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I am starting Allopurinol today. I have uric acid level that has been running above 9, below 10, for at least 4 years. I have had gout attacks in my toes and feet, and once in the knee. When I get the attacks I am usually able to stop it with Colchicine and ibuprofen.
I am 25 lbs overweight, in my late mid sixties, male. I restrict my diet to a small degree, not eating organ meats, large amounts of red meat, shell fish, and staying away from beer. I do drink a few ounces of alcohol once or twice a week, but not more than that and not more often than that.
I take a low dose of atenolol for blood pressure. I have psoriasis. I don’t medication for it.
I have had kidney stones and bladder stones. The stones have been evaluated to be mostly made of uric acid. I have started taking potassium citrate pills to keep the stones from developing.
I tried Allopurinol about a year ago and stopped after the first lab tests showed that my ALT liver function level was not good. During that period I did not get a gout attack and I felt pretty good. I remember that my feet felt nicer and it was unfortunate that I had to stop. My ALT level returned to normal when I had it tested again at a later period.
I am trying Allopurinol again to see if I my liver can do better this time. My rheumatologist advised that I start at 100mg a day, go to 200 after two weeks and then 300 after two more additional weeks. Then get tested again.
He has also prescribed Sulindac to control pain if I get an attack. — Not sure if he wants me to take Colchicine also, if I get an attack. I will ask him via email and report it here at some point.
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Steve, can I ask about:
I am trying Allopurinol again to see if I my liver can do better this time. My rheumatologist advised that I start at 100mg a day, go to 200 after two weeks and then 300 after two more additional weeks. Then get tested again.
That seems to say you only get tested after the 2nd dose change. But, safe allopurinol prescribing says you get blood tests after 2 weeks, then change dose according to those results. To clarify, those blood tests should be uric acid; kidney function; and liver function.
So, please can you clarify your exact allopurinol treatment plan.
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I am at day 10 and taking 100mg per day. I will step up to 200mg in about the 4th week and get tested in the 6th week while taking that dosage. My doctor has said that is not the standard way to ramp up, testing at 6 weeks is, but that a slow ramp up might be helpful to prevent gout attacks that can happen while people are starting to increase dosages. That’s what my rheumatologist at Kaiser in California is telling me.
BTW, as part of this personal diary and as info for others, in the first 5 or 6 days I was feeling a lot of itching, mostly in legs, but I am feeling less itching since then.
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Thank Steve,
a slow ramp up might be helpful to prevent gout attacks that can happen while people are starting to increase dosages
When you get chance, could you ask him for any research references on that. I agree with the ramp-up. But I want you to stay safe. I need to be convinced that increasing from 100 to 200mg allopurinol per day without liver function and kidney function tests is safe. Statistically, it’s very safe. But, I’d hate you to be one of the tiny minority that gets caught out. Maybe this tight-assed Brit needs a lesson in chilling from the Wild West!?!
That itching thing is weird, but I’m glad it’s getting less. I’m trying to resist making comments about affirming the itching isn’t serious with blood tests. [oops! I didn’t try very hard, did I?]
Finally, welcome to your gout diary. I hope to publish some helpful guidance soon. Anyway, it’s yours to do as you like.
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After five and half weeks on 100mg of allopurinol per day I went and got lab tests. My UA dropped from above 9.1 down to 5.5. My ALT level actually got better, down from 29 to 19. My Creatinine lowered from 1.25 to 1.19 which is in the normal range. So I appear to be tolerating the allopurinol this time.
I have not had any dramatic gout attack during the last five weeks. My ankles and feet have felt sore and stiff at times but not hot or swollen. One wrist hurt but might have been a pulled tendon or ligament from lifting something heavy and that went away in a couple days. The rheumatologist has prescribed Sulindac (two per day), an NSAID that he says might be easier than ibuprofen on the kidneys, to be taken as needed if I need pain relief. I have taken them when my feet felt kind of stiff. I don’t know if the stiffness is from the gout but taking the Sulindac is effective for that. I’ve taken one at a time about 3 a week.
The doctor has said that getting the UA level under 6 is good and to continue with the 100mg and test in four months. I am going to do that. Anybody have any predictions whether the allopurinol will continue to lower the levels? It would be great if it really brought the levels lower over more time at that dosage, as my liver and kidneys have so far tolerated that level.
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That’s great news, Steve.
I’ve no data about what happens during the first few months of allopurinol use. But, logic tells me that it might fall further. Because, you will have fewer old uric acid crystals to dissolve.
However, we’ve seen elsewhere that a single test is not the full picture. Because, there are natural variations in uric acid. But, the main objective is for old crystals to dissolve, and gout attacks to reduce to zero. And that is likely to take months rather than weeks. So, you should see gout symptoms reducing in intensity and frequency. Then, the magic day comes when you can’t remember when you last had an attack.
I’m looking forward to that happening for you ๐
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