Allopurinol and Alcohol

[Al O’Purinol]

Update: The discussion on allopurinol and alcohol has moved.

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I'm approaching 50 and had my first two gout attacks this year. Yes, I was drinking regularly, an average of 4 units of alcohol per day. And yes, I was cycling hard, on a regular basis. Both attacks occurred two days after some I overdid the wine. For me, it would appear thar overconsumption of alcohol leads to dehydration during the night, creating the crystal formation ? in my case a couple of days later. My doc has now put me on Allopurinol and I've cut down both on the drinking and the strenuous exercise and have not had a further attack. But I cannot know which of these three variables is keeping me gout free ? probably the Allopurinol. The doc did not advise me not to drink alcohol with Allopurinol, which is strange as your site advises us not to mix the two. Any additional advice? By the way, thanks for creating this site.

[Keith Taylor (GoutPal Admin)]

I’m not sure where I have advised not to mix allopurinol and alcohol. If you can remember where you saw it, please let me know, as I should correct this.

Allopurinol should mean an end to alcohol restriction, but I believe it can reduce the effect. Therefore prolonged excessive drinking might lead to allopurinol not lowering uric acid enough, and becoming ineffective. I cannot imagine that this would be a problem with 4 units per day.

As ever, the important thing for gout is to get the uric acid below 6mg/dL. Dosage needs to be adjusted in the light of regular uric acid test results. That’s not to say that allopurinol should be used to prop-up an unhealthy lifestyle, as other health problems will soon become apparent.

One of the worst things you can do for gout is drastic lifestyle changes as these often have the effect of raising uric acid. Allopurinol will minimize these effects.

As far as reduced gout attacks are concerned, it’s anyone’s guess. So many things can cause a flare, that it is almost impossible to discern the exact culprit.

The only thing that truly matters is to keep uric acid below 6mg/dL. It does not guarantee complete freedom from gout attacks until all uric acid crystals have dissolved. It will however guarantee that you do not cause further joint damage, and it should allow you to eat, drink and exercise without too much concern.

[Keith Taylor (GoutPal Admin)]

Here is my understanding of the action of alcohol on allopurinol.

Allopurinol works by inhibiting the enzyme zanthine oxidase (XO) which is responsible for uric acid production. It is only effective for about 2 hours, when it breaks down to produce oxipurinol. Oxipurinol also acts as an XO inhibitor, and hangs around much longer – giving you a couple of days uric acid reduction.

Do not rely on this couple of days – take your allopurinol every day to avoid risk.

Oxipurinol is excreted by the kidneys, but just like uric acid, a large percentage is reabsorbed from the kidneys to the bloodstream before it gets lost in urine.

Just like uric acid, the original excretion and subsequent re-absorption can be affected in different ways by different concentrations of other substances. This is a very complex process, and there is no way that I can describe it completely.

Alcohol can interfere with the re-absorption of oxipurinol, so the net effect is that it reduces the effectiveness.

I cannot find any relevant research to quantify the exact effect.

Let me state publicly, that I am completely willing to act as a guinea pig in any studies that measure the effect of alcohol on allopurinol (or any other aspect of gout). Just post your research info and joining instructions here 😉

[zip2play]

Tim,

My vote is that the cessation of your attacks is due almost entirely to the effectiveness of allopurinol.

Two thoughts:

My GUT feeling is that alcohol will preciptate an attack by dehydration BUT here's a little cutie from a Med School in Prague::

QUOTE: The acute administration of ethanol by gastric cathether significantly increases the plasma xanthine oxidase activity in both rats and hamsters without changing other enzyme activities — alanine aminotransferase and aspartate aminotransferase. The plasma xanthine oxidase level seems to be a sensitive marker of liver damage. Its higher activity due to the acute ethanol intoxication may have an impact on ethanol organ damage. 

^{Thus more xanthine oxidase the more readily xanthines (purines) are converted to uric acid. Thus a likely connection between chronic alcohol abuse and gout.}

^{(How can we use quotes properly on this forum?…I've tried HTML coding and Bulletin Board coding…NADA!)}

[zip2play]

So then we are certain of ONE FACT: alcohol administration either raises or lowers utic acid levels.

It's good to have something so completely settled.

But it's simple…take allopurinol and enjoy the booze.

[Keith Taylor (GoutPal Admin)]

I do not usually bother closing topics, but as this has the perfect ending, it is now closed.

zip2play said:

But it's simple?take allopurinol and enjoy the booze.

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Please see my summary of allopurinol and alcohol

The discussion is now at https://gout-pal.com/allopurinol-and-alcohol-debate/2011/08/

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