Allopurinol (Zyloprim), 200 mg/day, is prescribed for the client with renal calculi to take home. The nurse should teach the client about which of the following side effects of this medication?
A. Retinopathy
B. Maculopapular rash
C. Nasal congestion
D. Dizziness
Correct Answer: B. Maculopapular rash
Allopurinol is used to treat renal calculi composed of uric acid. Side effects of allopurinol include drowsiness, maculopapular rash, anemia, abdominal pain, nausea, vomiting, and bone marrow depression. Clients should be instructed to report skin rashes and any unusual bleeding or bruising.
Option A: Maculopapular pruritic rash, gastrointestinal adverse effects, including nausea and diarrhea, are other common adverse effects. Laboratory abnormalities, including transaminitis and elevated serum alkaline phosphatase, leukopenia, and thrombocytopenia, can occur.
Option C: Allopurinol hypersensitivity syndrome (AHS) is a rare severe adverse effect of allopurinol with an incidence of about 1 in 1000, with a high mortality rate of 20% to 25%. The mechanism is a T-cell mediated immune reaction to oxypurinol. The highest risk is in the first few months of therapy, especially with higher starting doses of allopurinol.
Option D: Retinopathy, nasal congestion, and dizziness are not side effects of allopurinol. Due to the destabilization of intra-articular uric acid microtophi on the initiation of any urate-lowering therapy, there is an increased incidence of acute gouty flares, especially during the initial few months.
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