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Key takeaways
Prescription allopurinol tablets lower uric acid levels, thereby reducing the risk of gout attacks.
An incomplete response to allopurinol, side effects, or drug interactions can push people to look into alternatives like Uloric or probenecid, which have their own advantages and disadvantages.
Developing an optimal gout treatment plan can prove to have great benefits, as well as significant pitfalls, so taking a team approach by getting the medical advice of a healthcare provider is essential.
The pain of a gout attack is intense, unexpected, and often without a known precipitant, so, fortunately, allopurinol is available to prevent flares. As a xanthine oxidase inhibitor, allopurinol lowers urate (uric acid) levels, thereby conferring less risk of urate crystallizing within a joint to produce a gout flare. Allopurinol can be a godsend to people suffering through repeated gout attacks, but it can be ineffective or contraindicated due to side effects or drug interactions for some patients. Luckily, alternatives are available and worth knowing more about.
What can I take instead of allopurinol?
Allopurinol is not the other xanthine oxidase inhibitor to reduce urate production, and the alternative member of the class, Uloric (febuxostat), may be preferable in certain situations. Beyond that drug class, the uricosuric medication probenecid is an option to lower urate by increasing urinary excretion rather than via reduced production. Lastly, Elitek (rasburicase) and Krystexxa (pegloticase) can drop urate levels by using the enzyme uricase to break down uric acid. If reducing gout-induced inflammation instead of urate is needed for a few months, Mitigare (colchicine) may be called upon instead. Analyzing the difference between these options, from economics to adverse effects, can show some striking contrasts.
Compare allopurinol alternatives |
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|---|---|---|---|
| Drug name | Price without insurance | SingleCare price | Savings options |
| Allopurinol | $88 per 90, 300 mg tablets | $15 per 90, 300 mg tablets of generic allopurinol | See latest prices |
| Aloprim (allopurinol sodium intravenous solution) | $3,590 per 1, 500 mg solution | $42,130 per 30, 500 mg solutions of generic allopurinol sodium | See latest prices |
| Uloric (febuxostat) | $420 per 30, 40 mg tablets | $23 per 30, 40 mg tablets of generic febuxostat | See latest prices |
| Probenecid | $110 per 60, 500 mg tablets | $55 per 60, 500 mg tablets of generic probenecid | See latest prices |
| Elitek (rasburicase) | $2,260 per 2, 1.5 mg solutions | $2,170 per 2, 1.5 mg solutions of brand-name Elitek | See latest prices |
| Mitigare (colchicine capsules | $88 per 10, 0.6 mg capsules | $28 per 10, 0.6 mg capsules of generic colchicine | See latest prices |
| Colchicine tablets | $230 per 30 0.6 mg tablets | $18 per 30, 0.6 mg tablets of generic colchicine | See latest prices |
Prescription drug prices often change. These are the most accurate medication prices at the time of publishing. The listed price without insurance references the price of brand-name drugs (unless otherwise specified). The listed SingleCare price references the price of generic drugs if available. Click the link under “Savings options” to see the latest drug prices.
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Top 5 allopurinol alternatives
The following are some of the most common alternatives to allopurinol.
1. Uloric
Uloric and its generic version febuxostat provide an alternative xanthine oxidase inhibitor to use for the long-term reduction in urate and future attacks of gout. Like allopurinol, it is not to be started during an acute attack but rather as a prophylactic drug after the flare has subsided. Uloric can be easier to dose than allopurinol in the setting of kidney disease or renal insufficiency than allopurinol, and in some cases, it can be more effective.
However, the Food and Drug Administration (FDA) warns on Uloric’s label that it may be associated with a higher risk of cardiovascular death compared to allopurinol. For that reason, it is avoided in the setting of heart disease or past myocardial infarction (heart attack). The higher price of Uloric compared to allopurinol’s cost can be another deterrent, but a SingleCare discount card can make the price comparable to allopurinol.
2. Probenecid
Eliminating urate by increasing urinary excretion of the compound is probenecid’s mechanism of action. Prescriptions for probenecid are typically reserved for people with high blood levels of urate but low urinary levels. In limited situations, it may be a worthy alternative if allopurinol needs to be avoided due to drug interactions or side effects, or if allopurinol alone proves insufficient in reducing urate numbers, they can be used in combination. Unfortunately, probenecid has its own interactions with other drugs, can precipitate uric acid kidney stones, and has the inconvenience of requiring multiple daily doses.
3. Aloprim
Aside from gout, urate levels can also be elevated in tumor lysis syndrome, a more emergent condition in which cancer cells are being rapidly destroyed and releasing uric acid. This occurs most commonly during chemotherapy. Intravenous treatments are necessary to address the situation with urgency. Aloprim is an allopurinol sodium solution that can be infused in such a case.
4. Elitek
Elitek (rasburicase) is another intravenous treatment for tumor lysis syndrome. Infusing the uricase enzyme drops urate levels by enzymatically degrading uric acid. When a quick onset of action is essential, as it is with treating tumor lysis syndrome, Elitek may be chosen.
Krystexxa (pegloticase) is a pegylated form of uricase and is FDA-approved for gout treatment in severe disease that is refractory to xanthine oxidase inhibitors like allopurinol or that is associated with urate deposits under the skin, called tophi. Severe tophaceous gout often requires a different approach.
5. Colchicine
Although not a urate-lowering therapy or long-term prophylactic drug for gout, colchicine can be used both for acute relief of gout flares and for short-term prophylaxis. Its anti-inflammatory effects help to extinguish the pain of a red, hot, swollen, and painful joint from urate crystals, and colchicine can help it from rekindling while a xanthine oxidase inhibitor is begun. Many times, colchicine is used for months while allopurinol is begun and titrated to higher doses if needed based on blood tests for uric acid. Once a stable and effective urate-lowering strategy is in place, colchicine is usually stopped.
Over-the-counter gout treatment
There are no over-the-counter (OTC) xanthine oxidase inhibitors, but acute gout treatment can involve non-steroidal anti-inflammatory drugs (NSAIDS) like Motrin (ibuprofen) and Naprosyn (naproxen). They can alleviate the pain of an attack but not prevent a recurrence. Lower doses are sometimes used concurrently when allopurinol initiation or dose adjustment is done.
Natural alternatives to allopurinol
Reducing gout risk does not always require drug treatment. Our bodies convert purines from food into uric acid, so naturally, if we can lower our purine intake, urate levels should go down. Red meat, shellfish, alcohol, and high-fructose corn syrup are some common sources. The American College of Rheumatology mentions dietary changes in its gout treatment guidelines, which also tout the benefits that weight loss has for gout in the setting of obesity. Notably, the guidelines did not draw a conclusion on the use of cherry supplements for gout prevention. A 2019 clinical trial involving obese and overweight patients found that tart cherry juice reduced urate levels, but other studies on tart cherry concentrate did not reproduce this finding.
How to switch to an allopurinol alternative
Stopping allopurinol or other xanthine oxidase inhibitor therapy can lead to a gout attack. Nonetheless, it may need to be done, and sometimes quickly. If a rash develops as a side effect of allopurinol, it could be the start of a serious reaction like Stevens-Johnson syndrome, toxic epidermal necrolysis, or drug reaction with eosinophilia and systemic symptoms (DRESS), and these circumstances require prompt discontinuation of allopurinol. Regardless of the reason for stopping allopurinol or for wanting a different option, reach out to the healthcare provider managing your gout before making any decisions.
Choosing the right path for gout treatment
Your primary care provider or rheumatologist can guide you through the dietary and medicinal options available to reduce gout attack risk. Talk about the risks and benefits of Uloric and probenecid and how they compare to allopurinol. The conversation can touch on uricase enzyme treatments if marked urate level elevation is still noted despite allopurinol. Ask your pharmacist about drug interactions as well. Reviewing the differences between urate-lowering therapies may lead your healthcare team to stick with allopurinol or to try an alternative.
- Uloric drug label, NIH DailyMed (2023)
- Aloprim drug label, NIH DailyMed (2022)
- Krystexxa drug label, NIH DailyMed (2025)
- 2020 American College of Rheumatology guideline for the management of gout, Arthritis and Rheumatology (2020)
- Consumption of 100% tart cherry juice reduces serum urate in overweight and obese adults, Current Developments in Nutrition (2019)
- Lack of effect of tart cherry concentrate dose on serum urate in people with gout, Rheumatology (2019)