On-going gout issues

[Claudiu Cojocaru Mason]

Hi Keith. Thank you for getting back to me ,so soon. As we speak I am experiencing a gout atack . Once again I have no idea what it could have trigged it this time. As you probably know ,I am on medication with : metformin, ramipril, amlodipine and rosuvastatin. I was given allopurinol 300mg to use before but still didn’t work on me, maybe because I was still consuming alchool at the time ,not quite sure.I have stopped taking allopurinol now as its not indicated to have it together with ramipril. As mentioned, on your reply email ,I will have to arrange for a blood test to have a look at my uric acid levels. Looking forward hearing from you. Kind regards. Claudiu

[nobody]

Hi! I’m not Keith but I would like to let you know three things:
-allpurinol takes a very long time to work and does not stop a gout attack (that’s the job of anti-inflammatory drugs)
-there’s a well-known alternative to allopurinol which has been used in combination with ramipril in at least one published study
-medications for blood pressure can have an impact on uric acid (some help and some are harmful) so it is very important to have one doctor consider carefully (with input from specialists) the drugs you take for both gout and hypertension in order to try to make the drugs you take work together instead of one against another

[Claudiu Cojocaru Mason]

Hithere.Thank you for taking your time to reply. Ive had a feeling and always was wondering if the actual medication I am on could be the trigger of the gout atacks. In the last few months during the lock down I had experienced a lot more often gout atacks(maybe due to the lack of exercise and higher level of financial distress). Also I have been intoduced to amlodipine and for the last month remipril and quited alchool.When I was taking allopurinol did mentioned to my doctor that the 300mg I am using might not be the corect dosage.Also I always thought that taking allopurinol is to prevent gout attacks never been told or had any slight idea that this is the job of anti-inflammatory drugs ,( I have taken and using Naproxen during gout attacks).I have been advised that I should be carefull taking Naproxen for an extended period of time as it could affect your liver,kidneys and so on ,and to stop Allopurinol during the attacks.So I am still confused on this bit (your paragraph that says:
-allpurinol takes a very long time to work and does not stop a gout attack (that’s the job of anti-inflammatory drugs)…
As I understood and been told by my doctor allopurinol its taken to prevent gout attacks and the anti-inflammatorory(Naproxen) during and after the atacks. Will you please be kind to explain how that exactly works.Thank you once again. Looking forward hearing from you. Kind regards. Claudiu

[nobody]

How it works exactly depends on the progression of the disease and other individual factors.
But basically, yes: if you take enough allopurinol for long enough, that should prevent all attacks. At this point, anti-inflammatories are not needed anymore. The problem is that in many cases “long enough” can be a very long time indeed… hence the need for anti-inflammatories which are not as good at preventing attacks but work as soon as you start taking them.
Another valid approach is to take an anti-inflammatory such as Naproxen after the attack starts as you are doing. But if you wait for the attack to start before taking it, you may need to take a lot more to stop it than would have been needed to prevent it in the first place. Which approach is best depends on how frequent your attacks are among other factors.
Although Naproxen works to prevent attacks, in many cases the side-effects (some of which you just mentioned) make it a poor choice. When you are taking an anti-inflammatory to prevent attacks, you might have additional options not only in terms of dosage and delayed-release pills but you might also for instance be able to use colchicine which is arguably not an anti-inflammatory as such even though it prevents inflammation and helps it come down. Whether any of the alternatives to Naproxen-type drugs would be easier or harder on your kidney, I can not say. So this is something to discuss with a doctor who understands your specific challenges.
Whatever approach you end up taking (and they can be combined), the important thing is not to be discouraged if allopurinol (or any other drugs which reduces the amount of uric acid in your system) seems ineffective at first.
The time necessary for allopurinol-type drugs to work is also what makes uric acid testing important. That helps in guessing what a reasonable dose might be for each individual without having to wait years for the effect of a dose on the apparent part of the disease to become conclusive.

Finally, there are many medications which can bring about gout attacks. But I can not say if that is what happened in your case or not.

[Claudiu Cojocaru Mason]

Hi there. This information its really helpful indeed. I will have to discuss with the doctor the idea of putting me back to allopurinol treatment once again and start getting tested my uric acid levels. Also I will be extremely cautious of what I am having in terms of eating(avoiding all this foods that could trigger my gout attacks).Lets hope for the best results and I will definitely keep you all updated of the improvement.Your time its really appreciated and I would like to Thank you once again 😊. Kind regards. Claudiu

[akkers5]

Actually, I have read somewhere that Duiretic blood pressure tablets can be bad for gout or even cause gout. But finding solid proof is hard.
I have been on Duiretic tablets for some 28 yrs and have had gout for last 21 yrs.

[Author]

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