Allopurinol vs. Uloric for My Gout

[Leo Minegishi]

So I’ve been digging around these forums for a while now (great resource by the way) and haven’t really found anything that directly addressed what I’m seeing with my gout treatments. So I apologize if I missed something but I thought I’d start a new topic to hopefully get some thoughts from the guru’s around here.

So here’s a little history, I apologize again if this is a long read.

I’ve had gout for about 15 years. For the first 10, I’d only get a flare up/attack maybe once or twice a year. And, it wasn’t diagnosed as gout and I was usually just given painkillers to deal with it (not the best idea….since they didn’t really work). About 5 years ago I was diagnosed with gout and the tests showed a “high normal”, according to my Dr. at the time, of around 7 mg/dl. He did drain fluid off my knee (about a red bull sized syringe full) and had it tested as well. There were no crystals in the fluid.

So fast forward to about 2 months ago. During the time in between, I had several flare-ups and was prescribed Indocin to combat the swelling. No additional blood tests or Uric acid-lowering therapy. About 2 months ago, I went to see a pretty highly regarded rheumatologist told her my story. She suspected gout as well, or RA, and had me take some more blood tests to find out. They came back with everything “good” but my UA levels. Which were at 10 mg/dl.

So she put me on Allopurinol and Colchicine (300mg and .6mg respectively), taking 1 of each per day. Over the next 2 weeks, every joint in my body (not really, but it felt like it) was sore, stiff, and has limited motion (without pain). Specifically my knees, ankles, shoulders and wrists. Keep in mind I’ve only every had a gout attack in my knees or ankles. At first I thought it was my body getting used to the meds, but I reached out to my doctor and asked her about it. She immediately pulled me off both meds for a week to see if I would start feeling better. I did. I spoke with her again, and she put me on Uloric (40mg) and colchicine again. That seemed to be work much better as I felt pretty good but it felt like, at least in my knees, I was always right at the start of an attack (if you have gout, you know what I mean). And had one minor attack in my ankle.

So I went back in for an office visit, told her how things were going. She wanted to get another blood test done to see how my UA was and to check my liver functions (to be safe). That came back with a UA of 5.7, which isn’t ideal, but we’re headed in the right direction. But my ALT was at 70, which is listed as being high. So I’m wondering if I should ask her to put me back on Allopurinol and see if my body deals with it better now that my UA is lower. Or just stay on Uloric since it’s working and my ALT wasn’t “that” high.

One thing though, is that I was having a pretty bad gout attack in my forefinger when I got my blood drawn (btw, I’ve NEVER had an attack in a finger….so that was new). Could that have caused my ALT to bump up a bit?

Oh, and since some folks will take the time to read this “novel”, here’s one thing I did learn. Don’t ever take Uloric and colchicine at the same time on an empty stomach. That did a number on me (stomach pain, diarrhea, etc.)

Anyway, thanks to anyone who reads this and comments.

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Do you choose Allopurinol or Uloric?

[Keith Taylor]

Allopurinol vs Uloric for Heart disease

Is allopurinol and heart disease information important to you? Please let me know with your replies here.

I’ve flagged Have A Heart! Allopurinol Helps More Than Gout for review. And, I’ve added a comment at the end of that article, about some recent research. So, I really should review all articles related to heart disease and allopurinol.

Importantly, I should also review how all alternatives to allopurinol might affect cardiovascular events. So I should research Uloric and heart disease.

What are your thoughts on Uloric, allopurinol, and heart disease? How do you think I can improve my current information?

[nobody]

Loads of drugs can raise your ALT, not just Uloric. Among gouty pills, NSAIDs in particular can make it go through the roof.
My median ALT reading over more than 20 years has been 104. Amusingly enough, my median reading before I developped joint problems was also 104 which goes to show lots of non-phramacological stuff such as booze can affect liver tests as well.
Such tests should be interepreted in context. So while my results might reassure you as to how high 70 really is, in your situation they may actually signal a problem. Ideally you’d compare your latest result to a baseline test done before starting UA-reducing drugs. If your doctor isn’t too worried about 70, consider trusting her judgement. She may ask for another liver panel before long if she doesn’t know whether 70 is within your normal range.
Good luck curing your arthritis!

[Keith Taylor]

Leo, your doctor does not understand gout! Nobody in their right mind would start gout treatment with 300mg allopurinol and .6mg colchicine. Your experience shows exactly why it’s a very bad idea.

Over the next 2 weeks every joint in my body (not really, but it felt like it) was sore, stiff, and has limited motion (without pain). Specifically my knees, ankles, shoulders, and wrists. Keep in mind I’ve only ever had a gout attack in my knees or ankles.

I hope I explain why that happens at Allopurinol Medication: Why It Hurts To Get Rid Of Gout. It’s time I reviewed that article. So, if you need a better explanation, please let me know.

Yes, your gout attack could explain the raised ALT. So, best keep an eye on it. Anyway, you need to keep monitoring liver function and kidney function when you are on Uloric. So, your doctor should know if your meds need to change.

I suspect that the reason you got less pain with Uloric is:
– Either, it isn’t as effective at clearing old uric acid deposits.
– Or, substantial old crystals have already dissolved.

Whether you take allopurinol or Uloric, you need to be prepared for gout attacks until most old crystals have dissolved. The typical timescale is 6 months, but every gout patient is different. The way to reduce that timescale is to get uric acid lower.

Leo, it’s your choice about “So I’m wondering if I should ask her to put me back on Allopurinol and see if my body deals with it better now that my UA is lower. Or just stay on Uloric since it’s working and my ALT wasn’t “that” high.”

It’s a pity you’ve had unnecessary pain. But, you might well be over the worst by now. Personally, I’d recommend allopurinol. But, the most important thing is to keep going in your “right direction” with uric acid numbers.

If there’s anything I can clarify, to help you decide, please ask.

[Leo Minegishi]

Thanks for the input guys.

My “baseline” right before I started any treatment was an ALT of 40. My UA was 10 then too. My latest tests form last week, when I noticed my ALT was 70, showed my UA at 5.7. So my UA is coming down, I just hope not at the expense of my liver.

I saw my rheumatologist yesterday for my monthly check in (3rd visit) and she was happy with my UA levels but did comment about my ALT being higher than before. She said it wasn’t high enough for her to send me to get an ultrasound or any more liver tests, but we need to watch it. So my next visit is now 3 months out (she switched it to quarterly now) and my next blood test is then too. I kind of want to get another blood test before then, just to see what’s going on, I may ask her to order another round of tests in about 4-5 weeks.

I did ask her if either the gout attack I was having or the viral infection I was getting over (I had just gotten over a nasty respiratory infection that going around) could raise my ALT and she said “no”. So I don’t know if maybe she hasn’t dealt with a lot of gout patients (which I’m leaning more and more towards) or what.

But, she’s been quite accommodating to my requests so far and seems willing to work with me instead of just telling me to do it her way. So I like that part.

I was going to push to try Allopurinol again, but I’m leaving for a trip overseas for a week or so and would rather wait to change anything until I’m back on my home turf. Luckily (if you want to look at it that way), I’ve already hit my maximum deductible for my health insurance, so my Uloric prescription is pretty cheap (just the copay).

[Keith Taylor]

Thanks for the update, Leo.

You say “she was happy with my UA levels”.
My question is – are you?

Leave the answer until you get back from your trip, if you like. Going anywhere nice?

[Leo Minegishi]

Eh, I’d like to see my UA down to in the 3 range or lower. Then I’d be happy. But I’ve only been on a UA lowering treatment for about 6 weeks, so I’m hoping that by staying on it, my UA will continue to go down a bit more.

I don’t leave for my trip until the end of the month. I’m going to the Philippines so that should be interesting.

[Ucatsexas .]

Allopurinol vs Uloric

1. The price difference is huge: $ 1.90 for Allipurinol vs $98.00 for Uloric (each a 30-day supply). My doc switched to Uloric because he thought it would remove tophi better. I did fine on Allipurinol. Seem fine, too, on Uloric.

2. What other differences are there?

My testing for uric acid in the blood: 8.6 in mid-May. Next test will be in 2 weeks.

[nobody]

The properties of these two drugs are quite different but there is no reason to believe that one would remove tophi better than the other. With both drugs, it’s the dose which matters. Your Uloric pills are probably stronger than the ones you used to take but you could have taken more than one allopurinol pill every day instead of switching to Uloric.

[Jose Ney Morales]

Allopurinol and Uloric side effects

Hello, I’m 37 and had my first gout flare up over ten years ago. I had a couple more flare ups before a doctor finally prescribed allopurinol, at first they were skeptical. I think most thought I was too young.

I just recently, within the last two to three months, realized allopurinol was what was causing pretty severe drowsiness. I would take allopurinol and be okay, but anytime I ate I would get very drowsy about 20 minutes later. At times the drowsiness and mental fog were debilitating. I realized every time I ate I felt drowsy and that when I fasted I felt better. For the past few years I’ve been playing with my diet trying to find what it was I was having an allergy/intolerance to. I started feeling better, and eventually stopped being drowsy most of the time but couldn’t pinpoint what still made me drowsy every now and then. I had also began taking allopurinol more sporadically until eventually abandoning it altogether.

In April I had a physical exam at work and my uric acid was 9.2. I thought maybe a change in diet and exercise would help so I stayed away from the allopurinol. I had a physical scheduled with my primary DR for the end of June so I gave myself until then to give dieting a shot.

I took allopurinol for the first time in a long time at some point in May or June. I had been fasting that day until 3pm, slept well the night before and hadn’t felt the drowsiness I dreaded for a very long time. About 20 minutes after eating the dreaded drowsiness hit me like a truck, It was unmistakable. It quickly became apparent that the only thing I had done differently was taking allopurinol. I stopped taking it again and experimented with it a few days later, same reaction.

During my physical with my Dr I told him about the side effects and that I wanted to try a different medicine to control my Uric Acid, this time it tested at 9.6 my doctor prescribed uloric but it seems to have the same side effects as allopurinol.

I used to take 300mg allopurinol, my dr prescribed 80mg of uloric. I want to reduce my uric acid levels to a safe number. without meds I haven’t had a flare up in at least two years.

Any suggestions as to what my next steps should be would be greatly appreciated.

Please excuse me if I left information out or jumped around a bit, today the drowsiness and brain fog have been intense.

[nobody]

Hi,
80mg Uloric is much stronger than 300mg allopurinol. You could try taking less to see if you still get the same side effect.
What are your blood test results like when you are taking either drug every day? Did you check your blood pressure, blood sugar and so forth while you feel drowsy?
Considering you haven’t had a flare in more than two years however, I’m not sure you even need to take a drug. Did any tests establish that gout was indeed the cause of your flares 5-10 years ago?

[Jose Ney Morales]

I’m always checking my blood pressure, I’m a paramedic and always have blood pressure machines nearby. My pressure is always normal and my heart rate is always below 60. I’ve been very active (exercising) in the last six months and weigh 180 @ 5’8”.

I’m also prescribed adderall and drink a good amount of caffeine. The only time I feel any side effects from adderall or caffeine is when I’m taking allopurinol or uloric. I’ve also noticed my pressure tends to be on the high side when taking meds for gout, even got up to 230/120 one time. At that time I was asymptomatic except for a bit of double vision. I believe the rise in BP is due to the effects of the gout meds and adhd meds combined.

My blood sugar has always been normal, fasting and after meals. I started testing it regularly approximately two years ago. I stopped testing my blood sugar after failing to see a correlation between the drowsiness I was feeling and Blood glucose level

Date. SUA.
09/21/2010 10.7
03/10/2014 7.1
05/18/2015 4.7
12/06/2016 3.4
04/03/2017 6.0
04/05/2018 8.2
06/30/2018 9.6

[Jose Ney Morales]

I’m assuming the periods of lower uric acid coincide with the times when I would take the medicine more regularly.

I’ve never had any other tests besides serum uric acid and actually having the doctors see my ankles and toes during a flare up.

[nobody]

I don’t know how experienced these doctors were with gout-like symptoms but as you know, many things can cause inflammation.
That said, your SUA tested low enough for long enough that it may explain why your hypothetical gout didn’t come back even though you didn’t take your medication regularly. In theory, symptoms should come back if you allow your SUA to remain above 8 long enough.

The variations in your SUA are impressive by the way.
Did you change your diet, take drugs known to affect SUA as a side effect or something? Because if 300mg allopurinol was enough to bring your SUA down to 3.4, that dose may have been excessive… which probably means 80mg Uloric is way too much for you.

I’m clueless about interactions between ADHD meds and xanthine oxidase inhibitors (that’s what allopurinol and Uloric are). Have you asked a good doctor about this or looked up reports yourself? If my blood pressure read that high at rest, I’d be concerned.
Have you tried other types of gout meds? There’s a BP drug which also lowers uric acid for instance.
The problem with reporting drowsiness as a side effect is that it’s subjective. But if you could bring a doctor a more systematic report about your XOI-driven hypertension, maybe they’d be willing to explore other drugs or drug combinations with you.
Even small XOI doses do have a significant effect on SUA so if the side effects you get are dose-dependent, a small Uloric or allopurinol dose could be part of the solution.

[Jose Ney Morales]

I’m guessing my next best step is to try and find a good rheumatologist and make an appointment, possibly request a urine uric acid test and play with the idea of taking probenecid.

[Author]

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