Aluminium hydroxide Allopurinol

When aluminium hydroxide is given with allopurinol, the serum uric acid concentration can increase, probably because the antacid reduces the absorption of allopurinol (SEDA-13, 84). 

Three haemodialysis patients had a marked reduction in the effects of allopurinol while taking aluminium hydroxide. Separating the doses by 3 hours reduced the effects of this interaction. 

Three patients receiving haemodialysis, taking 5.7 g of aluminium hydroxide daily and allopurinol 300 mg daily for high phosphate and uric acid levels, had no reduction in their hyperuricaemia until the aluminium hydroxide was given 3 hours before the allopurinol, whereupon their uric acid levels fell by 40 to 65%. When one patient returned to taking both preparations together, her uric acid levels began to rise. ... 

Treatment was started with allopurinol (5 mg/kg/24h) and a low purine diet. Urinary purines and allopurinol metabolites were measured to monitor treatment. Aluminium hydroxide was administered to control hyperphosphataeraia and co-trimoxazole as a prophylactic urinaiy antiseptic. Renal function remains impaired (plasma creatinine 160 umolA) and she has had several episodes of unexplained coma with cerebral oedema since her initial presentation. These have responded to dexamethasone, correction of fluid and electrolyte imbalance and allopurinol. Lack of compliance with allopurinol medication was not confirmed but at least 1 attack of neurological disturbance was linked to excess intake of high purine foods. An adenosine-like substance and other unidentified compounds were found in the urine. 

Treatment consisted of allopurinol 5-10 rag/kg/2 h and sodium bicarbonate. Aluminium hydroxide was given for hyperphosphataemia and Paracetamol for the pain in his fingers. Plasma uric acid on discharge after 7 weeks had fallen to 0.5 mmol/L. Plasma creatinine had dropped from 350 umolA to 90 umol/l over the same period. 

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See also in sourсe #XX -- [ ]

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