The xanthine oxidase inhibitor allopurinol effectively lowers the plasma level of uric acid and the drug has become widely used in the treatment of gout, especially in patients with renal failure, uric acid calculi, or intolerance to uricosuric agents (Scott, Hall, and Grahame, 1966). Various theoretical complications of treatment have been considered from time to time, such as possible incorporation of ribonucleotide into genetic material or the effects of crystals of allopurinol in voluntary muscle, as discussed below. For these reasons it was thought reasonable a few years ago to determine the effect of discontinuing allopurinol therapy in gouty patients who were not over-producers of uric acid and whose renal function was not impaired.Plan of study Medication was discontinued in 33 patients with gout (32 men and one woman), with a mean age of 58 years (range 33-75 yrs). In five of them the drug would have had to be discontinued in any case because of a skin rash or malaise probably attributable to the drug; in 28 the drug was stopped in the absence of side effects after full discussion with individual patients. None of these latter patients had impairment of renal function (as estimated by blood urea) and none were over-producers of uric acid as indicated by a 24-hour urinary uric acid excretion of less than 600 mg on a low-purine diet.The mean length of history of gout before starting treatment had been 15 years (range 05-42 yrs), with an average of 4-5 attacks per year before starting therapy. The mean duration of allopurinol treatment before the drug was discontinued was 93 weeks (range 19-236 wks), and the mean duration off allopurinol at the time this analysis was made was 86 weeks (range 14-210 wks).
No significant abnormality could be seen in an electroencephalograph about two weeks after the event, but a right carotid angiograph showed narrowing of a distal branch of the middle cerebral artery in the region of the trifurcation.
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