcoming thiopurine hepatotoxicity in treating inflammatory bowel disease. Ansari A, Elliott T, Baburajan B, Mayhead P, O’Donohue J, Chocair P, Sanderson J, Duley J. Aliment Pharmacol Ther. 2008 Sep 15;28(6):734-41. Azathioprine (or related mercaptopurine) used for Chrohn’s disease or ulcerative colitis can induce liver disease in 10% of patients. Allopurinol stops this, though authors suggest monitoring for bone marrow suppression.
A skewed thiopurine metabolism is a common clinical phenomenon that can be successfully managed with a combination of low-dose azathioprine and allopurinol. Appell ML, Wagner A, Hindorf U. J Crohns Colitis. 2012 Nov 15. pii: S1873-9946(12)00453-9. Presents 2 casesstudies that suggest that liver damage and bone marrow suppression can be treated with low-dose azathioprine and allopurinol.

These are unusual aspects of allopurinol use, affecting very few gout patients. However, they may be important to patients who have been denied allopurinol because they are taking azathioprine.

Let’s discuss this further, and I will improve the guidelines at Allopurinol And Other Medicines.