Few questions

[funandsmile1]

I suffer from gout from almost 11 years… always used to treat gout with anti inflammatory pain killer until I found this site. since then, I have been eating AP300mg everyday from last 5weeks for Keith Taylor.

As time passes by…, few questions start to come in my head. so, thought to put it in front of you all:

1. what is the  long term side effects of AP (worse of all)?

2. does the use of AP effect other organs IE, liver, kidney etc?

3. apparently, people on AP has to under go LFT.(Liver function test) is it true? if so, how often and why(does AP really harm the liver?)

4. what other tests should i be asking with my doctor? (if any and why?)

5. how long does it take for AP to be fully effective?(when do i stop having all this flare ups?)

6. how often do i have to check my UA level with my doctor (minimum..)

7. can I ruduce the dose of AP from 300mg to 200mg or even 100mg a day?  because:

(when i first started AP five weeks ago, i was kind of happy that i was saving a lot of money on alcohol because ap300mg used to give me the same effect. bit sad ending…. don't get that no more.)

8. Thank you.

[zip2play]

1. Almost always there are NO long term side effects. Rarely there is rash, and even more rarely sometimes that rash can point to a very serious condition. (10,000 hyperuricemic veterans were studied in Canada…some on allopurinol, some not. The allopurinol group lived longer.)

This answers your long term concerns but remember hypersensitivity to the first dose can be serious and life threatening with itching, hives swollen lips and throat and even asphyxiation. After a couple weeks this becomes a non-issue.

2. If AP has an effect it is to the skin.

3. Liver function tests are more necessary for febuxostat (Uloric) whose excretion is by liver breakdown…allopurinol il excreted through the kidneys (although the interaction with xanthine oxidase occusrs primarily in the liver.) Doe AP really harm the liver? NO!

4. Test serum uric acid regularly.

5. How long allopuyrinol takes to be really effective ddepends on dosage, serum uric acid levels achieved, and the amount of stored urate (tophi.) Your mileage may vary.

6. At first check SUA regualarly maybe every 2 months minimum. Once your SUA and your AP dosage is constant, every 6 months or year is sufficient. Make it part of your annual physical.

7. Hmmm, how can I get the alcoholic effect from my allopurinol. That would save me a LOT of money. It is not likely you will be able to reduce your dosage to 100 mg./day.

8. You're welcome!

[Keith Taylor (GoutPal Admin)]

I can't add much to zip2play's answers, but I would like to point out that allopurinol  is generally considered a safe drug. Apart from a tiny percentage of intolerant gout patients, the main problems with it fall into 2 very similar categories:

1. Insufficient monitoring to check that the dose is correct for bringing uric acid to the correct level. This occurs as both over and under dosing, as a result of practitioners assuming a standard 300mg per day fits all.
2. Patients not taking it every day. You can get away with missing one day, but stopping and starting allopurinol is very, very naughty.

The other major consideration is the risk of not taking it (or other appropriate urate lowering therapy).

Once you have had a gout attack, high uric acid means buildup of uric acid crystals. You might not get a gout flare everyday with uric acid levels above 7mg/dL, but you will get uric acid deposits. As you get older, and less able to cope, these will show as tophi, joint erosion and kidney stones. This is not a risk – it is a certainty.

High uric acid is also associated with an increased risk of heart disease, stroke, and diabetes.

Of course, nobody wants to be reliant on medication, and it pays to be as aware as you can be about any possible side-effects. However, you need to be equally aware of the problems of no medication.

You also need to be aware of the long term effects of pain relief. NSAIDs (ibuprofen, naproxen, indomethacin etc) are associated with increased heart disease risks in long-term use.

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