January 18, 2010 at 2:13 pm #2731
I have had Gout for ten years; I have treated attacks with Indomethacin which used to be very effective but is now much less so. I decided about 4.5 months ago to try and take control of my gout. I have cut down 90% of my beer (currently not drinking anything at all) as this was the prime trigger for my flare ups. I have been taking 300mg of allopurinol daily and have had constant problems since then. These include the most prolonged acute attack (~3 weeks) I have ever had plus since then constant joint and muscle pain (usually where I have had attacks previously but also new joints). I feel terrible all of the time; I strongly believe these pains are related to allopurinol as if I am OK in the morning they get gradually worse after taking the allopurinol. Also I have been suffering from depression (I personally think this is due to the extensive Indomethacin usage during the early stages of taking allopurinol as this drug has always had a profound effect on my central nervous system; dizziness, fatigue, confusion etc.). I find if I take any NSAIDs then the depression/anxiety gets worse but I feel I need to to alleviate the very unpleasant symptoms from the Allopurinol. I am close to giving up the Allopurinol as I worry that the allopurinol side effects aren't going to stop and are drug related rather than deposit breakdown related. However I am tempted to carry on with them in case this is down to the breakdown od crystal deposits. Has anyone had such a prolonged period of pain associated with beginning gout treatment? Is this normal and if so should I continue?
Also have tried cochicine (didn't work) and am trying Naproxen today to attempt to alleviate the symptoms.
Thanks for any pointers, also sorry if a repeat topic but I couldn't find a similar one.
Dominic.January 18, 2010 at 3:23 pm #3782
I am sending this message (instead of posting a reply) because I do not wish to go against, too much, from mainstream discussion – which is focused mainly on medications for gout.
I would advise you to try “black bean broth” as a last resort. It's natural, inexpensive and without any known side/adverse effects. Most importantly, it had worked for me and many of those who believed in it and/or dared to try it. I am not too sure how it's going to work for you, but no matter what do try your best to persevere. If the first dose does not give immediate results, try another dose. After 3 doses at the most (for the worst gout flared-up I had experienced myself), it should work!
Hope BBB can help relieve you of you gout pains and all your other concerns and worries.
All you need are – DETERMINATION AND PERSEVERENCE!
MetamorphJanuary 18, 2010 at 3:40 pm #3783
I am sure several of us will chime in, but here is my initial thoughts…
First off, by your user name “fatdom” I will assume you are (like most of us) a heavy male. Cutting back on beer while you take control is a critical first step and I want to acknowledge its importance. Everyone who has cut back on the beer has been more sucessful than those who have not. Eliminating beer alone though will not solve your gout problems and the rest of your diet needs to be self-examined. I personally modified my diet to eat less red meat (~1/3 as often and that is mostly by substituting ground turkey for ground beef) and avoiding shellfish as part of my lifestyle changes.
It would be helpful to know your uric acid numbers before Allopurinol and after you started taking 300 daily. Without those numbers we cant tell you if the flareup is because the drug is working well and flushing the acid out of your system or if 300 is not enough and you are having a regular gout attack anyway. 6% of people who start Allopurinol experience a severe flareup within the few few months as crystals begin to dissolve. Those usually go away and become less frequent as you get it under control.
Aches in joints that previously experienced flareups is also expected and will reduce over time also. Crystals form in EVERY joint – not just in the ones that had an attack previously.
The first couple months I was on Allopurinol I slept differently also. I was tired earlier in the evening and tended to sleep more deeply (and woke a bit more tired). That faded over time and I now sleep as I did before I started.
We also need to know what other drugs you are taking. Most of what you described do not sound like allopurinol side effects – but could be a result of a drug combination. (HBP? Cholesterol? Anti-depression? etc) Other than that, I cannot address the mood symptoms you are experiencing because that is too far outside my comfort zone.January 19, 2010 at 12:22 am #3784
Also I have been suffering from depression (I personally think this is due to the extensive Indomethacin usage during the early stages of taking allopurinol as this drug has always had a profound effect on my central nervous system; dizziness, fatigue, confusion etc.). I find if I take any NSAIDs then the depression/anxiety gets worse but I feel I need to to alleviate the very unpleasant symptoms from the Allopurinol.
I had similar symptoms of dizziness, confusion, fatigue etc. and I reported them in many posts earlier. I always thought that they were because of Allopurinol but most likely I was wrong. I was also taking Ativan to cure Anxiety symptoms, which were caused due to high dosage of Ibuprofen. Looks like, the body was reacting by showing symptoms of dizziness and confusion as a way of asking more dose of Ativan. It is very common to get dependent on these medications and the body demands it by showing these symptoms.
I eventually took a bold step of tapering down and then stopping Ativan. I have not taken any anti anxiety drug in last 10 weeks. I use to get dizziness, confusion, out of balance and other anxiety symptoms as withdrawl effects but I somehow sustained them.
For last 5 weeks or so, all these symptoms have almost disappeared and now I do not have dizziness or confusion problems.
I WAS UNNECESSARY BLAMING ALLOPURINOL WHILE THE CORE REASON WAS ANXIETY AND ANXIETY MEDICATION.
The worst problem with anxiety is acceptance of the fact that it is anxiety and it is not easy to come out of it.
It is possible that your symptoms may not be due to Allopurinol at all, like it was in my case, though I always wrongly thought Allopurinol to be the culprit.January 19, 2010 at 12:52 am #3785
Fatdom- all prescription drugs are acid forming from all I've read.I've never associated pain killers with depression- only risk of over-dependence and rebound headaches etc.
BBB is worth a try for sure- but I really think now you have broken the back of the UA lowering drug you should persist with it now.
It takes persistent monitoring of diet, fluid intakes and exercise to go 'med free' [Commando? ] and if you are suffering from anxiety depression [and I know about that] -it may be hard to keep focus and positive ,whilst suffering attack+side effects of other meds too.
Of these things mentioned I think the thing you may be missing is fluid intake.
Whatever you're taking now you may need as much as double the amount, in truth.
Make it spring ar good well water if you're lucky enough to have a source and a filter is nearly as good, especially if 'sink top' type.
Chlorine, fluoride & run off pollutants are no good when your system is out of balance and water quality figures for general consumption are for average known reactions. Gout sufferers are not average people -nor is your fluid intake requirement average.
I've just got a UA testing meter [another post here] and that gave me a great sense of getting control back over my health + it is really necessary if you want to manage diet as a main control in gout.
Meanwhile, try to persist with the AlloP- it's always darkest before the dawn and, later, you should be able to try a cutback in dose -if it really is not helping with other issues.
Keep going Bud!January 19, 2010 at 2:54 am #3786
Keith Taylor (GoutPal Admin)Keymaster
Some great advice – thanks guys – but the real issue has only been hinted at.
Allopurinol is a urate lowering drug. It should only be taken as part of a properly controlled urate lowering program. Unfortunately, it does not appear to be illegal to prescribe allopurinol without monitoring uric acid levels and adjusting dosage as appropriate, but it is immoral and unprofessional.
You must get uric acid tested immediately. If your usual healthcare provider cannot do this immediately, I understand from several posts here that independent lab tests are available around $20 (why not try for a discount – you are going to be a regular)
The absolutely vital thing to do, is to ensure that your level is below 6mg/dL, and adjust your allopurinol dose accordingly. You should also consider a few months with a target level of around 3mg/dL, which will get rid of the uric acid crystal deposits from your joints and other tissues.
Come back with your uric acid numbers as soon as you can, and we can give better quality advice. Let's hope the Naproxen helps in the meantime, Dominic, but it can only be a short term plan to help you while you get your uric acid properly under control.January 19, 2010 at 5:14 am #3787
thanks for the replies and words of encouragement. Regarding the questions that arose:
UA numbers I am getting tested on Thursday, plan is to wait a month again and then get another. It's not really my GPs fault about the lack of a test, he did attempt to organise them but I travel regularly with work and didn't persevere with getting them organised.
Regarding the weight; “fatdom” is now historical; I've lost ~3 stone, since I gave up/cut down the ale, to a fairly healthy 12.5 stone for a 5'11″ male. I also have a very good diet and excellent fluid intake. I have got myself fit (joint dependent though). It just seems that since I embarked on this lifestyle change I have found myself in more and more pain as well as managing to get myself into a mildly depressed state but also a very anxious state. I'm not an anxious person, never have been and have also always been quite the opposite of depressed. I do think there is a correlation with the Indomethacin and the depression (I don't know about allopurinol side effects but probably it would be secondary because of the increased pain I associate with it). With the Indomethacin I suffer from virtually all of the CNS side effects that can occur when I take them; one of these is also depression. I was taking the Indo alot during my early allopurinol regime and became more and more depressed/anxious. Also, post christmas I decided to have some more Indo as I indulged as was having more twinges – my anxiety/depression immediately increased for 10 days until I stopped the Indo. Next day I was much better mentally. The only problem is is that the Naproxen doesn't seem to touch it; in fact I feel in more pain than I did yesterday after taking two doses (the Indo would already be working it's magic by now!).
My plan is to keep on the Allopurinol and see how my numbers are over a Month (or would a two week period be better?). I guess I will just have to live with the pain , I will try the BBB though. Also I am convinced that I have gout in one of my vertebrae as the pain in it mirrors that in my right toe and right knee which are all my worst affected joints. If the pain in these dies down then so does the vertebrae pain; also likewise for an increase in pain. I have had an x-ray and there were no issues; GP doesn't seem to think Gout can occur in the back; however I have read a paper on this very subject. I just wondered what the general consensus on here was regarding back pain and gout?
Once again thanks for all of your support,
Dominic.January 19, 2010 at 7:19 am #3788
Ha! If God trained on earth it would have been at medical school
I had a locum doc last year [who's still with the practice] -and we quickly got onto gout, as he'd just had 2 years off with it. Un-diagnosed by 2 other doctors- IN the spine !! Say no more !
He told me he'd been pretty well suicidal – and though it's unusual for this level of confidence from a medic- it shows what a great leveller Gout can be.
Unless someone's had it, they have NO idea of the pain- but I have heard comparisons with both heart attack and birth pains – and they don't last weeks.
A slight difference in emphasis we all know…
The good news is this… He is only on 200mg AlloP daily- and been working like that since a year back- so megadoses are not de rigour in bad attack cases, however painful.
From what you've said, you're well aware of the need for lifestyle management and your first post got a swift responses due to clear posting, overall.
Gouties do seem to be intelligent acheivers , in the main [no idea why!] and perhaps more sensitive than many, as well. Thus, depression is always a possiblility under continued painful & widespread attacks.
You've also confirmed this work point too, and I'm pretty certain that 50% of the gout inclusion in my life was caused by stress and fatigue. get more rest, maybe?
If you're drinking plenty [and have no other medical issues that might be affecting your metabolism]- I would suggest that your commendable weight loss is high on the culprit list!
Others here can explain better about the effects of heavy exercise, weight loss and lactic acid- but you are better off without the extra ,now it's gone. I stick to middle distance walking mainly.
I have read that out of all the Gouty pain killers Aleve is the least likely to cause side effects- but it is Asprin based and that is not the best till you have stabilised your UA. However, in heavier dosage, Asprin is apparently helpful in reducing UA , but then, the well know gastric problems may occur.January 19, 2010 at 10:01 am #5764
First and most important thought: DO NOT discontinue the allopurinol.
Weight loss is perhaps the biggest trigger for gout; probably had you remained pleasantly plump the allopurinol would be working its magic after these 4 months. This is NOT an argument for obesity but rather a simple sad fact. We must lose weight when overweight but all the consequences are not necessarily good ones.
Indomethacin has CNS side effects. I was on it short term and got very dizzy…I still have the first bottle. Let us know how the naproxyn works. I have suffered lower back pain since 1973 from an injury…whether gout has been involved these 35 years I don't know. Maybe yes, maybe no (or maybe halfway between.) A controversial doctor claims spinal colchicine injections work miraculaously for thousands of his patients? Maybe?
Yep, test your uric acid. Your doctor should have done it before prescribing allopurinol.
Ativan (lorazapam) is one of the worst drugs ever invented. It drove my mother into the deepest depression…she took it efvery night and became addicted, taking it daily for 10 years. The problem with the drug is that it stops anxiety for about 4 hours and then rebounds with a vengeance. She'd take it for sleep and wake up in a panic at 3AM.I gave it to my partner and a single pill caused the blackest depression I've ever seen and it lasted days and days in a person who was NEVER depressed.
I LOVE pills but that one scares the s#$t out of me.
A far better benzodiazapine is Valium (diazapam) with a half life measured in days instead of in a couple hours…no ups and downs, just smooth sailing.
Remember, allopurinol is for life and when judging side effects from it make sure you evaluate it in isolation. If someone is taking a drug for sleep and allopurinol, he should not be surprised to be groggy all day. If he's taking something else for pain, then THAT is a likely candidate for side effects. Problems with allopurinol after the first week (to check for hypersensitivity or allergy) are quite rare. It is among the most tolerated of drugs. And since it is THE gout cure (if you must pay for your meds) and it must be taken forever, be very careful lest you dismiss it without really needing to.
(((I edited this to read correctly now…originally typed Ibuprofen when I meant to say Indomethacin. I guess I typed the “I” and my fingers ran with the ball while my brain took a brieef snooze.)))
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