Allopurinol And Alcohol Debate

August 13, 2011 in Gout Remedies Forum For Gout Treatment

This Allopurinol And Alcohol Debate is closed. If you still have any questions about allopurinol tablets, please read the updated allopurinol and alcohol review. If you still have questions after reading that, please follow the links to ask further questions, or to share your experiences and opinions.

The original allopurinol and alcohol debate is:


Many gout sufferers worry that alcohol might reduce the effectiveness of allopurinol. However, my recent review suggests that the biggest problem facing gout patients on uric acid lowering treatment is ineffective dosing.

It is ridiculous to suggest that alcohol is affecting allopurinol treatment if that treatment is not set at the right level in the first place.

I do not feel I have covered all the aspects of the allopurinol and alcohol debate, but I suggest that a sensible approach is to arrange a proper uric acid lowering management plan, and then only consider alcohol intake if that plan is not working.

Now is the time to collect more views on this, so please add yours below. I would also appreciate any relevant research, if you know of any.

Please keep your comments related to alcohol and allopurinol, or alcohol and other uric acid lowering treatments. You can join other discussions by searching for them in the search box above, or start a new discussion in the gout forum.


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18 responses to Allopurinol And Alcohol Debate

  1. Allopurinol And Alcohol: Can You Spirit Away Gout?
    Keith, I for one, agree with you on your comments re Allopurinol and alcohol. Even though we discuss Allopurinol here (to which I am Allergic) I think that we could/should also allow Uloric to be mentioned here . Reason 1: It’s the only other med comparable to Allo and reason 2: It’s the one I am taking and can comment on, especially since alcohol was/is part of my life style.

    • Yes.
      I have not specifically mentioned febuxostat (the generic name for Uloric brand in the States, and Adenuric elsewhere), but I did have it in mind when I mentioned ‘other uric acid lowering treatments.’

      I cannot find any specific research on febuxostat and alcohol, but I guess the approach should be similar to allopurinol – i.e. set the dose correctly, then worry about alcohol if you cannot get uric acid low enough.

      I have also had a quick look at probenecid. I am more concerned about this, as it acts by encouraging elimination of uric acid through the kidneys. Alcohol may well have an impact, but I cannot find anything specific yet.

  2. I have tried and could not get any answers to Uloric/Probenecid/alcohol either.
    So, I have stated my own one-person experiment. If you can tell me how to copy a chart from Excel to your forum I can show the results up till now very clearly.
    I have one chart for my SUA’s starting in 1976, one starting in Feb.2010, and one chart starting in July 2010 when I began my final fight against gout with Uloric. This one includes the period where I am on Uloric 80 mg plus 500 mg Benuryl=Probenecid. My charts include remarks regarding alcohol consumption and so-called forbidden fruits (meat and vegies.)

    • I have been taking Allopurinol for several years now. I have also been attempting to reduce or eliminate my alcohol consumption with sporadic results. I have not noticed any relationship between my periods of abstinence and occasional attacks of gout; but have notice a link between forgeting to take the Allopurinol and these attacks.

      So I would tend to agree with the statement that alcohol’s alleged negitive impact with Allopurinol is exaggerated.

      For several months now I, like hansinnm, have logged a spread sheet of my daily consumptions of food, beverage, and medication (or lack of); as well as daily activities and gout flares.

      I am eager to look at any trends that pop up after a year or so of data and will be glad to share the results.

      • hansinnm and I have agreed that the easiest way to share spreadsheet data is to load it into Google Docs (docs.google.com). It is very easy to upload spreadsheets from Excel or Open Office.

        So that we can keep this discussion focused on allopurinol and alcohol, please raise any technical issues using my contact form or the tech stuff forum.

        On allopurinol, I agree that failure to take the pills is the biggest problem with allopurinol. This is a problem whether or not alcohol is involved, though it is pretty clear that alcohol can make missing a dose more likely.

        Due to the way allopurinol works, missing a single day should not have a massive impact. Personally, I reduce the risk of missing a dose by using a daily pill dispenser (Global Pill DispenserUK Pill Dispenser)

  3. I have been a 40 units per day man for many years and as i am now 60 years old and started suffering gout about 2 years ago. I had a blood test about 2+ months ago which showed a high level of uric acid, i was put on 100mg allopurinol per day with anti inflammatory s However after 2 weeks still getting flares so i decided to forget the alcohol completely and within one week a 100% improvement As i worked with allot of heavy drinkers over the years 80% suffered from gout and i would rather abstain from alcohol than suffer the pain of gout it may not work for everyone but it is worth a try
    Regards jimmy

    • I’m pleased you are pain-free, Jimmy.

      Please remember to get uric acid tests at least once per year. Irrespective of alcohol intake, you must be on enough allopurinol to maintain uric acid at, or below, 5mg/dL (0.30mmol/L). Above these levels, uric acid crystals can build slowly again – you might not notice them immediately, but one day they will start the pain again unless you keep them away.

  4. What dose 5mg/dl mean in layman terms and can i eat all my seafood treats or other foods high in purines while on allopurine.Also i am on diclofenac sodium for last 2 months with omeprazole to counter act flares until allopurene kicks in is it ok to stop now as i am afraid these will affect my stomach long term.
    MANY THANKS IN ADVANCE,
    JIMMY.

    • 5mg/dL IS a layman’s term. You have got to know this number, as uric acid testing is vital, and this is the result. You may also get an assessment such as high/normal/low. This is meaningless – see Normal Uric Acid? No Thanks!. To complicate matters slightly, different countries adopt different scales. Click Uric Acid Levels in the Reference section in the Menu near the top of this page.

      This is one part of gout treatment you have to take control of. Your doctor can arrange blood tests, but you have to take responsibility for the results. Many doctors simply do not know the importance of getting down to 5mg/dL.

      One significant benefit of allopurinol is that you can eat whatever you like. Allopurinol, at the right dose, stops all the uric acid from food, and about half of the uric acid we produce from our own flesh. I do not believe this is affected by alcohol, though alcohol may restrict uric acid excretion. Also, alcohol might make us forget to take the allopurinol, though I find that advancing years are good enough for this (hence my daily pill dispenser).

      Pain relief during the time it takes to get rid of old uric acid crystals is a personal matter. My preference is to take it for about one week whenever I increase my allopurinol dose, then whenever I feel an attack coming on. I would not take any NSAID for two months continuously – again that is my personal view, but I believe alcohol is less risky.

  5. I’m fairly new to gout and this forum. So I’ve only gotten 2 attacks. My first attack was 4 years ago and I never want to feel it again. I did everything I could to lose it. I lost 20 pounds, changed completely they way I ate, exercise everyday and am in my BMI range. Recently I felt a little pinch in my middle toe and got scared. I did a blood test for UA and it was 9. I couldn’t understand. Then 2 weeks later I did another one it dropped to 5.6. I was confused. Worried I saw my doctor and he gave me allopurinol 100mg per day. My question, because my doctor never had gout is. Allopurinol reduces your body’s UA, but does that mean it blocks the rest. If so what happens to the rest of the UA. Also what is the side effect of alcohol then? My doctor say it was ok, but don’t drink too much. I can’t find anything online regarding alcohol and allopurinol? I’ve gotten drunk while on allopurinol hanging out with my friends and from my experience. It only gives me hangovers, though it is the worst.

    • “[1]If so what happens to the rest of the UA. [2]Also what is the side effect of alcohol then?”
      [1]Uric acid forms when an enzyme in our body called xanthine oxidase works on purines to produce uric acid, The purines can come from animal flesh that we eat, or our own flesh as it naturally regenerates. Allopurinol blocks xanthine oxidase, so there is no “rest of the UA”, there is just unchanged purines, which get excreted along with other body waste.
      [2]What is the side effect of alcohol? That is the big question that is at the heart of this debate. I am pretty sure it is a personal issue. I.e. there is probably no effect for most gout sufferers, but some might have a problem. If you think you have a problem, then carefully monitor uric acid levels. This means testing after a period with alcohol, then testing after a period with no alcohol. You need to repeat this a few time to make sure the results are not just chance.
      Personally, I think life is too short to worry about things like this. As long as uric acid is at 5mg/dL or lower, there is nothing to worry about. Be sure to get liver and kidney function tests when you get a uric acid test.

  6. I am a 20 year sufferer of Gout who only recently got a prescription for Allopurinal. My last attack before the meds saw a tophi on my elbow and my knee so swollen I literally could not stand. Doctor starts me at 100, a few  months later to 200, and then finally to 300. Still get flair ups. He won’t tell me my test results, last time I saw him he told me no more meds, instead quit all alcohol for 2 months (he wants to make a point its all alcohol now). I am going to do it – I really need to lose some weight and this big blob of belly fat – 46″ at the belly-button is not good! Figure laying off the beer and wine might help that, though I know  need to get more exercise. Hopefully I’ll have a flair up a coupe of weeks into the abstinence so I can tell him me meds are not adjusted and I am still getting rid of the 20 year build up of crystal in all my lower joints.

    What can I show him about the uric acid levels and how they need to be managed by the meds first? Once the backlog of UA is gone, can the allopurinal dosage be reduced?

    Funny, but I relate my most nasty gout attacks with simple stress, certainly not a night of 5 pints of good bitters – which if beer was the cause would certainly trigger it immediately!

     

    • This guy is clearly a waste of space. All I can suggest is either insist on a consultation with a rheumatologist, or change doctor, or consult a lawyer re withholding test results. Without that test result, there is no way to advise you on what to do next.

  7. after two attacks my doc put me on allopurinol my intake of pints is 4 or 5 about 3 times a week no problems but i did drink a lot more

    • I’m glad you’re on allopurinol, Brian, because it means you can live your life pain free, without worrying about what you eat and drink. However, it is absolutely vital to keep uric acid at 5mg/dL (0.30mmol/L) or below. That way, you can be certain that gout will clear completely, though it may take a few months.

      You make an interesting point that allopurinol might actually cause us to drink more. If we no longer fear gout pain, then we might lose the “inner voice” that tells us to slow down on the drink. Personally, I do not think it is an issue, but I’m interested to see other views.

      We can never be complacent where allopurinol and alcohol is concerned.

  8. 4 attack which was so bad that I had to be on a walker. I cut down on the perines, and alcohol and lost 35 lbs. taking 100mg allopurinol a lot less beer and a little Jack. The only time I a have a twinge was when I forgot to take the medicine for three days.

  9. I know it’s an old post, but I’m on Uloric. I’ve tested high in uric acid, even though I’ve only had 2 attacks over about 2 years. The first was seemingly random, the second after an injury to the same joint. I haven’t truly recognized any trigger, food or alcohol that is. I have never liked to drink water, and I think I am just always dehydrated. I spend a lot of time in the sun, so I think a lack of water is what was the root of my gout issues.

    Anyway, i have a question regarding Uloric and Alcohol: they are both bad for your liver, so is there any information showing the two in conjunction exacerbate liver damage? I’ve only been on the med for 3 months and will get a blood test soon to prove what is happening in my case, but curious if others have noticed any trend regarding liver damage in past test results?

    • “Uloric and Alcohol: they are both bad for your liver”
      What!!! Alcohol is not bad for your liver Excess alcohol can cause liver disease, but if you are drinking at that level it’s an alcoholism issue, not a gout issue.

      Anyone taking Uloric or allopurinol should get a liver function test within one month of starting, and also whenever uric acid is tested.

      Adequate fluid intake is important for gout sufferers. This still applies when taking uric acid lowering medicine, as the by-products get excreted through the kidneys. We talk of water, but it does not have to be pure water. All drinks are mostly water, and all help hydration. Dehydration does not cause gout., but it makes it worse.