ADR

Toxic epidermal necrolysis (TEN)

Steven Johnson Syndrome (SJS)

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS)

What do these three cases have in common?

1. They are not uncommon.
2. They are major adverse drug reaction (ADR), which are serious and potentially life-threatening.
3. These three patients had ADR secondary to ALLOPURINOL.
4. All three were prescribed without indication, i.e. asymptomatic hyperuricaemia.

Again, come to a question, why check uric acid level in the first place?

*Although a raised serum uric acid level is an important risk factor for gout, the use of serum uric acid as a diagnostic test is limited. It can be normal during acute gout, whilst patients with hyperuricaemia may never develop an attack. (EULAR guidelines)

*Asymptomatic hyperuricaemia per se is generally NOT considered an indication for use of Allopurinol. (GSK)

*Treating hyperuricaemia does not retard the progression of renal failure and can not be recommended for this indication. (CARI Guidelines)

Links:
Hyperuricemia (eMedicine).
Fatal Allopurinol Hypersensitivity Syndrome after Treatment of Asymptomatic Hyperuricaemia. (BMJ)
Asymptomatic hyperuricaemia: To treat or not to treat?
Hyperuricaemia and gout.
Treatment of Asymptomatic Hyperuricemia: When do you have a good reason to provide therapy?

Questions to ponder:
When will our doctors ever learned?
Is it just pure ignorance or stubborn?
What is the legal implication?