Allopurinol for gout

Gout and Allopurinol

Allopurinol: The standard for gout

If you suffer or have suffered from gout, you have come across the prescription drug called allopurinol, first marketed in the United States since 1966. It is used to treat gout and certain types of kidney stones and reduces the amount of uric acid made by the body in order to prevent a gout attack or flare up rather than treat gout attacks. Allopurinol does this by blocking uric acid production. Remember that uric acid is a waste product usually present in the blood as a result of the breakdown of purines and any excess leaves in the urine. It is the most common drug used for long term gout treatment or chronic gout, when surplus uric acid causes crystals to form in the joints, which then leads to gout.

Allopurinol is usually prescribed anywhere between 50mg to 900mg depending obviously on the severity and common allopurinol gout treatment dosage is usually 300mg a day. It is imperative that you have regular uric acid tests while on this treatment and to ensure that the prescribed dosage is right for you. The medication is taken orally, at the same time every day and after a meal to reduce stomach upset. It is advisable to drink a full glass of water with each dose and recommended for the gout sufferer to at least drink 8 to 12 glasses of water a day unless your doctor has directed you to drink less fluids for other medical reasons.

The weird part about taking allopurinol is that in the beginning ,it may increase the number of gout attacks cause it can take up to several weeks for this drug to take effect. In the meantime, to relieve you from the pain of gout, your doctor will probably prescribe you colchicine, ibuprofen and/or nonsteroidal anti-inflammatory drugs (NSAIDs). It is common for the starting dose of allopurinol to be low and gradually increased. Eventually, allopurinol will do its job and keep your uric acid at a healthy level and prevent any further gout attacks.

A recent study that monitored 4966 patients newly diagnosed with gout concluded that allopurinol has no beneficial effects on the heart/cardiovascular for gout patients. In fact, from two groups, one that took allopurinol and another which didn’t take the drug found that the group that took the allopurinol had a 20% increased cardiovascular risk!

NutriGout Dietary Supplement for Gout

 

What are the side effects of allopurinol?

If you are allergic to the medication you should obviously not take it and if you take other medications it is important to tell your doctor and/or pharmacist because very serious drug interactions can occur and cause you more harm. Stomach upset, nausea, diarrhea, or drowsiness may occur. Rash is one of the more common side effects and can occur even after months or years of treatment with allopurinol.

Rarer side effects that are more severe if they do occur include the following: numbness/tingling of arms/legs, itching and/or swelling, hypersensitive reactions, easy bleeding and/or bruising, unusual tiredness, blood in urine or pain when urinating, dark urine, signs of infection, vision changes, eye pain, loss of appetite, breathing problems…Allopurinol is one of the drugs commonly known to cause Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TENS), two life-threatening dermatological conditions. 1

Store allopurinol at room temperature between 59-77 degrees F (15-25 degrees C) away from light and moisture and do not store allopurinol in the bathroom.

The question is are you one of those gout sufferers who actually sticks with your allopurinol therapy? Dr. Robert Shmerling, clinical chief of the Division of Rheumatology at BethIsraelDeaconessMedicalCenter in Boston is quoted here:

Perhaps the biggest problem with the uric acid–lowering therapy is sticking with it. A study done several years ago showed that over a two-year period, less than 20% of patients on allopurinol were taking it as prescribed. Poor adherence is understandable. Once people are taking gout prevention medicine, there are usually no immediate symptoms to remind them to take the pills daily. And the memory of the last attack is bound to fade, no matter how excruciating it might have been.2

Spiro’s take on allopurinol

I admit I am one of those 80% plus gout sufferers who doesn’t want to be stuck on this drug for the rest of my life and have experimented by fazing it out and stopping it completely twice already with 2 failed attempts. As I have this developed this blog in the quest for knowledge in defeating this disease, I have learnt from those 2 failed attempts and learned what triggered those past 2 attacks. I am moving forward though since my last attack in the fall of 2012 with 100mg allopurinol daily and dietary changes. I am hoping to remove allopurinol sometime in the near future again. Why you ask? It’s important to flush out all the crystals in your bloodstream and that can take up to a year, if not it may trigger another gout attack more easily. My plan also consists to not drink a drop of alcohol for a year after the withdrawal of allopurinol and not consume anything that carries high fructose. Mistakes that I paid for in my last 2 failed attempts since my body is personally more sensitive to alcohol and high fructose beverages and/or foods. Please note, I am followed by my doctor while conducting these experiments with myself, do not take any of my advice here without the consent and monitoring of your doctor! Your gout problem can vary and be very different than mine, so please do not take me as an example, do your own research with your body along with your doctor. I am responsible for my actions and have made the decision to also live with the consequences at my own risk of course. I will beat this next time around, it’s just a matter of executing properly and keeping a very strict diet afterwards to get your body functioning like it used to originally. Until next time fellow gout sufferer!

Sources

2. Roujeau JC, Kelly JP, Naldi L, Rzany B, Stern RS, Anderson T et al. (1995). “Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis”. N Engl J Med333 (24): 1600–

2. www.health.harvard.edu

Posted by Spiro Koulouris

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49 Comments

  • Mustapha

    Reply Reply October 17, 2017

    Hi Spiro!

    I’m on allopurinol for about a year right now (200 mg a day); my question is if I have a gout diet can I stop taking it or it is a life treatment .Thanks!

    Mustapha

    • Spiro Koulouris

      Reply Reply October 18, 2017

      Hi Mustapha!

      Regardless if you take allopurinol or not, you should follow a strict gout diet so your gout doesn’t worsen in the future and no complications arise like diabetes, kidney stones, arthritis and other diseases. Any plan to get off of your medication should be done along with your doctor’s advice cause you will need your doctor to monitor your uric acid levels by doing frequent blood tests. It is a personal decision at the end of the day.

  • Bas

    Reply Reply October 12, 2017

    I am having an onset of Gout in my knee. I am trying to figure out what caused it. I had some beef and rice for lunch. I am on Allopurinol. I didn’t drink much water yesterday and today after taking Allopurinol. I am trying to figure out if eating beef yesterday or eating Allopurinol this morning without too much water is causing it. Thanks for your help.

    • Spiro Koulouris

      Reply Reply October 13, 2017

      Hi Ahmed!

      It could be the beef or it could be anything else too. Dehydration too can cause a flare-up.

  • Kevin

    Reply Reply August 5, 2017

    Hi can I still take allopurinol if I have burcitice in my elbow ?

    • Spiro Koulouris

      Reply Reply August 6, 2017

      Hi Kevin!

      Unfortunately I am not a doctor so best to refer this question to him/her.

  • Micah

    Reply Reply June 5, 2017

    Spiro,
    Thanks for the website. I’ve had a few gout attacks and was putting off long-term medication. What pushed me to Allopurinol (and Colchicine for a few months while starting) was the ultrasound of my toe joint the doctor showed me. He pointed out that while my attacks were few, I had tophi formations and the uric acid crystals had already eroded parts of my toe joint. There was a possibility I could go years without a flare-up and then have severe problems because of extensive joint damage.

    Bottom line: before deciding to not take (or not continue) Allopurinol, get an ultrasound.

    Warm wishes,

    Micah

  • Kim

    Reply Reply May 19, 2017

    Hi I am a 50 year old female. I have high uric acid levels. I have had only one gout attack. I know this is not the norm. Neither is the fact that I have not reached menopause.I do take B 12 injections for B 12 deficiency. Could that cause it? Also my uric acid current level is 7.5. My doctor does not want to increase my current allopurinol dose which is 100. My foot is bothering me. Any thoughts of what I could do. Thanks!

    • Hi Kim!

      I take B12 supplement every day as well. I like the energy boost it gives me. I don’t think that is the reason your uric acid levels are high. Must be something else, most likely with your diet or could be genetic.

  • Mike

    Reply Reply May 3, 2017

    I made the mistake over the weekend of eating 2 bananas consecutively. Now I am on crutches with one of the worst gout attacks I have ever had. Do you think that fructose injection may have caused this ?

    • Doubtful! It could many other factors but it doesn’t necessarily mean that a gout attack was caused by last foods you ate, it can go back a few days as well. Very difficult to say unless in the future you have another 2 bananas and you get another gout attack, then you can pinpoint it to that.

    • Strongly doubt it! A gout attack can be from any food or beverage you had up to 3 days in the past. If you ever have another gout attack eating 2 bananas again, let me know, I need to investigate that.

  • Kay S.

    Reply Reply January 15, 2017

    Hallo,

    I became a (overnight) member of the ‘gout club’ approx 6 years ago. Apart from speculative prescription medication which I took on and off, it also lead me to visit the clinic 3-4 times a year for a cocktail injection of voltaren/cortisone, which was always relief within the same day of my attack.
    August 2016 I consulted a new GP- he put me onto a daily 300mg purinol pill, furthermore I stopped booze and fizzy softdrinks altogether and go to the gym 3x a week for normal exercise. My only vice is zero alcohol beer (Becks Blue). Since then my weight has dropped from 112kg to 105kg. I am not into any special food diet- mistake maybe?
    I was wrong in thinking that I have overcome my enemy. Since before Christmas my feet and knees take alternating turns in trying to besiege me- leading to a full flareup this past Friday.
    Today (early Sunday morning) I couldn’t take it any more and went to the clinic for my ‘cocktail fix’- the first one since August last year.
    I’ll see my GP again next week to seek advice.
    Only now do I read that one should stick to the allopurinol regimen, which I do- and during an attack skip the allopurinol and stick to colchicine. Your thoughts please?

    Regards,
    Kay

    • Spiro Koulouris

      Reply Reply January 18, 2017

      Hi Kay!

      I am not a doctor so I can’t be going and telling you what to do with your prescriptions. Best you seek your doctor’s advice. But generally colchicine is taken when fighting a gout attack and allopurinol should be taken daily for long term management of uric acid levels to avoid another gout attack.

  • MikeS

    Reply Reply October 15, 2016

    Hi,

    I am Vegan for the past 3.5 years. My first Gout attack was 11 years ago and then another one one 8 and 5 years ago or so. However in the past year, I have had multiple gout attacks and I am wondering why? I am Vegan and for the past 3.5 years, I don’t take any alcohol only sometimes, I used to have Non-Alcoholic Beers which I have stopped it 2 months ago. Finally 2 months ago, I agreed to get on Allopurinol and my Uric Acid dropped from 8.5 to 4.9 and during the process I have got 2 more gout attacks. I am wondering as Vegan, how come I am getting these gout attacks?

    Is there a better way to dissolve tophi faster? Is there a natural way to do it? My research on Google shows Celery Seed extract is good. Can you take it while taking Allopurinol?

    Sorry too many questions and in pain when writing this 🙁

    Thanks

    • Spiro Koulouris

      Reply Reply October 15, 2016

      Sorry to hear about that Mike.

      Although you can be vegan, you can eat really badly and many vegans are overweight. Problem is some vegans like too much fried food or are addicted to sugar which can also cause uric acid to rise. I don’t know enough about your diet to pinpoint it to anything specific. Since you mention you have tophi that means you have a very serious gout problem that dates back a very long time.

      I would visit a nephrologist to check your kidney function. If kidneys are damaged badly, no matter what you eat you will get gout attacks since your kidneys won’t be able to excrete uric acid effectively for you to not suffer. Hope this makes sense.

      • SoCalGuy

        Reply Reply November 20, 2016

        Vegan, check out the food list for gout/purines, unfortunately you can eat a purely vegan diet and include a lot of bad stuff. My first attack came from eating too much hummus! Do check out the celery seed, or just plain celery, it works for me, but I would not take it while on allopurinol.

        Once you’re clear, I do recommend you find a way to stop the allopurinol and try the celery seed instead. Again, or just plain celery, though it takes quite a bit to give you a day’s dose of the active ingredients. And you can get and use the celery seed as a spice, which I happen to like. There seems to be a shortage of the capsules right now, don’t know if that’s widespread or how long it can last. Your local big box grocery may sell you seven ounces for about five bucks, it will cost rather more at the local spice rack or in capsules.

    • Stavros

      Reply Reply December 31, 2016

      Hi Spiro. I would like to share what I have learned from dealing with my gout. My first attack was about 8 years ago and had about 4 to 5 attacks since then. The last attack about 6-7 months ago was the worst. I had it in both ankles, the tops of my feet, in my knee, all swollen, and I was developing a tophi in my pinky finger. I was drinking tart cherry juice, then moved to tart cherry pills, removed the meats and beans with high purines and it continued to get worse. I cut breakfast and lunch with vegetable and fruit smoothies and still couldn’t shake it. Now going on 2 weeks and countless hours on the internet trying to find a natural solution, my findings led me to gout relief. My gout was caused by taking 2 baby aspirin daily for
      8 years. The research I found suggested that
      low doses of salicytic acid (aspirin) prevents the kidneys from flushing out uric acid which led to build up of uric acid levels and eventually the gout attacks. After about 3-5 days of stopping the aspirin my swelling went considerably down and the pain went away a couple days later. After about 3-4 weeks the pain was gone and the swelling was just slightly noticable to me. I went and put my theory to the test and went to a buffet and ate about 3 pounds of bacon, pork loin, fried chicken, beef and sausage. This should have blown me up, nothing, no swelling no pain. Now I am here because I want to reduce my uric acid level down from 7
      to 4-5, I believe if I can get it down
      it will take care of my slightly elevated blood pressure. Before I fill my script for allopurinol, is there a natural supplement you are aware of I can try first? Thanks for you efforts, they are greatly appreciated.

      Stavros

      PS. I forgot to add, cherries and many of the fruits in my smoothies are high in salicytic acid which I believe in addition to the aspirin added to make the gout attack worse.

      • Spiro Koulouris

        Reply Reply December 31, 2016

        Hi Stavros!

        Thank you for sharing your story and experience. To answer your question, you can try either GoutandYou’s Tart Cherry Extract dietary supplement and/or NutriGout dietary supplement which is a proprietary blend of 6 key natural herbs that include celery seeds, dandelion extract, bromelain from pineapple, chanca piedra, turmeric and milk thistle extract. Each capsule is 500 mg, some gout sufferers can take more than one capsule a day to help keep uric acid levels healthy.

  • Mike

    Reply Reply October 8, 2016

    I had severe gout attacks about a decade ago. I changed my lifestyle. I haven’t had an attack for close to 8 years. I went from over 300lbs to being 210lbs with a muscular build. I eat healthy. Most of my protein intake comes from vegetables, legumes and chick peas. I do still drink beer and have the occasional pizza, cheeseburger or sugary treat. In the last month I had two terrible attacks. One in my ankle, and one in my finger. After getting the finger attack under control I was put on 200mg/daily of allopurinol for 90 days to gauge my iron acid levels. Two days in and I’m suffering from quite annoying diarrhea. I know this is a side effect, but is it one that will slowly fade as my body gets used to this medication? Or do I have 88 more days of this crap? (Pun fully intended)

    • Spiro Koulouris

      Reply Reply October 9, 2016

      Good question Mike!

      I don’t have an answer for you cause everybody is different when it comes to medication and I am not a doctor. Most probably, it is the allopurinol causing the diarrhea so bring it up to your doctor and take it from there. See if your body gets used to it in the next couple weeks. Make sure to drink lots of water in the process.

  • Jennifer M.

    Reply Reply August 11, 2016

    My uric levels are always quite low below 6, but I’d have gout attacks like crazy.
    Finally a doctor in California said, I had pseudo gout attacks.
    Just recently, I have suffered a gout attack and it had to do with my fasting and the usage of the diuretic hydrochlorothiazide, I believe each time I’ve taken this medication it has catapulted my body into a gouty state.
    Remember one doctor stating to me; allopurinol will exacerbate gout if started while going through a gout attack, is this true?

    • Spiro Koulouris

      Reply Reply August 13, 2016

      Hi Jennifer!

      Yes this is true in the beginning but then after a few weeks your body will adjust to the allopurinol.

    • David S.

      Reply Reply August 31, 2016

      Constant gout attacks with hydrochlorothiazide. Just quit alcohol a month ago due to fatty liver diagnosis. Read that going cold turkey can give you gout attacks also.
      I am miserable!

  • George S.

    Reply Reply June 18, 2016

    Hello,

    I have a uric acid level below the average, it’s 6.0 mg/dl, but have been having ongoing attacks in the right big toe and ankle since December 2015, every 2 or 3 weeks. This same exact pattern happened two years ago from about December to now (same months), but last time it switched sides and went to various joints below my knees. I thought that I “kicked” it with daily x2 tart cherry juice and GSE (12 drops), as well as Berberine 300mg x3, but it’s back again.

    Both series of attacks happened during stress. First time was my Mom’s second heart attack. Second attack came when she passed away right before Christmas this last year.

    During the first attack I saw 2 different doctors, the first was rheumatolgist, neither would diagnose as gout. They originally thought psoriatic arthritis. I read a bit, and concluded that it was parasitic die off from some parasites I picked up in Africa and started the Berberine, GSE, Tart cherry juice routine and seemingly “healed” it.

    Fast forward to another 6 months of attacks two years later, and I am considering Allopurinal.

    Should I be afraid of it’s side effects? Also, due to my low level of uric acid (6.0 mg/dl) I’m wondering if it can even really help and I’m a bit nervous about it causing even more acute attacks as I begin the medication. Is 100mg an effective dose even? That’s what my doctor gave me with a vague, we’ll test your uric acid levels in about 2 months statement.

    Would you take the Allopurinal with such a low uric acid level? Are the side effects common enough to fear a reaction?

    Thank you for any advice,

    George Swansea

    • Spiro Koulouris

      Reply Reply June 18, 2016

      Hi George!

      Allopurinol has no side effects for most people, you might experience a slight rash here and there but it’s not symptomatic. if you do experience side effects make sure to tell your doctor. The thing is with gout, uric acid levels of 6.0 mg are considered borderline, anything below that number is considered safe, so you may be suffering from hyperaemia and now all of sudden it’s causing you gout.

      Best advice I can give you, is to watch what you eat cause that’s going to play a big role with your uric acid levels. See if your doctor can monitor your uric acid levels maybe every 2 months as you follow a strict gout diet as outlined on my website and ebook. Drink nothing but water and avoid alcohol as much as you if not completely.

      Thanks for your comment George!

      • George S.

        Reply Reply July 14, 2016

        Hi Spiro,

        Thanks for getting back to me. I started 100 mg of Allopurinol yesterday and I’m crossing my fingers that it helps. I’ve cut out beer and spirits and now drink just a little bit of wine at night. Not ready to give up that pleasure yet. I’ve always been serious about hydrating (so that’s never an issue), and aside from tart cherry juice, I typically only drink water. I’m going to cut out red meat and be careful in general…I’ll read through your strict gout diet and try to apply it as much as possible.

        Take care and thanks for responding,

        George

  • Dorian

    Reply Reply May 31, 2015

    Hope this helps, I am someone who has finally accepted my gout instead of ignoring it(I had a long period of no flare ups, so thought it was gone) now it is back with a vengeance. As a practitioner of Chinese medicine I am trying to accomplish this through diet and supplements. During my research I found this article on banaba leaves/tea. This study supports many claims about the effectiveness of this herb for gout. Unlike many herbal remedies that utilize the diuretic effect to help eliminate uric acid through urine output, banaba acts similar to allopurinol, in that it inhibits xanthine oxidase from converting purines into uric acid in the first place, banaba contains valoneic acid dilactone which according to the abstract of the study was shown to have a stronger effect than allopurinol. Since this is only the abstract it says nothing about dosage. However since the compounds were isolated from aqueous extracts then using these leaves as tea does release the desired chemical. Additionally I may have an answer to your comment about taking allopurinol and it causing flare ups in the beginning, as I understand it once your uric acid falls below 5 mg/dl your body will start to get rid of the uric acid crystals but first it has to remove the protein coating it covered them in in order to deal with them, once exposed they can trigger a new attack while the are being taken care of.

  • Jeff

    Reply Reply May 11, 2015

    allopurinol has been a godsend for me personally. I have a weekly pill organizer that has helped me stay the course. I keep it filled with my dosage, plus vitamin C, Flax Seed, and a probiotic. You’ll find religiously stocking your pill organizer will help you stay the course with treatment. Just thought I’d share in case folks are having trouble remembering their daily dosage. Try my method.

  • joseph

    Reply Reply April 30, 2015

    Is this the only advance in treatment of gout ..to be lifelong on allpurinol. Doctors aint there a stop and live happily thereafter?

  • Morph

    Reply Reply March 9, 2015

    Hi Spiro! Why can’t I see the comments. This thread says 8 comments so far but I cannot see them.–Thanks, Morph

    • Spiro Koulouris

      Reply Reply March 10, 2015

      Hi Morph! Actually when another website links to that page, it adds it as a comment although there is no written comments below.

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