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. You can buy it at the drug store in either generic or brand name. The brand names for allopurinol are Zyloprim and Lopurin. 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.
Allopurinol may also be received in the form of an injection. If your local healthcare provider has it, you can get an allopurinol injection to help with your uric acid levels.
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. Do not fret if you have joint stiffness, swelling, or pain in the affected joint as this is actually a common side effect of taking allopurinol.
In the meantime, to relieve you from the pain of gout, your doctor may prescribe you colchicine, ibuprofen and/or non-steroidal 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.
It is important that you stay within the recommended dosage by your doctor. Do not take more or less of it. Also, do not take it longer than prescribed. Doing these may increase your risk for side effects.
If you forgot to take allopurinol on schedule, take it as soon as you remember. If it’s almost time for the next dose, count the missed dose and next dose as one. Avoid taking two to make up for the missed dose as this may only lead to unwanted side effects.
You’ll want to take allopurinol with food to avoid stomach upset. And for people with kidney problems, make sure to drink plenty of water to avoid kidney stones. Increasing fiber intake is also important.
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!
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. If you develop a skin reaction or allergic reaction from taking allopurinol, call your doctor right away. Your skin might blister, peel, loosen, develop red skin lesions, or sores as a reaction to this medication. If it’s an allergic reaction and you develop itchy hives, swelling, get chills, have fever, or trouble breathing, go to the nearest emergency room. You cannot take allopurinol again as this might be deadly the next time you take it.
Pay attention to other symptoms too as these are indications of a more serious health condition. If you have stomach pain, pale stool, loss of appetite, nausea, unusual tiredness, yellow eyes and skin, or dark urine, call your doctor right away as this means you have a liver proble. Because allopurinol makes you sleepy, it is important that you don’t take it when you’re doing activities that require you to be alert such as driving.
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
Allopurinol may also interact with other medications and supplements you are currently taking. Here are just some of them:
- Thiazide diuretics like hydrochlorothiazide
- Ampicillin or amoxicillin
- Mercaptopurine (chemotherapy drug for leukemia)
- Azathioprine (immunosuppressive)
- Chlorpropamide (antihyperglycemic for non-insulin-dependent diabetes)
- Cyclosporine (immunosuppressive)
- Dicumarol (anticoagulant)
These drugs raise your risk for experiencing serious side effects so make sure that you talk to your doctor if you take any of these. They may lower your dosage for these drugs or lower your allopurinol dosage instead. It all depends on how severe your conditions are. They will also weigh the benefits against the risks. If it’s too risky to take allopurinol, you may be recommended to take another type of gout medication instead.
Your doctor will perform blood and urine tests to check and see whether the drug is actually working and if they need to lower or increase the dose.
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. Remember that my results are not indicative of what you may experience.
I am hoping to remove allopurinol sometime in the near future again, but not without my doctor’s permission. 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 from 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!
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–