Gout Treat-to-Target Toolkit

Patient inputs

Current allopurinol dose (mg/day)

Enter 0 if not yet started.

Latest serum urate (mmol/L)

Check ≥2 weeks after any dose change.

eGFR (mL/min/1.73m²)

Tophi / chronic gouty arthritis present HLA-B*5801 positive (or untested high-risk)

Titration principles (ACR 2020 · EULAR 2016 · BSR 2017 · ACE Singapore 2023)

Start low: allopurinol ≤100 mg/day; 50 mg/day (or alternate-day) if eGFR <30.
Go slow, titrate to target: increase by 100 mg (50 mg if eGFR <60) every 2–4 weeks until urate at target.
Do NOT cap at 300 mg or by eGFR — dose can be pushed (with monitoring) to max 900 mg/day to reach target, even in CKD.
Target: urate <0.36 mmol/L; <0.30 mmol/L with tophi, until crystals dissolve.
Prophylaxis (colchicine 0.5 mg od–bd, renally adjusted) for the first 3–6 months — a mobilisation flare is a sign of success.
HLA-B*5801 positive → avoid allopurinol; use febuxostat (start 40 mg, then 80 mg).