Aloprim, Zyloprim Should Be Stopped at First Sign of Stevens-Johnson Syndrome, Study Warns

A group of researchers from Louisiana State University are urging doctors to immediately remove patients from Aloprim and Zyloprim treatment at the first sign of a potentially deadly skin reaction known as Stevens-Johnson Syndrome (SJS).

Both drugs include the active ingredient allopurinol, an uric acid reducer designed to relieve joint pain and inflammation linked to gout. However, in 2015 a study published in JAMA Internal Medicine linked Aloprim and Zyloprim to hypersensitivity reactions, including the development of SJS and other skin problems.

Stevens-Johnson Syndrom (SJS) is a painful and debilitating reaction linked to several different prescription medications, which results in burns, blisters, severe rashes, which may result in the skin separating from the body. When the skin lesions affect more than 30% of the body, the condition is typically referred to as Toxic Epidermal Necrolysis (TEN), which often results in the need for treatment in a hospital Intensive Care Unit (ICU) and Burn Unit, potentially resulting in blindness or death.

While there are a number of different drugs that have been associated with SJS and TENS, the drugs most commonly linked to the conditions are anticonvulsants, antibiotics and anti-inflammatory drugs, like Aloprim and Zyloprim, given to patients with acute-phase complications.

In this latest study, published on July 16 in the medical journal Cureus, a team of researchers from LSU conducted a review of known data on allopurinol, finding that SJS and TEN were two of the most dangerous side effects linked to the gout medications.

They called for healthcare professionals to check to see if a patient was on Aloprim or Zyloprim at the first sign of SJS or skin irritation, as it is the only way to prevent the full development of SJS or TEN. Every other treatment these patients receive is focused on the symptoms and mitigating the damage, they noted.

The researchers looked at three clinical cases of Aloprim or Zyloprim SJS, two of whom survived, and one of whom later had to be transferred to hospice care due to numerous adverse health events related to her treatment and hospitalization, including an antibiotic-resistant Staph infection, and acute kidney injury.

The team noted that the risks were higher among patients with certain genetic markers, particularly in the Asian population, who are 80-97 times more likely to experience allopurinal-triggered SJS than Black or White patients. However, they noted that many people still developed the condition even without that particular genetic trait, indicating the causes were multifactorial.

“Due to the relative rarity of presentation and the serious nature of SJS and TEN, it is important to consider many factors when deciding on a course of treatment,” the researchers warned in the report. “Of utmost importance is the identification and immediate cessation of the causative agent, as this increases the chances of successful outcomes.”

They indicated further treatment of the condition should only commence after the patients are removed from the drugs. The researchers also recommended medical professionals “establish a protocol for rapid and effective treatment of SJS, as prompt action is imperative in preventing disease progression.”