three months on

[charlie]

Hi All

Charliehorse here. (I somehow could not log in as that so rejoined)

I have had my UA Sure since 20th December.

I will list my readings below with dosage of Allopurinol/

20 Dec 08      4.1    600mg daily

9 Jan 09       low     600mg

20 Jan 09       5.1     600mg

3.Feb  09       4.0     600mg

26 Feb 09       4.0     600mg

6 April  09      8.4     forgot meds that morning

20 April 09    14.9   down to 300mg

All readings done at about 18:00 each day for consistancy.

I am back on 600mg daily and will stay where my UA is lower that 6.

600mg seems a lot but I don't have any side effects (that I can feel!)

My UA seems to jump very fast if I neglect my Allo.

I drink maybe a glass of whiskey or a glass of wine every night. (more at the weekends)

I have been gout free for about a month now after having non stop gout since I began tha Allo.

so hopefully I am rid of a lot of crystals. I use baking soda daily and watch my BP on it (Its ok)

My lumpy knuckles and ear lobe lumps have vanished. I still have a stiff knee from the big attack but its slowly improving (clicks a lot).

I will keep up the baking soda as I feel its doing me good. I had a life of heartburn so I feel I was always over acidic. Sleeping better too.   The BS is great. No heartburn any more, if I get a hint of it, it is killed with BS. I think its important to alkalise the blood and body.

I hear BS has uses against cancer too.

Sorry for the long post. Just my 2.5 cents worth.

[Keith Taylor (GoutPal Admin)]

Thank you for that – very interesting results.

It just goes to show how important the right dose of allopurinol is, and how important it is not to miss it.

Allopurinol does not last long in the body. I believe that doses above 300mg should be divided during the day, but of course this needs to be discussed with your doctor. Drinking plenty of water is important, as is alkalizing the urine, so the baking soda should be useful.

[zip2play]

You're doing GREAT Charlie.

I think after a reasonably short period of time you can probably back off on the allopurinol dose becasue I think most side effects are DOSE related and if you can get good numbers with 400 or 300 mg. allopurinol, then you should. I guess that's exactly what you and your doctor tried.

Dosing:

It is correct that allopurinol has a short half life in the body BUT it is metabolized to oxypurinol which is also a xanthine oxidase inhibitor (prevents xanthines from going to uric acid.) Though the half life of allopurinol is only a couple hours, the half life of oxypurinol is MANY hours, often several days and day after day the amount builds up. The net effect is that it is the OXYPURINOL metabolite that actually prevents  uric acid formation. Thus after a week of dosing you build up a HUGE suppply of oxypurinol in the bloodstream and missing a single dose or even two or three is without consequence.

 But your numbers are strange:

How often do you miss your dose? On what exact date did you switch from 600 mg. down to 300. That 14.9 is a real head scratcher and would seem to GUARANTEE a fierce atack?????

Something is not adding up!

[charlie]

Thanks Guys for your informative replies.

I did not know about the continuing effect of Allopurinol and its half life and metabolism into Oxypurinol.That would suggest to me that the 14.9 reading could be disregarded as spurious. I did not have any signs of a new attack at that time. 

I will try reducing by maybe 150mg daily, wait a week and retest like I did before. I was surprised by the reading myself as I use a pill dispenser box so I rarely miss my dose. I was away for the weekend when I missed but it was only one day and I would have taken a half dose that evening as opposed to full dose in the morning. I am drinking about four pints of fluids daily (excluding wine or whiskey). I ate some prawns (I love seafood!) but doubt if food alone would account for that big a rise.

My basic aim is to titrate myself by adjusting my dose to get my UA level to 5 or 6 and try to maintain that with as low a dose as possible. I just hope I am out of the woods regarding attacks. I was close to giving up after about eight months of continous attacks in knees, feet and index finger. I read that only a small percentage of people who start Allo. contiunue taking it, and that of those who do continue only a small percentage are taking a dose high enough to lower their UA below 6. Maybe the 600mg daily was responsible for my eight months of agony….too much too soon.

I am considering trying the new drugs. Uloric, Febuxostat, Pegloticase are mentioned. Has anyone any feedback on these in use ? There is also a HIV drug that they have found dramatically lowers UA in the blood. It is RDEA594. This was an accidental find. Just shows that there are probably other drugs that would help gout sufferers but the fact we are a small minority means that drug companies have little interest in us. No new drugs in forty years says something.

Goutpal, Thanks for this site. It and other sites like it are a great source of comfort, information and inspiration to people with this affliction. 

Charlie

Since I posted this, I did another test. It came up “low” so that confirms that it is time to slowly reduce my Allopurinol. If the UA Sure is working accurately it is an indespensibly piece of equipment in the fight against gout.

[zip2play]

My basic aim is to titrate myself by adjusting my dose to get my UA level to 5 or 6 and try to maintain that with as low a dose as possible.

That is exactly the right approach.

I am considering trying the new drugs. Uloric, Febuxostat, Pegloticase are mentioned.

DON'T doo it for two reasons:

1. Both are PREPOSTEROUSLY expensive for a lifetime of useage.

2. Both are NEW so why be a guinea pig to find out the efffects after taking it for 20 years? Allopurinol is over half a century old. The new approaches are sensible only for those who do poorly on allopurinol or are hypersensitive to it.

As for how many people STAY on allopurinol for a lifetime…my guess is the answer is VERY MANY. Untreated hyperuricemia is a slow killer. But I don't have the numbers.

(I think also that 14.9 was probably spurious)

[pagey57]

Hi

My doctor has told me to take my alopurinol at night. 300mg.

Is this the best time to take it?

Wondered what the general opinion was

Thanks

[zip2play]

pagey,

It really doesn't matter because the half life of the first metabolite of allopurinol, oxypurinol, which is responsible for most of the uric acid formation blockage, has a preposterously long half life of several days. Thus whenever you take new allopurinol it is the large residual pool of oxypurinol, several days worth, that is protecting you.

Perhaps with meals is best because anything with food is apt to be less annoying to a delicate stomach.

But whatever is most convenient for you is aok.

[pagey57]

Hi

I sometimes sleep very heavy and dream a lot when I take it before bed.

Maybe its coincidental

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