Is 300mg Allopurinol Dose best for Gout?

[Rebecca Nahid]

For Keith Taylor sorry I have took on board what you said and started a new topic which I hope you respond to. I just have so many questions about gout I end up babbling on

I did say in the last thread that the doctor talked about my recent blood test results and said my liver and kidney function creatine etc..was in her words “excellent” so she said she had no worries over increasing to 300mg and would get another blood test done after several months to carry on monitoring everything.

Initially I was weary but I take a few days to come round to things. I am willing to try the 300mg as fed up of my life being on hold.thats why I was alarmed that others seem concerned when previously higher doses of Allopurinol have been defended.

I did request a gout plan filled in a form not sure if it all went through okay. Please understand I am a worrier and take everything said to me to heart so I stressed over the fact that maybe I should not take 300mg etc…after coming round to it. It is jyst very confusing and I apologise.

[Keith Taylor]

Hey Rebecca, I totally understand how overwhelming things can be when you first learn you have gout. In my case, I wasted a lot of time reading stuff on the Internet. Then, I eventually learned that 95% is self-serving garbage. Now, with the growth of the Internet, the situation is even worse. But, I try to maintain GoutPal with a logical approach backed by real science.

Now, if you restrict yourself to studying British Rheumatology Guidelines and NHS information, you should soon realise that our health service is better than most. So, you now have a great allopurinol plan with your doctor. Or, at least the basics sound correct.

If I were in your shoes, I’d forget about everything else and focus on getting your uric acid controlled. Then, you will not be troubled by gout, and your life will take on a new happier meaning in a few months.

All the recent posts coupled with some personal problems are delaying my progress on new styles of structured plans. But, it’s only a slightly different format from what we are doing here.

So, let’s get all your allopurinol issues resolved here. Then, tell me which of your other topics you want to resolve next.

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Is Allopurinol 300 mg right for your gout treatment plan?

[Rebecca Nahid]

Thank you that sounds great. I did think my uric acid was already getting really low and at 2.7 you would think it fully under control but maybe it is not low enough. I am hopefully towards the final stages of latest attack. Thinking it would be wise to wait till next week, give it a few more days and then start on 300mg dose? Carrying on with 100mg this week.

[Keith Taylor]

Uric acid level 2.7? Really?

Now, I’m totally confused. Is it possible to get the result emailed from your doctor, and paste it here? Ideally, you can get a list of results with dates, numbers, and measurement scale. If you have your blood test results in printed form, please let me know. Then I’ll give you instructions for sending me a scan or photograph of them.

[Rebecca Nahid]

I can take a pic and then send it via email if its easier? What should it say on the form as i don’t think mine says “uric acid”

[Rebecca Nahid]

Right I have tried 4 times now shrinking it down so it is very small and it won’t work. Rather than me spending the rest of the day getting stressed out by computers I will tell you what the results say and I am sure you can trust me. Am looking right now at the print out in my hand.
Serum Urate Level Result- 0.27 mmo/L
(Normal range- 0.14-.36 mmo/L)

Just let me know what other readings you need and I will happily type them straight up from the sheet

[Rebecca Nahid]

Please help! Still not started the 200mg dose. I was trying to upload a photo to show my uric acid but could not do it. To avoid any more stress please take my word it is 2.7!! Too low it was agreed to triple my dose. Can someone advise? Should I get a 2nd opinion with the doctor? Thank you

[Rebecca Nahid]

Meant to say 0.27 mmo/L

[nobody]

Hi again,

There’s no need for a photo but what you could do is to clarify the history of your test results. Here’s what I guess your history might look like:
February: started allopurinol 100mg
March: uric acid 0.30 mmol/l
July: uric acid 0.27 mmol/l
If that’s wrong (which is probably the case), please correct me. And if you have older test results, please add them.

If your uric acid indeed dropped 10% after a few months, that wouldn’t be surprising. The second result would have provided much-need confirmation that you’re on the right track and would be a sign that the therapy seems to be working.
Testing at 0.27 also confirms 100% that you can quit worrying about the purines in regular plant-based foods.
Finally, your test result would also be an argument against raising your dose as 0.27 is quite fine even considering that you seem to frequently have especially cold feet.

Now you know my non-expert opinion: there’s no real need to change anything or to see a doctor at this stage.
A small increase in your allopurinol dose might be helpful. Or it might be useless. So you might want to try 150mg as the risk would be minimal. Or you might stick to 100mg and be patient. We know that gout symptoms can take a while to go away… sometimes more than a year after starting the drug, even with super-strong doses resulting in a lower uric acid level than yours.
But if your symptoms do not go away by next year, then it might be worth seeing a rheumatologist about the failure of your treatment. If on the other hand your symptoms finally cease, after a while on your current dose you might want to try decreasing it to 50mg.

[Rebecca Nahid]

Yes true thank you!! Ur correct re my previous results almost spot on! Be interested to have Keiths view too if he doesn’t mind as he expressed surprise when hearing the 0.27 number and asked me to provide the results but just confused again I guess feel like if I get another attack doctor will be thinking “I told you so”

[nobody]

Actually, Keith was confused when you said 2.7 rather than 0.27.
Note that some women might actually have 2.7 in another unit commonly used in test reports. And since 2.7 mg/dl equals 0.16 mmol/l (the unit you use), you can see how that might be confusing…

If you doctor ever tells you “I told you so” after you have an attack, ask “why didn’t you increase my dose in March then?”. Because that’s when it would have done the most good.
My current doctor sometimes makes mistakes too. It’s OK.

[Keith Taylor]

Yes, I was surprised and confused by 2.7mg/dL. But, I think most doctors and patients would be pleased with 0.27 mmol/L. Personally, I wanted a lower uric acid level to speed dissolving tophi. Because I had untreated excess uric acid for many years before I came to my senses and started allopurinol.

Like every aspect of gout management, uric acid targets have to be set according to individual needs. So, Rebecca, I’m surprised that your doctor didn’t explain why she thought a lower target suited your case.

It’s obvious at 0.27 that you are on your way to gout recovery. That’s excellent news. But I still don’t understand what the issues are? Do you want to speed up your recovery? Then, increase your dose. If you’re happy as things are, then stay on 100mg. If you have doubts, please tell me what they are, and I’ll try to explain better.

[Rebecca Nahid]

Thank you Keith! I thought if the recent attack was part of the expected attacks that may occur when starting allopurinol until the gout is eventually out of your system I could cope with that as the attack was much quicker and much less long-winded and painful than previous attacks so I thought maybe just stay on 100mg that was my issue. I am happy for now at 100mg but perhaps if I get another attack I will go see a different doctor and make sure I relay my uric acid levels and get a proper explanation as to why increasing would help.

[Keith Taylor]

That’s great Rebecca. But, personally, I wouldn’t worry too much about getting another attack. Because, if it happens when your uric acid levels are below 0.30 mmol/L, it is a happy sign that your gout recovery is going well.

I’m not saying these attacks are something to look forward to. But, they are a good sign that old uric acid crystals are leaving your body for good. So, attacks become less frequent and less intense.

I remember this well from my own experience. Because it made me happy to know I was recovering. Then one day I realized I couldn’t remember the last time I had an attack.

Gout Freedom is good! 😀

[Rebecca Nahid]

Thank you Keith thats great to know!! How long til it take do you remember? I am assuming that anything up to a year may be considered reasonable? Just need to stop linking to food, last night ate sweetcorn and my joint seemed really red afterwards (though it may have been before and I had not noticed) i started to panic and drunk plenty of water and all ok. But logic tells me its rubbish to ever imagine it would be poor sweetcorns fault?

Wanted to ask you, want to take an African Mango supplement (for reasons i wont go into not to do with gout? Not heard of studies showing it could increase gout likelihood?

[nobody]

Almost anything could potentially be triggering.
Log your flareups into a notebook along with whatever you ate before. Then make yourself wait until the same food or food type shows up many times in your notebook before getting your imagination and logic on the case of any particular food.
Such a joint trouble notebook, with dates and all, might contain information useful to a doctor if your symptoms don’t end up going go away. Or you could use it yourself to see if your flareups are getting less frequent over time.

[Keith Taylor]

Log your flareups into a notebook along with whatever you ate before. Then make yourself wait until the same food or food type shows up many times in your notebook before getting your imagination and logic on the case of any particular food.
Such a joint trouble notebook, with dates and all, might contain information useful to a doctor if your symptoms don’t end up going go away. Or you could use it yourself to see if your flareups are getting less frequent over time.

This is an excellent tip for all gout sufferers. Because it can help with diagnosis problems and help with measuring treatment progress. Also, for gout patients who worry about side effects, it’s a great tool for isolating real problems.

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