Allopurinol Advice Needed
Posted by nina bak in Gout Cures, tags: allopurinol, uric acid levelHello, i run into web site after helplessly trying to get some info about gout. My dad is visiting me here, and he is having one of his attacks. He is 72.
I guess he was never diagnosed properly, and last 15 years he was given some non-steroid, anti-inflammatory medication. At the end he ended up in a hospital for a bleeding ulcer, and that was first time he was diagnosed with gout. That was last year in September.
His gout was so bad, that he couldn’t walk. He was given injections for pain and inflammation. They put him on allopurinol 100 mg. he got better, but never 100%. When he came here, I looked through his lab tests. Back in September his uric acid was 516 umol/l. Average should be 182-403. In November it was 400umol/l, and in December was 474umol/l. All this time he was taking 100mg allopurinol.
I was trying to contact his doctor and ask, and comment, that 100mg is not working for him, but no luck getting right answer. Right now he is having another attack, his elbow is swollen, hot ,red. His foot ankle has same problem. He is cold all the time, not a happy camper. I increased his allopurinol to 200mg one week ago.
Today we had his blood drawn, and I will know his uric acid measurements tomorrow. His diet is very healthy, no alcohol, lots of water. I am not giving him any ibuprofens because of his stomach ulcers.
Please advise about mg of allopurinol/ uric acid levels, or any other medication that might work. Do you know how long it takes for allopurinol to have an affect on uric acid? Thanks a lot. Nina
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Though the average range for uric acid is often given in the area you suggest, the top end is really too high for someone who has had gout, and 350µmol/L (6mg/dL) is the best target for gout sufferers. This will stop new urate crystals forming, and will start to dissolve old crystals. To get old urate deposits to dissolve faster, it is good to aim much lower for a few months, maybe as low as 200, but you should discuss this with his doctor first.
Allopurinol begins to work almost immediately, but the full effect on blood uric acid is reached over 2 to 3 days. As you increased dosage a week ago, the latest test will show a reasonable result reflecting the effect of 200mg dose.
You and Dad need to be aware that, until all old crystals are dissolved, there is still a risk of gout attacks. This gets less and less as time goes by, but Dad will still need pain relief if he cannot stand the pain. I have no qualifications to advise you what the best pain relief is, but if you cannot get a clear recommendation from his doctor, it is best to ask a pharmacist, making sure they know about the ulcer history.
hello. thank you so much for your letter. it is so hard to look at someone suffer so much and not being able to help.i just got lab result, and uric acid is 6,7.i will be keeping him on 200mg until next lab work. it is not so bad comparing to previous results. we will do next lab work in two weeks. i do have another questions; how did you convert umol/l to mg/dl? i been thinking: is his body producing to much uuric acid, or his urinal organs are working slow to get rid of extra uric acid and that is how is accumulating? he is not complaining much about pain, but this is making him very disable- can not walk, shower, eat with right hand. what do you think about another medication for gout- something called cohcellin? thank you so much.
Hi Nina,
You must understand that 6.7mg/dL is borderline safe. It can easily lead to a horrible situation where the uric acid from old crystals dissolving raise the uric acid to the point where new crystals start forming. As I have said, you can never be sure that you will not get a gout attack until all crystals have gone, but at 6.7, you are not reducing the risk by much. The “standard” dose, i.e. the dose that almost two-thirds of gout sufferers take is 300mg, and I urge you to contact your doctor to discuss this ASAP. This will get your Dad out of the pain risk zone much quicker.
You can read a fuller explanation of safe levels on the uric acid levels page in the reference section at the top. This also has a link to my uric acid conversion calculator, which uses mmol/L, but all you have to do is multiply by 1000.
There is a test to help discover if your Dad is an under-excretor or over-producer of uric acid. This cannot be done without taking two weeks off allopurinol, but it is not necessary in your Dad’s case, as allopurinol treats both types. His only problem is that the dose is still too low.
The pain relieving drug you are thinking of is colchicine. This is very effective against gout pain, but very hard on the stomach. Have you tried to discuss suitable pain relief with a doctor, or pharmacist?
Your best course of action is to increase allopurinol to 300mg and test uric acid levels again in two weeks. This should have been done in September/October, and delaying it is simply extending your Dad’s time in the pain-risk zone.
Thanks gout pal. His doctor is in Croatia and is not helping me a lot , I am trying to find a doctor here in San Francisco who would be helpfull with advice. I realized, I should increase his allopurinol to 300mg, and test uric acid in two weeks. Should I give him 300 mg at once, or 200mg in the morning and 100mg at night? Please advice. Thank you.
Doses up to 300mg per day are taken all at once. Sometimes doses over 300mg are split during the day.
Hi. Dad is now for tree days on 300 mg, and it is just misserable. Hot, swollen, pinfull ankle, and than, in a day goes to his elbow,knee, now to his shoulder. He can not walk, getting up is just a painfull action. I can not believe what happend to him in a few days. Doctor said it takes some time, and because of his stomach ulcers there is not much they can do. Poor dad, he is very depressed, worired, and thinks this is never going to go away. Now he thinks he has bone cancer! We lost my mom just a five months ago. We will test his uric acid on Monday. Doctor said if is not going down, to increase his allopurinol to 400mg. I keep telling him that everything will be back to normal, I am cooking healthy meals, lots of liquid, doing my best. Now I am vorried if allopurinol is working for him. It seems it is just making things worse. I was suprised to see his shoulder is getting inflamed. I red somewhere that usually it doesn’t attack hips, or shoulders. More I read, more I am confused. Some article say not this, do this, some say that is just fine.. I got in touch with a few doctors and they are just giving me different opinion. I am thinking… Please any comments. Thanks.
Gout can attack any joint – I’m just recovering from a left shoulder attack myself.
I am confident that this pain will pass soon. The doctor seems to know what he is talking about, and you are doing right to keep uric acid monitored.
I know how hard it is when you are doing everything right, and the pain still lingers, but please keep up the allopurinol. Missing one day is not serious, but missing more than that will cause more problems.
Some people get relief by applying heat to the joint. You can get microwave bags that you heat then apply to the affected joint. These are quite easy to make. Search for “microwave heat bags” if you want to buy one, or “make microwave heat bags” if you want to make your own.
I have also heard that TENS machines are good – but not for everyone. Sometimes you can hire them to tryout before purchasing. Same applies to low level lasers.
I want to reply on your letter, and it looks I am replying on my own. Anyway, dad is getting a bit better. His knees are just not “working”. I am afraid if something permanent will get damage, and he will never be the same. Thanks so much about comment about heat pads. I made two, filling socks with rice. He said, it feels good. What is your daily dossage of allopurinol? If you feel attack coming do you increase dosage for 100mg? How long your attacks are lasting? Thanks gout pal.
Sorry about that – I have changed the settings to allow more replies.
It’s good to hear the heat treatment is working. I like the idea of filling socks with rice. It is an unfortunate fact of life that as we get older, our bodies are less able to recover quickly. It might be that there is indeed some permanent damage to dad’s knee, but the only way to tell is to get x-ray or other types of scan.
Allopurinol dose should be set by uric acid test results, and you do not change it if you get a gout attack. Every attack varies in length. I treat mine with ibuprofen, but this is not an option if there is a history of ulcers. The best thing to do, besides the heat packs, is to keep the joint warm at all times, and drink plenty of fluids. Some people get relief from cherries or cherry juice, but that has never worked for me. Another possibility is Black Bean Broth, which is discussed at length in the gout cures forum.
Hello gout pal. I feel much better today. Dad’s uric acid is 4,7. He is on 300 mg allopurinol, very strict diet, lots of herbal tee, water, cherry juice. He is recovering very slow, but I think he is on right path to be very soon himself again. Lots of pain he has under his knee, he still feels pins and needles in another shoulder, and has to walk with cane. He is very vorried that this inflamation will never go away. We are very cerefull and conservative what he is taking for inflamamtion and pain because of stomach ulcers. But, because of this diet(lots of vegatebles, no beef, pork…, some chicken, lots of water, fruits, less salt), his blood pressure is very normal. I just hope old cristals will melt, and no new will form, and he will be independent again. Thanks. Nina
You are doing everything right. Just be patient, and in a few months, I’m sure your dad’s gout pains will be a thing of the past.
Hello Gout Pal. It is almost February 16 th, and my dad is now for two weeks being able to walk again. We are keeping him on a very strict diet with lots of water. The only antiinflamatory medicine that I have to let him use was Voltaren 50mg twice a day, and it comes in sopposotory shape. He used it for four days and really helped him alot. It was just like a miracle. Night before, swollen, painfull joints, in the morning no pain , walking without cane. One doctor said it is ok to use Voltaren supposotory because dad had stomach ulcer just a few months ago.Another doctor said- that is all the same: you shouldn’t be using any NSAD if you have stomac ulcer, it doesn’t matter if you take them oraly or in a suppository shape. Well, it is hard. Between gout and stomach ulcer what you can eat? We learned so much abou gout, and I hope dad will be ok when he goes back to Croatia. This forum is great.It helped me so much back in January. Thanks.
Great news that your dad is more mobile.
Voltaren (diclofenac) like all NSAIDs is not really suitable because once it gets in the bloodstream, it still affects the stomach no matter how it is taken.
If the allopurinol is continuing to keep uric acid below 6mg/dL, then the gout attacks will become less intense, and less frequent. If that is the case, corticosteroids can be useful for short term use – but they are best used as sparingly as possible.
Don’t forget, most gout attacks clear up by themselves within 3 days to a week.
Hello Gout Pal. Last time you comment on my letter, you didin,t leave me an option to replay. Now we are in March, my Dad is doing ok. We are still on very strict diet, 300 mg Allopurinol, lots of water. Dad still has mild inflamations from time to time. They are not that intense , and they don’t last that long. Last two test on uric acid are 5,1. What do you think, why person gets inflamation and uric acid is below 6? Do you think if we increase Allopurinol to 400 mg, that would lower uric acid more, and help in prevention of attacks? Thanks.Nina
There is a maximum number of replies built into the software that runs this site. Sorry, there is nothing I can do about that.
Low intensity gout attacks are common during the first few months of uric acid lowering treatment. This is from old crystals dissolving. As long as uric acid stays below 6mg/dL, these attacks will eventually stop. Raising the dose to 400mg allopurinol will help uric acid crystals dissolve quicker, so it shortens the legth of time where there is still a risk of attacks.
The one thing that I would caution you about is that some people, like me, have adverse reactions to high doses of Allopurinol. I would suggest you get his liver enzymes tested the next time you have his uric acid levels checked, just to be sure.
Nina
I am no doctor but just started Allpurinol today My dosage is 200mg once a day
Bob m
Just joined your Gout Interactive Group. I developed gout in 2003, post breast surgery for CA. I assume it was caused by chemotherapy drugs, although my Uric Acid levels were high before the CA. Taking Allopurinol for 7 years and I want to stop because I now have foot nerve damage which is a side effect of this drug.
Please share your insight or experiences on discontinueing this drup, AP.
I’ve never really been able to take it for any considerable time, because each time I try, my liver enzymes get out of whack, and it freaks my doctors out. But Uloric is new, and may not have the same effects. This is the first time I’ve heard of Allopurinol leading to nerve damage. I know that repeated flares can cause nerve, muscle, tendon and joint damage (I’m living proof of this!). My brother has been on Allopurinol for 10 years and it has done a great job of minimizing his flares, and to my knowledge, he hasn’t had any adverse effects. Hope that helps.
Hi Leidy,
First, we cannot do anything without better history on uric acid. “High / Normal / Low” assessments are simply not good enough for the management of gout. We need to know your specific uric acid level. Better still, the history of your uric acid tests since 2003.
If your gout was caused by chemotherapy, then there is the possibility that you do not need any urate lowering therapy at all.
If your results indicate that uric acid lowering therapy is still required, then the issue of allopurinol causing nerve damage has to be considered. Is this a confirmed diagnosis? What is the nature of the damage, and can we be certain that allopurinol is at fault. There have been so few cases of nerve damage when taking allopurinol, that it is difficult to say with any certainty that such a risk exists. Diagnosing and treating nerve damage is way beyond the scope of my knowledge, so you must consult a specialist in this area.
Stopping and starting allopurinol without proper diagnostic testing and investigation by a qualified doctor is not the way to go. I feel you must get some proper medical advice on this. If you are not sure if the advice is correct, or want to know what questions to ask, we can help.
If your thoughts on stopping allopurinol have been suggested by a medical professional, then I urge you to seek a better opinion from a doctor who understands gout, and knows about the latest treatments. Febuxostat is available for lowering uric acid, so if allopurinol is really a risk, and if you do still need urate lowering therapy, then this would be your best alternative.
I have just been put on allopurinol 300g after suffering with gout in excess of 10 years which I have always treated with Ibuprofen. Since starting the allopurinol on 25 May this year I have suffered from some of the worst bouts of pain ever. Both my feet were affected to the extent I could hardly walk. I am still ‘hobbling’. Simultaneously I have pain in my elbow, knee and fingers. Previously I would suffer pain from only one place at a time. Presumably this is a sign that the old crystals are dissolving ? I understand that allopurinol is only considered for treatment after a person has had at least two attacks of gout a year. It appears to me that if allopurinol was prescribed earlier in the course of the disease then the sufferer would not have to go through these painful symptoms when taking allopurinol, to quite the same extent. The longer a person has had gout the longer it takes to get better after treatment commences. I also understand why a high proportion of people give up on allopurinol. However, having read this forum (which is very enlightening) I intend to stick with the treatment and put up with the pain but I can understand why some people would give up on it. It is very tempting to take much higher doses of Ibuprofen than is good for me.
You are absolutely correct in everything you say.
Perhaps one day, as the GoutPal influence grows, we can all work together to persuade health authorities throughout the world to take a stronger stance on lowering uric acid before it becomes a problem. This type of prevention is common in high blood pressure, which unfortunately leads to gout for many diuretic takers. Why can’t prevention of gout be given as high a priority?
If you want some inspiration to help you stick with allopurinol, read Nate’s inspirational Gout And The Active Person.
Your story sounds similar to what I am dealing with taking Allopurinol. I am in my third full week taking it and I am having a flare up on my right big toe at the moment that is killing me. My first week was 100 mg, second week was 200 mg and started the 300 mg this past Sunday. I was having different types of pain than the normal gout pain when I first started it. I would get these sharp short jolts of pain in the tops of my feet but they didn’t last. Then when I went to the 300 mg my ankles started swelling up and I could hardly walk this past Tuesday. Now my toe pain is a full blown attack and I’m having my doubts about the treatment but I know I can’t stop. I guess my question is does anyone really know how long I need to plan on dealing with these attacks while taking the medication? I just pray it goes away, I’m only 45 and these attacks just started about 4 years ago about the same time I started taking high blood pressure medication so I’m guessing there is a link.
Hi Tater,
There is no definite answer to how long it takes, but it is a function of how much urate has built up, and what you get your uric acid down to during the ‘decrystallization’ phase.
There is nothing you can do about the first part, but I have a couple of articles in my allopurinol pages that show how lowering uric acid more gets rid of old uric acid crystals faster.
And yes, some blood pressure medicines do cause higher uric acid levels, so when you get your uric acid levels checked, ask about BP medicine choices that do not raise uric acid – they might not be suitable in your case, but it’s worth asking the question.