Is it ever appropriate to initiate a higher initial dose of allopurinol (such as 300mg daily) than is typically recommended in gout patients at low risk of allopurinol hypersensitivity syndrome and severe hyperuricemia?   

Usually, allopurinol is started at a dose lower than that and gradually titrated up. This is the best strategy. In a rare instance, allopurinol may be started at 300 mg initial dose - where the patient has tolerated it at this or higher dose previously and is currently non-adherent; or has severe hy...

We often start allopurinol at a 300mg/day dose in non-Asian gout patients who have an absence of renal impairment or other grave comorbid diseases.  This shortens the often protracted ULT titration phase during which there is a higher propensity for gout attacks. For patients with stage III CKD...