Asian Allopurinol Dosing: Don’t Bear The SCARs

This Asian allopurinol dosing article is about the risk of developing serious skin reactions to allopurinol in Asian ethnic groups. I will publish similar articles for Black or African American ethnic groups, for Caucasian ethnic groups, and for others including Hispanic, Latino, and Middle Eastern.

If you are currently taking allopurinol without serious skin problems, then this article is irrelevant. If you are not controlling uric acid, you should not be put-off by risks of reactions to drugs. There are alternatives to allopurinol, but there is no alternative to lowering uric acid. It is dangerous to ignore high uric acid. Even when you are not in pain, uric acid crystals will grow slowly, eventually causing permanent damage to skin, kidneys, heart, and other organs.

Asian Allopurinol Dosing Introduction

In October 2012, the American College of Rheumatology (ACR) introduced new gout guidelines. This led me to explain how to minimize allopurinol side effects. Those ACR guidelines identify Korean, Han Chinese, and Thai racial groups as highest risk groups of severe allopurinol rash. Therefore, they recommend screening for the specific genetic variant (HLA-B*5801) prior to allopurinol dosing.

New research goes much deeper into this specific problem. Because it explains which ethnic groups have been identified as most at risk. The resulting guidelines explain that their work is not complete, and other groups may still need testing. However, they point out that 100 mg allopurinol starting dose will not usually cause very severe reactions.

If existing allopurinol dosing recommendations are followed correctly, allopurinol continues to be the safest option for most gout patients. This means starting at 100mg, and increasing dose based on uric acid test results, stopping if serious rash occurs, or if liver function test results show serious anomalies.

Your doctor should be aware of the screening procedures. I will summarize the latest guidelines from the Clinical Pharmacogenetics Implementation Consortium (CPIC) separately. Before that, I present tables of the ethnic groups affected, starting with Asian races.

Asian Allopurinol Dosing Risks

Please note that these are risk statistics. Do not worry if you are currently taking allopurinol and belong to a high risk ethnic group. These risk factors are published to allow doctors to recommend the best treatment choices. Now that alternatives to allopurinol exist, it makes most sense to screen high risk groups, and prescribe Uloric if you are affected by the specific gene.

Ethnicity HLA-B*5801 frequency (%) Sample Size
China Guangdong Province Meizhou Han 17 100
Taiwan Han Chinese 10.6 504
Singapore Chinese 10.4 149
Taiwan pop 3 10.1 212
Taiwan pop 2 10 364
Taiwan Tzu Chi Cord Blood Bank 9.8 710
China Canton Han 8.9 264
China South Han 8.9 284
China Inner Mongolia Region 8.8 102
Taiwan Minnan pop 1 8.8 102
Singapore Thai 8.6 100
China Guangzhou 8.5 102
China Guizhou Province Bouyei 8.3 109
Thailand Northeast pop 2 7.9 400
China Southwest Dai 7.7 124
Thailand 7.7 142
China Yunnan Province Han 7.4 101
USA Asian 7.4 358
Hong Kong Chinese 7.3 569
India Andhra Pradesh Golla 7.2 111
Russia Tuva pop 2 Siberian 6.7 169
South Korea pop 3 6.5 485
Vietnam Hanoi Kinh pop 2 6.5 170
China Beijing Shijiazhuang Tianjian Han 6 618
Indonesia Sundanese and Javanese 6 201
Indonesia Java Western 5.9 236
USA Asian pop 2 5.7 1772
Singapore Riau Malay 5 132
China Guangzhou Han 4.7 106
China Guangxi Region Maonan 4.2 108
China North Han 2.9 105
China Yunnan Province Hani pop 2 2.7 150
China Qinghai Province Hui 2.3 110
China Yunnan Province Nu 1.9 107
China Yunnan Province Wa 1.7 119
China Tibet Region Tibetan 1.6 158
China Guizhou Province Shui 1.5 153
China Yunnan Province Lisu 0.7 111
China Yunnan Province Jinuo 0.5 109
Japan pop 3 0.5 1018
China Yunnan Province Bulang 0.4 116
Japan Central 0.4 371

If this is unavailable, please ask for a copy in the gout forums.

Asian Allopurinol Dosing: Next Steps

Allopurinol is recommended by rheumatologists as the first choice treatment for uric acid lowering, due to its low cost and long safety history. The biggest obstacle is the risk of allopurinol rash, or as this report describes it: Severe Cutaneous Adverse Reactions (SCAR). By identifying those people most at risk of SCAR, doctors can offer more suitable treatment, such as Uloric, whilst retaining the best treatment for those not at high risk.

I will present data for other ethnic groups soon, so please ensure you do not miss it by subscribing to my free gout update service. If you need help before I publish the rest of the allopurinol dosing study, please ask in the gout forum. Please note, that link takes you to the form to post a new question, but for best responses you should search to see if we are already discussing Asian allopurinol dosing using the box above or below.

Leave Asian Allopurinol Dosing to browse the Minimize Allopurinol Side Effects guidelines.

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Medical Disclaimer: The pupose of GoutPal is to provide jargon-free explanations of medical gout-related terms and procedures. Because gout sufferers need to know what questions to ask their doctor. Also, you need to understand what your doctor tells you. So this website explains gout science. But it is definitely NOT a substitute for medical advice.

Information on this website is provided by a fellow gout sufferer (Keith Taylor) with an accountant's precision for accurate data. But no medical qualifications. So you must seek professional medical advice about gout and any other health matters.

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