January 22, 2010 at 12:51 pm #7360
Keith I am so pleased that I start off the New Year with another question for you to ponder. It will be a good year.
The source was a Doctor, 30 years ago and a Specialist 6 months ago and we all know they are experts.Yet my current Doctor was not aware of any problems. The specialist just came out with it as I asked the question.
Maybe it it a Southern Hemisphere thing.
I’ll go and hide in my cave again.I’ll have a search to see if I come up with anything.
Just noted I’ve cracked the 50 posts, do I turn into a pumpkin or something now.January 22, 2010 at 2:40 pm #7366zip2playParticipant
Any rheumatologist claiming that allopurinol causes kidney disease should perhaps talk to a nephrologist who will tell him that he is spouting nonsense. Perhaps another wise course for him is to stick to reheumatology…or retire.
Allopurinol is often used to TREAT kidney disease.January 22, 2010 at 10:56 pm #7377January 23, 2010 at 3:28 am #7381AnonymousInactive
I don't understand that reference, David, in the context of kidney disease. All it says about kidneys is that if they are already impaired then allopurinol dose may be lower.
As Terkeltaub said last year, when talking about allopurinol failing to reach low enough uric acid in many cases (my bold):
“This situation has been promoted by longstanding, non-evidence-based guidelines for allopurinol use calibrated to renal function (and oxypurinol levels) and designed, without proof of efficacy, to avoid allopurinol hypersensitivity syndrome”
He clearly hadn't read my earlier discussion of New Zealand study on allopurinol dosing in renal impairment. Very clever, these Southern Hemisphere Johnnies. They reckon that dosing above the recommended guidelines be considered, though they do call for additional research.
Once again, your trip out of the cave prompts me to look at more recent research for any additional advice. I had to move north of the equator for this, but maintaining the Eastern influence, we journey to Korea.
A very recent study has suggested better ways to assess kidney impairment. These clever Eastern Hemisphere Johnnies include some interesting points about allopurinol and kidney disease. First, they remind us of the dangers to kidneys from high uric acid:
Murray and Goldberg showed that hyperuricemia was a primary cause of chronic interstitial nephritis in a retrospective study of 101 patients. Recent study determined that hyperuricemia may contribute to the development of chronic gouty nephropathy as well as play a crucial role in the progression of renal pathology.
Then they suggest:
It may be considered that gout patients with renal impairment have allopurinol rather than benzbromarone as a uric acid lowering agent.
But I'm no nearer finding anything showing a bad side of alllopurinol for kidney patients.January 23, 2010 at 5:58 am #7375
Sorry Keith , I guess it was a bit cryptic, I thought I had been a bit verbal on the Site and cut down on words.
The article actually states that there appears to be no evidence of long term side effects.
As to the Rheumatologist, I doubted her knowledge and won't be going back, but there has been some underlying concern by the Doctors going way back about Allopurinol and kidneys. Maybe as the drug has been around for 40/50 years, these fears have been displaced. As stated above my current Doctor was not aware of any problems, likewise he wasn't aware of the reason you have Gout flares on Allopurinol and a few other things, like why you prescribe Colgout. It is just the recommended treatment. That still leaves us up in the air.
The trouble is I have been dealing with Gout too long and you pick up a lot and lack of information along the way . Things do change over the years and I guess there is now confidence in the drug, whereas in the 1970's there was doubt.January 23, 2010 at 10:18 am #7384zip2playParticipant
Actually in the 1970's the general feeling was that Zyloprim was completely without side effects…remarkable for ANY drug.
It is only lately that quibbles are being made about allopurinol, and I suspect a lot of that stems from it's loss of patent protection (and it's old high price) and the emergence of an expensive new kid on the block…patent protected Uloric.
Allopurinol remains in a rarefied atmosphere of drugs that cause almost NO untoward side effects.
(I've run through the almost entire gamut of anti-hypertensives…dozens of them. If a single one of them was as free of side effects as allopurinol, its maker would get the Nobel Prize and deserve it.)January 23, 2010 at 6:30 pm #7389
Sorry Zip I have to personally disagree with you on the comment about “no side effects”
As I have stated before.
“My main purpose in continuing the treatment, albeit at the low dose of 150mg / per day and still function, is to reduce the toe tophi , I can well cope with the few attacks a year that I normally suffer. The effects I experience on 300mg of Allopurinol are life changing and I pretty much cease to function. Movement outside of the house is not really an option as I can't drive or walk, converse or think sensibly due to the side effects.
If you are able to take Allopurinol and be gout free, you have won the lottery”
For me it is a very cruel drug!
Even kicking up from 150 to 200mg a couple of weeks ago has brought back all the negative side effects and I am back here on Site, waffling to fill in the time as my movements are again restricted, particularly by the overwhelming tiredness, head aches and wanting to sleep all the time.
For me, Allopurinol is not the magic bullet. If it were the cure all, why are so many people on this Site looking for cures , advice and expressing general fear of the drug.
In the 70's / 80's there was doubt about Zyloprim (Allopurinol) and its effect on the kidneys, amongst the GP's. There was a reluctance to prescribe it . Maybe the word hadn't filtered down here or maybe we were ahead of the pack.
My medical treatments , based on the GP's advice over the years started with Zyloprim, then in the 80's I think it was ORUDIS , followed by the Voltaren/Colgout and now I am back to the Allopurinol/Colgout/Voltaren combination.
The Orudis was a bit nasty but the Allopurinol is the the cruelest drug of them all as the side effects never seem to end.January 29, 2013 at 5:08 pm #14095KeithTaylorParticipant
This topic is now closed.
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