The use of allopurinol for the decrease of uric acid levels in plasma for primary and secondary gout is well documented. Long-term administration is indicated when the affected patient suffers repeated severe gout seizures. The treatment generally causes the reduction or disappearance of the tophi and urate renal stones (nephrolithia?). In the long run the gout seizures also disappear. Allopurinol does, however, not have an immediate impact during the seizure. In addition to that, one has to expect a multiplication of gout seizures in the first 6 to 12 months of treatment.

A further unambiguous indication is the prevention of hyperuricemia for radio- and chemotherapy of leukemias or lymphomas. Allopurinol is also effective against enzyme disorders that lead to hyperuricemia. Good results are also achieved with leishmaniasis, probably due to the disturbance of the protozoa purine metabolism.

The benefit of allopurinol for asymptomatic hyperuricemia — including renal failure — has not been demonstrated. Nevertheless, many specialists recommend treatment if uric acid levels exceed 600 µmol/l.

Calcium oxalate renal stones are not clearly affected by allopurinol. Because of its effect on free radicals allopurinol has an (as yet insufficiently defined) potential in cancer treatment.

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