In patients with acute gouty attacks, should allopurinol be started immediately or delayed?

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EVIDENCE-BASED ANSWERStarting allopurinol immediately may not have large adverse effects on duration, severity, or recurrence of acute gouty attacks (SOR: B, limited-quality noninferiority RCTs). In patients who are candidates for allopurinol, allopurinol 100 mg daily may be started with colchicine 0.6 mg BID at the onset of an acute flair, with a goal of titrating allopurinol up after 2–5 weeks (SOR: C, consensus guideline).

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