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Gout — RACP Adult Medicine MCQ

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ModerateClinical PharmacologyGoutRACP Adult Medicine

A 62-year-old man with gout and CKD stage 4 (eGFR 18 mL/min/1.73 m²) is commenced on allopurinol for urate-lowering therapy. What is the appropriate starting dose?

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Correct answer: B — 50 mg daily

In patients with eGFR <30 mL/min/1.73 m², allopurinol should be started at 50 mg daily (or lower). The dose is then up-titrated gradually (by 50 mg every 2–4 weeks) to achieve a target serum urate of <0.36 mmol/L. Dose reduction in CKD reduces the risk of allopurinol hypersensitivity syndrome. HLA-B*5801 testing should be performed in patients of Southeast Asian or African descent before starting.

Reference: eTG – 2025 – Rheumatology; ACR – 2020 – Gout Management Guideline; AMH – 2025