A client with type 2 diabetes develops gout, and allopurinol is prescribed. The client is also taking metformin and an over-the-counter nonsteroidal antiinflammatory drug (NSAID). Which instruction would be provided by the nurse when teaching about administration of allopurinol? Decrease the daily dose of NSAIDs. Limit fluid intake to 1 quart a day. Take the medication on an empty stomach. Monitor blood glucose levels more frequently.

Allopurinol is usually given to control gout by lowering uric acid levels, and it’s important to take precautions when a client is on other medications that affect renal function (like NSAIDs and metformin). One key teaching point is that NSAIDs and metformin both are excreted by the kidneys, and NSAIDs in particular can reduce renal blood flow. When combined with allopurinol, which is also renally eliminated, there is an increased risk for impaired renal function. Reduced kidney function can, in turn, alter the clearance of metformin and potentially affect blood glucose control. Therefore, the nurse should advise the client to monitor blood glucose levels more frequently so that any alterations in glycemic control can be detected and addressed promptly. The other options are not appropriate: • “Decrease the daily dose of NSAIDs” – There is no standard recommendation to reduce NSAIDs when starting allopurinol. • “Limit fluid intake to 1 quart a day” – In fact, adequate fluid intake is encouraged with allopurinol to help prevent uric acid crystallization and renal stone formation. • “Take the medication on an empty stomach” – Allopurinol is generally recommended to be taken after meals to minimize gastrointestinal upset. Thus, the correct instruction is to monitor blood glucose levels more frequently.