Does Allopurinol Cause Neuropathy? A Look at the Risk, Symptoms, and Management

October 11, 2025 •

3 min read

Peripheral neuropathy, while a very rare adverse event, has been reported in a small number of patients undergoing allopurinol treatment. For instance, case studies exist where patients developed nerve damage during long-term therapy, with symptoms improving after discontinuing the drug.

Quick Summary

Allopurinol can, in very rare instances, cause peripheral neuropathy, a condition affecting the nerves. Symptoms include numbness and tingling, and they can reverse after stopping the medication, but medical evaluation is crucial.

Key Points

Rare Adverse Effect: Peripheral neuropathy is a very rare side effect of allopurinol, with a reported incidence of less than 0.01%.
Symptom Recognition: Patients should be aware of potential symptoms such as numbness, tingling, or pain in the hands and feet while on allopurinol.
Reversibility: In reported cases, neuropathy symptoms have often regressed or resolved after discontinuing allopurinol under a doctor's care.
Consult a Doctor: It is critical to contact a healthcare provider immediately if new neurological symptoms appear; never stop the medication on your own.
Underlying Causes: Many other conditions can cause neuropathy, so a medical evaluation is necessary to confirm if allopurinol is the cause.
Management: If neuropathy is linked to allopurinol, treatment involves stopping the drug and addressing symptoms, often leading to improvement.

Understanding Allopurinol and its Side Effects

Allopurinol is a widely used medication that treats gout and certain types of kidney stones by reducing the body's uric acid levels. It does this by inhibiting an enzyme called xanthine oxidase, which is involved in uric acid production. Like any medication, allopurinol comes with potential side effects, the most common being a skin rash, nausea, and diarrhea. However, more serious, though much rarer, adverse effects have been documented, including a potential link to neuropathy.

What is Peripheral Neuropathy?

Peripheral neuropathy is a condition that results from damage to the peripheral nerves, which are the nerves outside of the brain and spinal cord. This damage can disrupt the communication between the central nervous system and the rest of the body. Symptoms often manifest in the hands and feet and can vary depending on which nerves are affected (sensory, motor, or autonomic).

Common symptoms of peripheral neuropathy include:

Numbness or tingling, often described as 'pins and needles'.
Sharp, shooting, or burning pain.
Increased sensitivity to touch.
Muscle weakness.
Loss of coordination or balance.
Taste changes or loss of taste.

The Rare Link Between Allopurinol and Neuropathy

Medical literature, including reports submitted to regulatory agencies like the FDA, acknowledges that allopurinol can, in rare cases, be associated with peripheral neuropathy. It is important to emphasize that this is a very uncommon occurrence, reported in less than 0.01% of patients. The link has primarily been established through case reports where patients developed neuropathy symptoms that improved or resolved after the medication was stopped.

One potential pathway for drug-induced neuropathy is the severe allergic reaction known as Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome. While DRESS syndrome is a distinct and serious condition, neuropathy can be one of its manifestations. A causal relationship between allopurinol and neuropathy is challenging to prove conclusively, as many factors can cause nerve damage, and individual sensitivities may play a role.

Differential Diagnosis and Risk Factors

When a patient develops neuropathy while on allopurinol, doctors must conduct a thorough investigation to rule out other, more common causes of the condition. Many different diseases and medications can cause nerve damage. Potential risk factors for developing neuropathy while on allopurinol may include underlying health conditions, such as diabetes, which is a major cause of neuropathy, or potentially even nutritional deficiencies, as some reports suggest a link to copper deficiency in patients on prolonged allopurinol.

Management and When to Seek Medical Attention

If you are taking allopurinol and begin to experience symptoms suggestive of neuropathy, it is crucial to contact your healthcare provider immediately. Never stop a prescribed medication without first consulting your doctor. Your physician will evaluate your symptoms, likely perform an examination, and may order tests to confirm the diagnosis and rule out other causes.

If allopurinol is suspected of causing the neuropathy, the typical management involves:

Drug Discontinuation: Your doctor may advise you to stop allopurinol, which, in reported cases, has often led to the resolution of symptoms.
Symptom Management: Treatment for neuropathic pain or discomfort may be necessary.
Exploring Alternatives: Your doctor may prescribe an alternative medication to control uric acid levels if needed.

Allopurinol Neuropathy vs. Diabetic Neuropathy

To put the risk in perspective, it is helpful to compare allopurinol-induced neuropathy to diabetic neuropathy, a far more common condition.


Feature	Allopurinol-Induced Neuropathy	Diabetic Neuropathy
Incidence	Very rare (less than 0.01%)	Very common, affecting up to 50% of people with diabetes
Cause	An adverse drug reaction or hypersensitivity response	High blood sugar levels damaging nerves over time
Reversibility	Often reversible upon discontinuation of the drug	Generally not reversible, though symptoms can be managed
Primary Treatment	Stopping allopurinol	Strict blood sugar control
Progression	Can appear relatively abruptly	Tends to develop slowly over many years

Conclusion

While the association between allopurinol and peripheral neuropathy is supported by medical case reports, it is an extremely rare side effect. Patients should not let this rare risk deter them from taking a necessary medication but should be aware of the symptoms to seek prompt medical attention if they arise. Open communication with your doctor is essential for safely managing your treatment plan. In cases where allopurinol is deemed the cause, symptoms are often reversible upon discontinuing the medication under a doctor's supervision. For comprehensive information on potential drug side effects, authoritative sources like Drugs.com offer valuable resources: Allopurinol Side Effects.

Frequently Asked Questions

Peripheral neuropathy is a very rare side effect of allopurinol, reported in less than 0.01% of patients. Other, more common side effects are much more likely to occur.

Symptoms include numbness or tingling in the hands and feet, paresthesia (a pricking sensation), muscle weakness, and, rarely, changes to your sense of taste.

You should not stop taking allopurinol without consulting your healthcare provider first. A doctor must evaluate your symptoms to determine the cause and if an alternative treatment is necessary.

In most documented cases, the symptoms of allopurinol-induced neuropathy have regressed and improved after the drug was withdrawn. However, as with any nerve damage, permanent effects are possible, though rare.

While it's very rare, individuals with certain genetic or metabolic factors may be more susceptible. There are also rare cases where neuropathy is part of a severe allergic reaction, such as DRESS syndrome.

If a doctor confirms allopurinol is the cause, they will likely have you stop the medication. The symptoms often improve once the drug is discontinued. Your doctor will then find an alternative treatment for your underlying condition.

Yes, many factors can cause neuropathy, including diabetes, vitamin deficiencies, other medications, and autoimmune conditions. A comprehensive medical evaluation is necessary to identify the correct cause.