Allopurinol Dosage: How to Take It Right

Allopurinol is the go‑to drug for lowering uric acid and easing gout attacks. Getting the dose right matters – too low won’t control the acid, too high can cause side effects. Below you’ll find practical advice on the usual starting dose, how doctors tweak it, and what to watch out for if you have kidney problems or other health issues.

Starting Dose and Titration

Most adults begin with 100 mg once a day. Doctors often ask you to take it after a meal to reduce stomach upset. After two weeks they check your blood uric‑acid level. If it’s still high, the dose climbs by 100 mg increments, usually up to 300 mg per day. Some people need 400 mg daily, but that’s only after labs show it’s safe.

The key is gradual titration. Your body needs time to adjust, and the step‑up plan helps avoid a rash called Stevens‑Johnson syndrome, which, while rare, is serious. If any rash or fever shows up, stop the pill and call your doctor right away.

Special Situations and Safety Tips

Kidney function is the biggest factor that changes the dose. If your eGFR (a measure of kidney health) is below 30 ml/min, doctors often start at 50 mg daily and may never exceed 100 mg. The reason is that allopurinol and its metabolites hang around longer in the blood when kidneys aren’t working well.

People on chemotherapy drugs like azathioprine need a lower dose too, because allopurinol can boost azathioprine levels and cause bone‑marrow suppression. In those cases the dose might be capped at 50 mg a day.

Alcohol can spike uric acid, so cutting back helps the drug work better. Also, stay hydrated – at least eight glasses of water a day – to flush out excess uric acid.

When you miss a dose, take it as soon as you remember unless it’s almost time for the next one. Don’t double up; just get back on schedule. Consistency matters more than a perfect time of day.

Finally, keep regular lab checks. Every three months during the first year, then twice a year after things settle. The tests confirm the dose is doing its job and that kidney function stays stable.

Bottom line: start low, go slow, and let your doctor fine‑tune the dose based on labs and how you feel. Follow the safety tips, and allopurinol can keep gout attacks at bay and protect your joints for the long haul.