Probenecid appears to increase the renal excretion of the active metabolite of allopurinol, while allopurinol is thought to inhibit the metabolism of probenecid. Theoretically, the concurrent use of allopurinol and probenecid could lead to uric acid precipitation in the kidneys.
The clinical significance of these interactions appears to be minimal. Nevertheless, the UK manufacturer of allopurinol recommends any reduction in efficacy should be assessed in each case. For allopurinol injection, the US manufacturer recom- mends a high urinary output of at least 2 litres daily, and the maintenance of neutral or slightly alkaline urine, to help prevent renal precipitation of urates.
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