AdultPediatricGeriatricDosage Forms & Strengths April 2019: Product discontinued by manufacturer tablet 200 mg/200 mg 200 mg/300 mg Gout Indicated for hyperuricemia associated with gout in patients who have not achieved target serum uric acid (sUA) levels with allopurinol alone Use 1 tablet of lesinurad/allopurinol equivalent to the total daily dose (TDD) of allopurinol; maintain TDD of allopurinol when initiating lesinurad/allopurinol Recommended combination dose based on current allopurinol For patients who have not achieved target sUA on a medically appropriate dose of allopurinol >300 mg, lesinurad/allopurinol may be initiated by using 1 tablet in place of an equivalent portion of the TDD of allopurinol Allopurinol 300 mg: Initiate 1 tablet of lesinurad 200 mg/allopurinol 300 mg PO qDay Allopurinol 200 mg: Initiate 1 tablet of lesinurad 200 mg/allopurinol 200 mg PO qDay Lesinurad coadministered with allopurinol: Initiate 1 tablet PO qDay equivalent to the daily lesinurad and allopurinol doses Dosage Modifications Renal impairment Mild-to-moderate (CrCl ≥45 mL/min): No dosage adjustment necessary; monitor CrCl more frequently if CrCl <60 mL/min Moderate-to-severe (CrCl 30-45 mL/min): Do not initiate; discontinued if CrCl is persistently <45 mL/min while taking lesinurad/allopurinol Severe renal impairment (CrCl <30 mL/min), end-stage renal disease, kidney transplant recipients, or patients on dialysis: Contraindicated See Black Box Warnings Hepatic impairment Mild-to-moderate (Child-Pugh A and B): No dosage adjustment necessary Severe (Child-Pugh C): Safety and efficacy not established Gout flares Gout flares may occur after initiation of urate-lowering therapy, including lesinurad/allopurinol, owing to changing sUA levels resulting in mobilization of urate from tissue deposits Patients not previously taking lesinurad: Gout flare prophylaxis is recommended when initiating treatment, according to practice guidelines If a gout flare occurs during treatment, lesinurad/allopurinol need not be discontinued; gout flare should be managed concurrently, as appropriate for the individual patient Dosing Considerations Limitation of use: Not recommended for treatment of asymptomatic hyperuricemia 1 tablet of lesinurad/allopurinol contains the maximum daily lesinurad dose (200 mg) Do not take more than 1 tablet of lesinurad/allopurinol per day Do not combine lesinurad/allopurinol with additional lesinuradSafety and efficacy not establishedNo dosage adjustment necessaryInteraction CheckerEnter a drug name and lesinurad/allopurinolNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (0)Serious - Use Alternative (23)aspirinaspirin decreases effects of lesinurad by unspecified interaction mechanism. Avoid or Use Alternate Drug. Aspirin at doses >325 mg/day may decrease lesinurad efficacy. Aspirin doses 325 mg/day or less (ie, for cardiovascular event prophylaxis) does not decrease lesinurad efficacy and can be coadministered.azathioprineallopurinol increases levels of azathioprine by decreasing metabolism. Avoid or Use Alternate Drug. Increased risk of bone marrow toxicity.benazeprilbenazepril increases toxicity of allopurinol by unspecified interaction mechanism. Avoid or Use Alternate Drug. May increase risk for allergic or hypersensitivity reactions to allopurinol. Monitor for symptoms of hypersensitivity reactions if both drugs must be used together.captoprilcaptopril, allopurinol. Mechanism: unknown. Avoid or Use Alternate Drug. Risk of anaphylaxis, Stevens Johnson syndrome.captopril increases toxicity of allopurinol by Mechanism: unspecified interaction mechanism. Avoid or Use Alternate Drug. May increase risk for allergic or hypersensitivity reactions to allopurinol Monitor for symptoms of hypersensitivty reactions if both drugs must be used together.didanosineallopurinol increases levels of didanosine by unknown mechanism. Contraindicated.dienogest/estradiol valeratelesinurad decreases effects of dienogest/estradiol valerate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Use additional methods of nonhormonal contraception. Do not rely on hormonal contraception alone when taking lesinurad.enalaprilenalapril, allopurinol. Mechanism: unknown. Avoid or Use Alternate Drug. Risk of anaphylaxis, Stevens Johnson syndrome.ethinylestradiollesinurad decreases effects of ethinylestradiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Use additional methods of nonhormonal contraception. Do not rely on hormonal contraception alone when taking lesinurad.etonogestrellesinurad decreases effects of etonogestrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Use additional methods of nonhormonal contraception. Do not rely on hormonal contraception alone when taking lesinurad.ivosidenibivosidenib will decrease the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2C9 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.levonorgestrel intrauterinelesinurad decreases effects of levonorgestrel intrauterine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Use additional methods of nonhormonal contraception. Do not rely on hormonal contraception alone when taking lesinurad.levonorgestrel orallesinurad decreases effects of levonorgestrel oral by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Use additional methods of nonhormonal contraception. Do not rely on hormonal contraception alone when taking lesinurad.medroxyprogesteronelesinurad decreases effects of medroxyprogesterone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Use additional methods of nonhormonal contraception. Do not rely on hormonal contraception alone when taking lesinurad.norethindronelesinurad decreases effects of norethindrone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Use additional methods of nonhormonal contraception. Do not rely on hormonal contraception alone when taking lesinurad.pacritiniblesinurad will decrease the level or effect of pacritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.perindoprilperindopril, allopurinol. Mechanism: unknown. Avoid or Use Alternate Drug. Risk of anaphylaxis, Stevens Johnson syndrome.pexidartiniballopurinol and pexidartinib both increase Other (see comment). Avoid or Use Alternate Drug. Pexidartinib can cause hepatotoxicity. Avoid coadministration of pexidartinib with other products know to cause hepatoxicity.pretomanidallopurinol, pretomanid. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Pretomanid regimen associated with hepatotoxicity. Avoid alcohol and hepatotoxic agents, including herbal supplements and drugs other than bedaquiline and linezolid.protamineallopurinol increases effects of protamine by decreasing metabolism. Avoid or Use Alternate Drug.ropeginterferon alfa 2bropeginterferon alfa 2b, allopurinol. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Myelosuppressive agents can produce additive myelosuppression. Avoid use and monitor patients receiving the combination for effects of excessive myelosuppression.theophyllineallopurinol increases levels of theophylline by decreasing metabolism. Avoid or Use Alternate Drug.valproic acidvalproic acid, lesinurad. Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid coadministration with inhibitors of epoxide hydrolase (valproic acid) which may interfere with metabolism of lesinurad.warfarinallopurinol increases effects of warfarin by anticoagulation. Avoid or Use Alternate Drug.Monitor Closely (55)acalabrutinibacalabrutinib, allopurinol. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may increase risk of myelosuppressive effects.alpelisibalpelisib will decrease the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.aluminum hydroxidealuminum hydroxide decreases levels of allopurinol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.amiodaroneamiodarone will increase the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.amlodipinelesinurad decreases levels of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.amoxicillinallopurinol decreases toxicity of amoxicillin by Other (see comment). Use Caution/Monitor. Comment: Allopurinol may increase potential for allergic or hypersensitivity reactions to amoxicillin.apalutamideapalutamide will decrease the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Coadministration of apalutamide, a weak CYP2C9 inducer, with drugs that are CYP2C9 substrates can result in lower exposure to these medications. Evaluate for loss of therapeutic effect if medication must be coadministered.atogepantlesinurad will decrease the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.bosentanbosentan will decrease the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.calcium carbonatecalcium carbonate decreases levels of allopurinol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.cannabidiolcannabidiol will increase the level or effect of lesinurad by decreasing metabolism. Modify Therapy/Monitor Closely. Cannabidiol may potentially inhibit CYP2C9 activity. Consider reducing the dose when concomitantly using CYP2C9 substrates.capecitabinecapecitabine will increase the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.carbamazepinecarbamazepine will decrease the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.cyclophosphamideallopurinol increases toxicity of cyclophosphamide by decreasing metabolism. Use Caution/Monitor.dichlorphenamidedichlorphenamide and allopurinol both decrease serum potassium. Use Caution/Monitor.dichlorphenamide, allopurinol. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.ethambutolethambutol decreases effects of allopurinol by Other (see comment). Use Caution/Monitor. Comment: Hyperuricemia reported with ethambutol and precipitation of gout reported; uric acid lowering agents may be require dosage adjustment.fluconazolefluconazole will increase the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.fluorouracilfluorouracil will increase the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.flurbiprofenflurbiprofen will increase the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.fosphenytoinfosphenytoin will decrease the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.gemfibrozilgemfibrozil will increase the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.hydroxyureaallopurinol, hydroxyurea. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of myelosuppression.ibuprofenibuprofen will increase the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.ibuprofen IVibuprofen IV will increase the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.indomethacinindomethacin will increase the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.isavuconazonium sulfatelesinurad will decrease the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.ketoconazoleketoconazole will increase the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.levoketoconazolelevoketoconazole will increase the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.levonorgestrel oral/ethinylestradiol/ferrous bisglycinatelesinurad will decrease the level or effect of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. The efficacy of hormonal contraceptives may be reduced. Use an alternative method of contraception or a backup method when enzyme inducers are used with combined hormonal contraceptives (CHCs), and continue backup contraception for 28 days after discontinuing enzyme inducer to ensure contraceptive reliability.mefenamic acidmefenamic acid will increase the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.mercaptopurineallopurinol increases levels of mercaptopurine by decreasing metabolism. Use Caution/Monitor. Potential for increased myelosuppression.methotrexateallopurinol decreases effects of methotrexate by Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of myelosuppression.mipomersenmipomersen, allopurinol. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.nicardipinenicardipine will increase the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.nitisinonenitisinone will increase the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Nitisinone inhibits CYP2C9. Caution if CYP2C9 substrate coadministered, particularly those with a narrow therapeutic index.phenobarbitalphenobarbital will decrease the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.phenytoinphenytoin will decrease the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.piroxicampiroxicam will increase the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.primidoneprimidone will decrease the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.rifampinrifampin will decrease the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.rifapentinerifapentine will decrease the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.rucaparibrucaparib will increase the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP2C9 substrates, if clinically indicated.secobarbitalsecobarbital will decrease the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.sildenafillesinurad decreases levels of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.sodium bicarbonatesodium bicarbonate decreases levels of allopurinol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.sodium citrate/citric acidsodium citrate/citric acid decreases levels of allopurinol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.sparsentansparsentan will decrease the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Sparsentan (a CYP2C9 inducer) decreases exposure of CYP2C9 substrates and reduces efficacy related to these substrates. sulfadiazinesulfadiazine will increase the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.sulfamethoxazolesulfamethoxazole will increase the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.tazemetostatlesinurad will decrease the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.thioguanineallopurinol, thioguanine. unknown mechanism. Use Caution/Monitor. Potential for increased myelosuppression.tolbutamidetolbutamide will increase the level or