Document Detail

Allopurinol or oxypurinol in heart failure therapy - a promising new development or end of story?
MedLine Citation:
PMID:  16382292     Owner:  NLM     Status:  MEDLINE    
The plasma level of the uric acid is frequently elevated in heart failure, due to increased production and/or to reduced renal excretion of this antioxidant metabolite. The transformation of hypoxanthine to xanthine and the conversion of the latter into uric acid, which occur in purine catabolism, are catalysed by xanthine oxidoreductase. The constitutive xanthine dehydrogenase form of this enzyme generally uses NAD(+) as an electron acceptor, whereas the post-translational xanthine oxidase form uses molecular oxygen and yields four units of reactive oxygen species per unit of transformed substrate. Allopurinol and oxypurinol inhibit xanthine oxidoreductase and thus diminish the generation of reactive species and decrease plasma uric acid. In a recent study in patients with NHYA class II-III heart failure, add-on treatment with allopurinol 300 mg/day for 3 months lowered plasma uric acid but failed to improve laboratory exercise performance or the distance walked in 6 minutes. In another recent trial, which was carried out in patients with NHYA class III-IV heart failure, add-on treatment with oxypurinol 600 mg/day for 24 weeks decreased plasma uric acid concentration but did not change a composite of patient outcome and state. These results indicate that the reduction in plasma uric acid caused by allopurinol or oxypurinol does not benefit patients with heart failure. Moreover, the hypothesis that the diminution in the renal excretion of the antioxidant uric acid caused by diuretics may be salutary in cardiac failure is strengthened by the study results considered.
Ariel J Reyes; William P Leary
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy     Volume:  19     ISSN:  0920-3206     ISO Abbreviation:  Cardiovasc Drugs Ther     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-12-29     Completed Date:  2006-06-06     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8712220     Medline TA:  Cardiovasc Drugs Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  311-3     Citation Subset:  IM    
Institute of Cardiovascular Theory, Montevideo, Uruguay.
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MeSH Terms
Allopurinol / pharmacology,  therapeutic use*
Antioxidants / therapeutic use*
Enzyme Inhibitors / pharmacology,  therapeutic use
Heart Failure / blood,  drug therapy*,  enzymology
Oxypurinol / pharmacology,  therapeutic use*
Randomized Controlled Trials as Topic
Uric Acid / blood
Xanthine Oxidase / antagonists & inhibitors
Reg. No./Substance:
0/Antioxidants; 0/Enzyme Inhibitors; 2465-59-0/Oxypurinol; 315-30-0/Allopurinol; 69-93-2/Uric Acid; EC Oxidase
Erratum In:
Cardiovasc Drugs Ther. 2006 Feb;20(1):75

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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