For the latest information about stopping allopurinol, see Is Allopurinol A Lifetime Drug? in the allopurinol pages. Also view Allopurinol for Gout video for the wrong way to stop uric acid treatment. You will find related information in the gout medications pages within the Gout Treatment Help Section.
Note: This discussion is about allopurinol withdrawal. There is a related discussion about coming off allopurinol.
Somebody asked me the other day, “Can I stop taking allopurinol?”
The short answer is, “Maybe.”
Not very useful, so read on for the long answer.
First of all understand how allopurinol works.
Withdrawing from Allopurinol
It is all to do with uric acid. Uric acid is a good thing, but, when you have too much, it can form uric acid crystals (commonly called urate). These crystals build up in and around your joints causing gout. The only way to get rid of them is to maintain your uric acid level at 5 mg/dL or below.
Allopurinol slows down an enzyme that causes uric acid production in your body. It does this immediately, but each dose does not last very long. Once you stop, your body will start producing uric acid again. That is all it does. It has no pain killing properties at all, and it does not do anything to change whatever causes you to produce too much uric acid.
It sounds as if it is not doing much. But in fact it is saving you from long-term joint damage and tophi – as long as you are getting the right dose. It is vital that you have frequent uric acid tests to ensure that it rises above 5 mg/dL. Your doctor will advise you how frequently these tests should be. If you want more frequent tests, easily carried out at home, see yesterday’s gout newsletter (if you missed it, subscribe now, and you will get a link to the back issues)
So, the general rule is that, once you start taking allopurinol, you must keep taking it every day. If you stop, you will soon be back where you started, and you will put yourself at risk of overloading your system with uric acid.
There is an unfortunate side effect of all urate lowering therapy, not just allopurinol. Anything that is effective at lowering uric acid will cause uric acid crystals to dissolve. As they are dissolving, they are exposed to the immune system and you can get a gout attack. Often this is more widespread than the familiar one or two joints that are affected by normal gout attacks. There is not much you can do about this – just make sure you have painkillers handy, and if these don’t work, go and see a doctor for something stronger. The gout attack won’t last for long, and as you continue to take your allopurinol they will become less frequent and less intense.
If you get a gout attack (often called gout flare) while you are taking allopurinol, you must continue. Missing a dose will do nothing to make the pain go away – it will just prolong the length of time that you have uric acid crystals in your body.
But that does not completely answer the question, “Can I stop taking allopurinol?”
If you are a good gout patient and keep taking your allopurinol daily, and keep checking that your uric acid level is never above 5 mg/dL, a wonderful thing happens.
All uric acid crystals dissolve.
Your gout is gone.
You dance with joy, but still you ask, “Can I stop taking allopurinol?”
And still I answer, “Maybe.”
You really need to consult a rheumatologist on this. I have seen a report somewhere that indicates that you can take a rest from allopurinol once all urate has been dissolved. Sorry, but despite searching, I can’t find where I read this – please let me know if you spot it. Anyway, I’m sure your rheumatologist will know best. Of course, it is vital that you keep checking uric acid levels if you stop taking allopurinol.
For more information, see Is Allopurinol A Lifetime Drug in the allopurinol pages. You will find related information in the gout medications pages within the Gout Treatment Help Section.
keith is now currently in the hospital with near kidney failure. the doctor said he may never know what caused this, however he said blood pressure medicine and allopurinol was against the kidneys. that is why we need to know if it can be stopped.
thank you
Go to rxhealth.com where you can get about six pages of information on medications. Run the report on allopurinol or zyloprim(trade name). It’ll show you all of the information accumulated by the Food and Drug Administration of the US government. Included is information on drugs that have been known to conflict with allopurinol. One of these are thiazide diuretics. Also, definitely read the information GoutPal has on allopurinol as well.
While Goutpal has some really good information on allopurinol, you need to check some other sites as well. There have been interactions between allopurinol and other medications. Also, there are advisories about dosages when kidneys are impaired. Get a list of Keith’s medications and their dosages. The Physicians’ Desk Reference has a good guide to check for interactions. Also, get their complete description on allopurinol (zyloprim). It will tell you of any reported cases of conflicts with other medications. This mentioned thiazide diuretics which is sometimes used for blood pressure. While Goutpal has excellent information on allopurinol, you need to look at the other medicines Keith is taking as well.
I believe somebody in hospital with near kidney failure requires immediate, expert, examination and advice. A rheumatologist, and nephrologist (kidney specialist) are vital.
Though allopurinol has been advised for patients with high uric acid levels to help relieve kidney disease (Use of allopurinol in slowing the progression of renal disease through its ability to lower serum uric acid level – Y.P. Sui and colleagues), each case must be considered on it’s merits.
Most drugs have the potential to cause problems in patients with kidney failure. Normally, the kidneys excrete drugs, or their by-products, but if kidney function is impaired, a normal dosage might be too high. Pillans and colleagues note that almost half of hospital patients have dosages too high on admission, with almost one third continuing with excessive doses (“Evaluation of dosage adjustment in patients with renal impairment”)
Dalbeth and Stamp (Allopurinol Dosing in Renal Impairment: Walking the Tightrope Between Adequate Urate Lowering and Adverse Events)…
But they note that:
Most recently, Avram & Krishnan published “Hyperuricaemia–where nephrology meets rheumatology.”, a review of 9 studies from the last 20 years that look at uric acid and chronic kidney function. They note that:
I hope that Keith, and any other gout patients with kidney problems are getting the care they need. Their advisers should be aware of the research that I have mentioned here. These advisers, armed with appropriate test results and medical history, are the only people who can advise whether to stop taking allopurinol or not. Each case must be decided on it’s own merits.
my husband wants to stop because we just learned it is causing our infertility. what are going to be the ramifications of stopping it?
First of all, you need to be sure that allopurinol is at fault. Though I have seen several references on the Internet indicating that allopurinol is linked to infertility, I cannot see where this has come from.
There are alternative uric acid lowering treatments, and your husband should discuss these with his doctor BEFORE stopping the allopurinol.
I had serious gout in my neck knees elbows and just about everywhere I was on Allopurinol for 6 years but then I realised it was bringing me out in rashes all over my body the doctors told me it was psoriases but it was Allopurinol and so over a year I reduced the tablet by a quarter every three months that was 4 years ago I have not had gout since then
Hi Brian,
Did you reduce allopurinol to nothing, or are you still taking a lower dose? Do you know your uric acid level?
hi brian,
could you please make bit more clearer…. you had AP for 6 yeares and AFTER 6yrs rashes started to show up? or you had rashes for 6 Yrs?
how strong AP did you take for 6 yrs? 300mg? 400mg? and could you also make it bit more clearer when you said you “reduced a quarter every three months…” can you be more precise about the dosage as well… have you completely stoped AP from last 4 years???
thank you.
Hi, I have been taking Allopurinol for 2 years. I am tired of taking them because I feel like I am not the same person. I was 26 years old when I started having kidney problems associated from hyperuricemia. I just had my 28th birthday. I have three small children and hope they do not have this condition. I plan on dieting and exercising starting in January. I am going to buy a home test kit that I can test my uric acid levels each week to make sure that they do not go over 6. I do not want to get cancer or some other disease due to something I feel maybe I can have control over. In the long run if I can’t stop the levels from being out of range then I will get back on the Allopurinol. I am giving it six months of my plan and if it doesn’t work I will let you all know. 😉
Please stay on the allourinol while you lose weight – losing weight is a sure-fire way to raise uric acid. The best plan is to use allopurinol as you lose weight and increase exercise. Once your BMI is down to the low-normal range, and you are comfortable with a good workout, start lowering the allopurinol. It’s a good idea to discuss this with a doctor before you start, so he can check for any risks associated with your planned lifestyle changes.
For more information, see Is Allopurinol A Lifetime Drug? in the allopurinol pages.