Allopurinol 300 mg : Good, bad, or ugly?

Allopurinol 300 mg per day is the most common dose for uric acid lowering. However, it might not be right for you.

This allopurinol 300 mg article is aimed at gout patients who are currently taking allopurinol. It is also aimed at gout sufferers who are considering starting allopurinol. I explain the principles of allopurinol dosing. I explain how those principles apply to you. Especially, how to tell if allopurinol 300 mg is the right dose for your gout.

It’s over 2 years since I published my allopurinol dosing guidelines. I will soon revise them to reflect latest best practice. However, I’ve seen from my gout forum that many gout patients are still getting the wrong dose of allopurinol. Therefore, I have produced this quick guide here. This allows you to make vital choices about allopurinol now. I’ll update the guidelines with appropriate references to gout studies.

Thinking About Allopurinol 300 mg

Anyone who has more than one gout attack in 12 months should seriously consider lowering their uric acid. If you have a family history of gout, you should consider it even sooner. Perhaps after the first gout attack. Also, you might want to control gout by diet. Gout diet takes a long time to affect uric acid crystals. You might consider allopurinol as a short term measure, until you can get your diet right.

Of course, there are alternatives to pharmaceutical medicines for gout. These are beyond the scope of this article. To learn more, browse my gout treatment guidelines. If you are happy to use pharmaceutical medicines for lowering uric acid, there are alternatives to allopurinol, though it is usually the first choice. To learn more, browse Gout Medications To Avoid Gout By Lower Uric Acid. I provide personal advice to help you choose the right gout treatment for your unique circumstances. Just ask in the gout forums.

Preparing for Allopurinol 300 mg

If you are still reading, we’ve established that you either take allopurinol already, or you are considering it. If you are already taking allopurinol, you can skip down to Effective Allopurinol.

You need to prepare to start allopurinol safely. You are not going to prepare to take allopurinol 300 mg, or any specific dose. You must take some tests, first.

All gout patients should get blood tests for uric acid, kidney function, and liver function before starting allopurinol. Those function tests establish a healthy baseline for your doctor. In the later stages of your allopurinol treatment plan, your doctor can use those values to check for adverse events. Whenever you get uric acid tested, you should always get kidney function and liver function tests.

One particular adverse event is Allopurinol Hypersensitivity Syndrome. This is most common in certain ethnic groups. Fortunately, it can be screened for. It is a one-off genetic test. The groups at risk are Han Chinese, Thai, and Korean with stage 3 Chronic Kidney Disease, or worse. If you fail this test, your doctor should advise you about other uric acid lowering medicines.

If you do not understand your test results, please ask in the gout forums.

Starting Allopurinol 300 mg

Now you are ready to start, note that you do not start with allopurinol 300 mg. You normally start at 100 mg per day, or 50 mg if you have kidney disease. With your first allopurinol prescription, you should get advice about gout pain control. You should also get a follow-up appointment in 2 to 6 weeks. Less than 2 is pointless because it takes 2 weeks for the allopurinol dose to be fully effective. More than 6 weeks is pointless because it shows total lack of concern.

If you are unsure about the advice you receive when starting allopurinol, please ask in the gout forums.

Effective Allopurinol 300 mg

At this stage, you have at least 2 sets of blood test results. Hopefully, liver function and kidney function are all OK, so we can focus on uric acid.

For effective allopurinol treatment, the long term goal is to keep uric acid safely below 5mg/dL. However, if you have had gout for a few years, it is important to get rid of old uric acid crystals as soon as you can. This is known as “reducing the uric acid crystal burden” or “urate debulking.”

Your doctor should assess your medical history, and set a target for your uric acid. It can be complicated if you have kidney disease, or if you are frequently exposed to cold temperatures. To keep this simple, I suggest two options for your target:

For gout sufferers less than 2 years: 5mg/dL or lower
For gout sufferers over 2 years: as low as possible

Now that you have a target, you can set an effective dose. Every 2-6 weeks, you increase allopurinol by 50 or 100 mg until you reach target uric acid. Allopurinol 300 mg might achieve that, but in most cases it will be higher. In some cases, it will be lower. There is no right or wrong dose – just the allopurinol dose that is right for you.

Allopurinol 300 mg is good, if you reach your personal uric acid target.
Allopurinol 300 mg is bad, if your uric acid remains above 5mg/dL. It can make your gout worse.
Allopurinol 300 mg is ugly, if your correct dose is less. It won’t harm you, but it shows inept care.

Once you’ve reached your target uric acid level for debulking, you will notice that gout attacks become less frequent, less intense, and less widespread.

Managing Allopurinol 300 mg

Now, you are almost ready to take total control of your gout. Keep a diary of gout flares. Once you have gone 6 months without a flare, with uric acid below 5 mg/dL, your gout is controlled.

If you’ve gone for “low as possible” during debulking, you can slowly reduce your allopurinol dose. You must never allow uric acid to go above 5 mg/dL.

At least once a year, get the blood tests to make sure you are never troubled by gout again.

If your allopurinol treatment plan is missing any of these features, you should discuss them with your doctor. If you are unsure what to ask, or if you do not understand your doctor’s responses, please ask in my gout forums.

Leave Allopurinol 300 mg : Good, bad, or ugly to browse my Allopurinol Guidelines.

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