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Allopurinol or oxypurinol in heart failure therapy - a promising new development or end of story?
Cardiovasc Drugs Ther. 2005 Oct; 19(5):311-3.CD

Abstract

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.

Authors+Show Affiliations

Institute of Cardiovascular Theory, Montevideo, Uruguay. ajreyes@internet.com.uyNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16382292

Citation

Reyes, Ariel J., and William P. Leary. "Allopurinol or Oxypurinol in Heart Failure Therapy - a Promising New Development or End of Story?" Cardiovascular Drugs and Therapy, vol. 19, no. 5, 2005, pp. 311-3.
Reyes AJ, Leary WP. Allopurinol or oxypurinol in heart failure therapy - a promising new development or end of story? Cardiovasc Drugs Ther. 2005;19(5):311-3.
Reyes, A. J., & Leary, W. P. (2005). Allopurinol or oxypurinol in heart failure therapy - a promising new development or end of story? Cardiovascular Drugs and Therapy, 19(5), 311-3.
Reyes AJ, Leary WP. Allopurinol or Oxypurinol in Heart Failure Therapy - a Promising New Development or End of Story. Cardiovasc Drugs Ther. 2005;19(5):311-3. PubMed PMID: 16382292.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Allopurinol or oxypurinol in heart failure therapy - a promising new development or end of story? AU - Reyes,Ariel J, AU - Leary,William P, PY - 2005/12/31/pubmed PY - 2006/6/7/medline PY - 2005/12/31/entrez SP - 311 EP - 3 JF - Cardiovascular drugs and therapy JO - Cardiovasc Drugs Ther VL - 19 IS - 5 N2 - 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. SN - 0920-3206 UR - https://www.unboundmedicine.com/medline/citation/16382292/Allopurinol_or_oxypurinol_in_heart_failure_therapy___a_promising_new_development_or_end_of_story L2 - https://doi.org/10.1007/s10557-005-4971-1 DB - PRIME DP - Unbound Medicine ER -