starting allopurinol

[Tim]

I see Mary said she wasn’t quite brave enough to start her Allopurinol yet. I expect to be put on that this week, my doctor will have my blood test results in a few days. my gout attack has lasted 5 weeks, with tophi in one toe. I am worried about taking Allopurinol while i still have some symptoms and just about it in general. Has anyone had any bad side effects? Especially long term? Can i expect attacks in the next few months? I also worry that 5 weeks of Indometacina (anti – inflammatory) is too much.
Tim

[Tim]

Hi again, just new to this forum stuff, so i am replying to myself! I just read Keith and Barry’s exchanges (am i the only one laughing?). I see there is a lot of stuff about Allopurinol and I see Keith’s rant (his words) is about the very stuff I was worried about. Ok, I will wait for my Doctor’s advise but i do still wonder if i should be on anti- inflammatories at the same time.
I, like Barry, do look forward to being able to have a few wines and beers, and I see his point about monitoring oneself (previously not caring too much).
I don’t like the idea of being on Allopurinol for life, but …..
Tim

[Keith Taylor]

Hi Tim,

It’s right to be careful about allopurinol, but it has to be balanced. The biggest worry is doing nothing about high uric acid. That has very scary implications, and I don’t think these are emphasized enough. Untreated gout is a crippling killer. Allopurinol is usually safe.

Recent research shows that bad side effects are largely genetic, and can be screened for. Han Chinese, Thai, and Korean ancestry is high-risk. Positive tests for the relevant gene indicate that Uloric (febuxostat) should be used instead of allopurinol.

The first allopurinol dose should be 100mg, and uric acid tests should be accompanied with liver function and kidney function. Increasing allopurinol according to blood test results is very safe, and has been successful for many decades. It all goes wrong when follow-up is poor. That is common, so you usually have to take control yourself. Insist on blood tests – monthly at first, but never less than once a year. Insist on safe uric acid levels – never more than 5mg/dL.

That way, you stand a chance of still being alive and healthy when future uric acid lowering treatments replace daily allopurinol with an annual shot. Beyond that, genetic engineering will fix the faulty genes. Gout, and GoutPal, will be history! Don’t worry – I’ll find something else to do in my long retirement. 🙂

[Author]

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