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Allopurinol initiation timing — GPhC CRA MCQ

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ModerateMusculoskeletal TherapeuticsAllopurinol initiation timingGPhC CRA

A 72-year-old man presents a prescription for allopurinol 100 mg daily for gout prophylaxis. He is currently experiencing an acute gout flare. What is the most appropriate advice?

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Correct answer: A — Start the allopurinol but also take colchicine 500 micrograms twice daily as anti-inflammatory prophylaxis

Current BSR and NICE guidance supports starting allopurinol during an acute flare provided appropriate anti-inflammatory cover (such as colchicine or NSAID) is given concurrently. Earlier practice of waiting until the flare resolved has been superseded by evidence that starting urate-lowering therapy during a flare, with prophylactic cover, does not significantly worsen or prolong the attack. Starting at a low dose (100 mg) and titrating slowly is important to minimise the risk of flare provocation.

Reference: BSR Gout Guidelines; NICE CKS Gout; BNF