Testing Uric Acid

[Irma Reitz]

When my doc sent me to test Uric acid levels she advised me to stop the Allopurinol for 3 days prior to testing. Please advise whether it is necessary and whether that is the correct procedure when testing.
Thanks

[nobody]

Hi!
That’s a question you should ask the doc. It’s definitely not routine but maybe there’s a good reason to do it once or twice that way in your situation. In any case that shouldn’t replace regular testing (while taking your usual allo dose).

[Keith Taylor]

Hi Irma,

I hope you got my help desk message. If not, please check your spam and also whitelist [email protected]. Or maybe this is your answer to my question about stopping allopurinol. If it was just a temporary stop, then that’s OK. But I will remain worried if you’ve been advised to stop allopurinol permanently without good reason.

Anyway, apologies to other readers for that private exchange. I’ll get back to the issue.

Doctors often stop treatments before blood tests if they are reviewing how the case is being managed. The idea is to get a fresh start by removing any complications caused by existing treatments before creating a new management plan. When I’ve spoken to people about this before, they’ve mentioned one or two weeks treatment-free before retesting blood. But that might depend on the drugs involved.

Allopurinol is soon eliminated from our bodies. But before elimination most of it changes to oxypurinol. Now oxypurinol lasts longer. But any remaining effects should be gone after three days. Since half of it is eliminated in 30 hours.

Allopurinol has relatively short half-life in plasma (2–3 h), whereas the half-life of oxypurinol is much longer (14–30 h) due to renal reabsorption (Pea,. 2005).

As nobody says, this is something that your doctor needs to explain. Because we are all in the dark about any potential change in your treatment. Also, I agree with his remarks about regular testing while taking allopurinol as normal. Otherwise, you cannot tell if your allopurinol dose is right.

I always worry when doctors start talking about withdrawing allopurinol without good reason. I’m oversensitive on this issue. Because I’ve seen too many friends have their later years ruined by illogical ill-informed allopurinol cessation.

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Prepare for Baseline Uric Acid Blood Test by Stopping Allopurinol.

[Irma Reitz]

Hi Keith,

I apologize for replying on the forum ,but I cannot send email at present.

Thanks for your emails. I did try to reply but for some reason the anti spam??thingy?? would not allow the email to send.

I have decided to go back onto Allopurinol and have been taking 100 mg daily again, because I have been in a lot of pain. Because I am unhappy with having to argue with my doc I have also just decided to take my health into my own hands and self medicate and try to manage the pain on my own.
I live in a very small town and there are not many medical people available. After waiting 6 months I eventually got an appointment with a neurologist in the city. She has put me on Cymbalta 30 (Duloxetine) once a day and VIMOVO® (naproxen and esomeprazole magnesium) twice a day. And as I mentioned she told me to stop Purinol as my Uric acid was normal !! and doubted that it would add value!! Anyway I have lost faith in the medical profession.

Thank you again for your response and also thank you so much for your two sites which are amazingly helpful.

Kind regards

Irma

Sent from my iPad

On 09 Jun 2020, at 11:45, GoutPal Gout Forum <[email protected]> wrote:

Keith Taylor wrote:

Hi Irma,

I hope you got my help desk message. If not, please check your spam and also whitelist [email protected]. Or maybe this is your answer to my question about stopping allopurinol. If it was just a temporary stop, then that’s OK. But I will remain worried if you’ve been advised to stop allopurinol permanently without good reason.

Anyway, apologies to other readers for that private exchange. I’ll get back to the issue.

Doctors often stop treatments before blood tests if they are reviewing how the case is being managed. The idea is to get a fresh start by removing any complications caused by existing treatments before creating a new management plan. When I’ve spoken to people about this before, they’ve mentioned one or two weeks treatment-free before retesting blood. But that might depend on the drugs involved.

Allopurinol is soon eliminated from our bodies. But before elimination most of it changes to oxypurinol. Now oxypurinol lasts longer. But any remaining effects should be gone after three days. Since half of it is eliminated in 30 hours. Allopurinol has relatively short half-life in plasma (2–3 h), whereas the half-life of oxypurinol is much longer (14–30 h) due to renal reabsorption (Pea,. 2005).

As nobody says, this is something that your doctor needs to explain. Because we are all in the dark about any potential change in your treatment. Also, I agree with his remarks about regular testing while taking allopurinol as normal. Otherwise, you cannot tell if your allopurinol dose is right.

I always worry when doctors start talking about withdrawing allopurinol without good reason. I’m oversensitive on this issue. Because I’ve seen too many friends have their later years ruined by illogical ill-informed allopurinol cessation.

Post Link: https://goutpal.net/forums/topic/testing-uric-acid/#post-9793

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[nobody]

“Normal” is useless when it comes to uric acid and gout. You need to look at the actual value.

[Irma Reitz]

Thanks – I quite agree. Using the Uric Acid Chart to compare. My Uric acid is .36 (6-7) which is in the Warning Zone. I have been taking 100gm Allopurinol for several years but it seems that I should increase the dose to bring the urid acid level down to below 5. At this stage I have increased the quantity of water I drink after reading Keith’s blog on that and I have found an immediate relief in my pain level.

[nobody]

I also like mine below 5 but that doesn’t mean increasing one’s allo dose is always the best course of action because there are side effects. I take a slightly different drug but in my case, the most noticeable side effect is the effect on my ALT (liver function test result), something allopurinol is also known to affect. Ideally, you would only increase your dose under medical supervision.
Even drinking more water (generally a good idea) could have side effects if you have a kidney problem.
Naproxen and omeprazole have side effects as well by the way. They’re pretty safe if you only take them for a few days or even weeks but I’d generally be more comfortable taking something like allopurinol every day for much longer periods.

There is also the matter of measurement errors and random fluctuations. I like to recommend more testing so that you can average several results.
There is little evidence that it is useful to reduce one’s uric acid under 5 but the noise in tests values is one of the reasons (together with individual and seasonal differences as well as changes in uric acid through the day as you eat, exercise and so forth) that having a safety margin is ideal. .36 is theoretically OK but too high for comfort in my opinion, especially if you aren’t testing often (the more you test, the more confident you can be that your uric acid remains at a safe level).

[Irma Reitz]

I will take your advise regarding the tests before I do anything more. Problem is my pain is really getting me down as I find it difficult to walk because of the pain. Today is especially painful. I am really disappointed and feel very discouraged since doc changed my meds (I was on diclofenac 100mg twice daily) as I really thought the new meds would help.

[nobody]

With gout, you can’t base reliable conclusions on the symptoms you experience over a short period of time. It can randomly get better or worse from one season to the next. You need more time to see the effects of drugs clearly.
Diclofenac pills have serious side effects as well and using them for a long period of time can be deadly so I can understand a doctor wanting you to change your meds. Omeprazole is supposed to protect you against stomach damage, arguably the worst side effect of this class of drug (different people get different side effects though). But when you change a drug, there is the matter of dosing it right. One pill of the old med might be stronger or weaker than a pill of the new one (the milligrams are likewise not equivalent)…

If you’re having a bad spell of gout, you might want to take another drug for a little while to try to break it. Colchicine would traditionally be used in such a situation (it’s not a drug you should take every day for a long time) but of course it’s definitely not something you should try without talking about it with a doctor first! It’s especially important to get the dose right with that one. People have even died just from eating the plant’s leaves.
With gout, I think it’s generally better to take a serious drug combination for a short while and then only allopurinol (or equivalent) than to keep taking a relatively light drug combination daily for months or even years. That’s because if you can completely stop the inflammation, it might not come back for a while. If you only keep it at a low level though, it might last a very long time which is not healthy.

[Irma Reitz]

Thanks Nobody! I appreciate your input. At this stage I’m not sure if the pain is gout or arthritis so I’ll get the Uric acid tests done more often so that I can evaluate uric acid levels but for now I will just continue with the prescribed meds.

[Irma Reitz]

I’ve just got results back from Uric acid test. .30. I’m so chuffed that it is now in the safe level. I have also just restarted the carnivore diet, which really helps my inflammation.

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