Allopurinol Drug – Is it Safe to take for Life?

[Keith Taylor]

As I attempted to answer a question about allopurinol vacations today, I referred to Is Allopurinol A Lifetime Drug.

I believe this is an important principle for Gout Seekers. Because many gout sufferers veer away from uric acid therapy. I’ve had this myself. In the prime of your life, you see the specter of lifelong medication. Pictures of Grandad and his daily ritual of pills make you run for the hills.

Of course, that’s ridiculous when you stop to analyze it. But, I still remember the same fear of having to wear spectacles for life when I was a boy. These are real fears that produce Gout Victims.

And, the truth is, when you take control, you do not have to take gout medication for life. As long as you understand exactly how you can start and stop it so that you are in control.

In the report attached to “Is Allopurinol A Lifetime Drug” there are detailed criteria for managing uric acid therapy properly. I don’t think I represented those ideas very well in my original article.

So, if you think I should stop dragging my heels, add your comments below. Constructive criticism, or simple “get on with it” comments are all welcome.

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Have you ever stopped uric acid treatment and had gout return?

[Keith Taylor]

Following another question about this topic today, I have looked for more recent research. Although there are some interesting studies, there are still no definitive guidelines about the temporary withdrawal of uric acid treatment. So, it seems it is still a matter for individual decision making between you and your rheumatologist or other doctors.

In 2011, Perez-Ruiz built on the 2006 report I used to create Is Allopurinol A Lifetime Drug. Because he published:
Perez‐Ruiz, Fernando, Ana Maria Herrero‐Beites, and Loreto Carmona. “A two‐stage approach to the treatment of hyperuricemia in gout: The “dirty dish” hypothesis.” Arthritis & Rheumatology 63, no. 12 (2011): 4002-4006. 2-stage Uric Acid Treatment (Dirty Dish) PDF.

The unusual “Dirty Dish” term is explained:

A figurative analogy to a dirty dish may help in visualizing the issue: the initial effort to clean the dish (serum urate therapeutic target) would depend on how dirty it is (urate deposition burden) and, once it is clean, light daily wiping may be enough (serum urate preventive target) from then on to avoid dust (new urate crystal) accumulation and keep it clean (no recurrence).

Last year, Beslon and colleagues reviewed all similar uric acid studies:
Beslon, Virginie, Perrine Moreau, Annabel Maruani, Hubert Maisonneuve, Bruno Giraudeau, and Jean-Pascal Fournier. “Effects of discontinuation of urate-lowering therapy: a systematic review.” Journal of general internal medicine (2017): 1-9. Relapse Rates after Stopping Uric Acid Treatment PDF.

So I used that report for the image you see above. But they conclude:

Relapse of gout is common although delayed after discontinuation of ULT. Short-term prognosis after ULT discontinuation appears favorable if the serum urate level was low before ULT discontinuation. The results of this review are limited by the paucity of existing studies and their low quality. Further comparative studies should consider larger primary care populations and discontinuation of febuxostat.

As I noted earlier, if this topic interests you, please encourage me to update the relevant resources on GoutPal.com by adding your comments below.

[simon watmore]

Allopurinol Vacation

I’ve been taking allopurinol since January, and now I don’t having any symptoms at all , the growths in my toes have nearly dispersed, I had suffered with gout for about 15 years , I take half a 300 mg tablet in the morning and the other half with an evening meal, do you think I should have a vacation ? or lower the dose? or stay as I am? Thank you very much for your help its given a new lease of life . Kind Regards Simon.

[Keith Taylor]

You should post your uric acid test results here.

[Keith Taylor]

I mentioned posting your uric acid test results here, Simon ( @simon-watmore ), because it helps me give a more complete answer. But there’s enough info in your post for me to say “Definitely not yet!”

That’s mainly due to “the growths in my toes have nearly dispersed”. Because you absolutely have to start counting from the time when there are no visible uric acid deposits. After that, without DECT, it’s all down to educated guesswork. But that “education” needs to come from your doctor more than from this forum. Because you must have the support of a doctor who understands exactly what to look for, and who has access to your complete medical history.

It’s a dangerous road to start looking for a break from your treatment when you haven’t completed your gout recovery yet. I must emphasize that the danger doesn’t come from gout attack pain. Or from dissolving tophi under your skin. The real danger comes from failure to give damaged joints time to recover after ALL uric acid crystals have dissolved.

Have you discussed any of this with your doctor?

By the way, I moved your topic here, because it’s very relevant to your situation. But if you want to start a separate topic, please make sure you post enough detail about your medical history, test results, etc so we can make reasonable estimates of timescales.

[Adrian]

Allopurinol when eating rich food

I have 8.2 uric acid level in a recent test and my doctor has prescribed 100mg Allupurinol to take as and when I will be eating slightly rich food. (In the past, I have got the level down to 4 if I eat a vegetarian diet but it soon shoots up if I eat meat even moderately.) Is this a valid approach in your experience please?
Many thanks
Adrian

PS I haven’t seen a mention on the forum of the idea of taking allupurinol ‘as and when’

[Posted via Feedback Form. But note that form is designed for non-urgent suggestions about improving GoutPal information. So if you need personal replies you should Start a new Gout Forum Topic.]

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[Keith Taylor]

The idea of only taking allopurinol “as required” is new to me and goes against everything I’ve learned so far. But I’m always willing to learn more.

However, I’d need a lot more information before I was convinced of the validity of this approach. For example, full medical history including uric acid test results, additional tests for uric acid excretion rate, height and weight (with significant weight change history) and diet details during non-allopurinol and allopurinol phases.

I’d like to say more. But I’ll wait to see if there is any input from other readers first, as this is an old question.

[Dave the Courier]

Have had gout for 35 years took allopurinol for 25, 1 year ago decided to stop, a few tweek’s, nothing serious, big parma on the make again, same, ol thing

[Keith Taylor]

I also stopped allopurinol for a few years. It took about 5 years until uric acid built up enough to start gout attacks again. Anyway I restarted allopurinol and the attacks stopped again after a few weeks. But I’m very annoyed with myself. Because I got more joint damage when I stopped allopurinol.

One things certain – I’ll never stop allopurinol again!

So if I were in your shoes Dave I’d get uric acid tested. Because if uric acid is high those tweeks will get serious.

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