To the Editor: In their trial of allopurinol for adolescents with newly diagnosed essential hypertension, Dr Feig and colleagues1 were attentive to new skin symptoms during the 4 weeks participants received therapy. In their discussion, the authors note that adverse effects of allopurinol should limit its use as a therapeutic option for hypertension. To expand on this comment, the Food and Drug Administration (FDA)–approved label2 for allopurinol includes the following caveat under Indications: “This is not an innocuous drug. It is not recommended for the treatment of asymptomatic hyperuricemia.” This is followed by the statement under Warnings, “Allopurinol should be discontinued at the first appearance of a skin rash or other signs which may indicate an allergic reaction. In some instances a skin rash may be followed by more severe hypersensitivity reactions such as exfoliative, urticarial and purpuric lesions as well as Stevens-Johnson syndrome (erythema multiforme exudativum) and/or generalized vasculitis, irreversible hepatotoxicity and on rare occasions, death.”
Cutaneous adverse reactions to allopurinol are relatively common. The product label for allopurinol states that skin reactions can occur in 1% to 3% of exposed patients.2 Clinically significant cutaneous reactions, sometimes referred to as the allopurinol hypersensitivity syndrome, are much less common. A frequency of 1 to 4 per 1000 exposed has been published.3 Further research may contribute to understanding the causes of essential hypertension.4 Life-threatening adverse effects like Stevens-Johnson syndrome make allopurinol an unattractive alternative to available antihypertensive medications.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Journal of American Medical Association editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.