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Unlike PURINETHOL (mercaptopurine) and IMURAN® (azathioprine), Thioguanine may be continued in the usual dosage when allopurinol is used conjointly to inhibit uric acid formation. A 63-year-old man receiving allopurinol for gout developed progressive uremia, proteinuria, edema, and purpura after beginning quinidine therapy. Adverse effects can be minimized by increased hydration, urine alkalinization, and the prophylactic administration of a xanthine oxidase inhibitor such as ZYLOPRIM® (allopurinol). In one study in mice, large amounts of allopurinol caused birth defects and other unwanted effects. Case reports have suggested that thiazide diuretics may increase the risk of allopurinol-induced hypersensitivity reactions, especially in patients with renal insufficiency. The product of methylation, 2-amino-6-methylthiopurine, is also substantially less active and less toxic than Thioguanine and its formation is likewise unaffected by the presence of allopurinol.
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