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Hi everyone,
Long time reader, first time poster.
Influenced by the excellent discussions here I asked my doctor to be put on Allopurinol. My serum uric acid was last measured at 9.6 so my doctor prescribed me at 300mg. The first couple of days I felt lethargic and a bit tingly in the fingertips. The tingly sensation went away but the lethargy did not. I work nights and never get much sleep anyway but now I'm much worse off for the same amount of sleep.
I'm fairly certain this is the Allopurinol. I see on GP's article on Allopurinol that drowsiness is listed as a possible side effect. I take the drug when I get home from work, right before sleep but I still feel tired a few hours after I wake up.
I did a search on this forum for any discussion related to this and didn't find much. Has anyone here had the drowsy side effect and has it gone away with time? It's becoming a deal breaker for me as it has affected my work and family life. I'll be getting my uric acid checked again next week and if the numbers are good, I'll see about moving to a lower dose or possible taking it a few days a week.
Any advice regarding this would be awesome.
I'm hoping someone will come along with an answer along the lines of “I had that happen, but I did ….. and the drowsiness went away”. All I can offer is some general advice.
The recommended dosing procedure is to start at 100mg, then increase week by week until blood uric acid levels drop below 6mg/dL – preferably 5. It probably does not pay to mess around with doses without discussing it with your doctor first.
All the references I have seen describe drowsiness as a minor side-effect, so there is no advice about how to treat or avoid it. There are some studies that show that side-effects have been overcome by very gradual dosage increase from a low dose. This is not specific to drowsiness, but it does hold out strong hope that tolerance can be improved over time.
Continuing wth clutching at straws, I notice that dosage recommendations also include advice to:
- Drink sufficient fluid to promote at least 2 liters of urine per day.
- Alkalize urine (or at least make it neutral) – baking soda or dietary alkalizing are options.
- Take allopurinol after meals.
I've no idea if these steps will affect drowsiness or not, but it cannot harm.
If all else fails, it might be necessary to look at alternatives. A 24 hour urine test will determine if you are an overproducer or underexcretor of uric acid. If you are an underexcretor then uricosuric medicines are available to promote extra uric acid excretion. Failing that, febuxostat is becoming available, which reported less side-effects, including drowsiness, in trials.
I've been taking allopurinol for 2 decades after breakfast and have never noticed that side effect…or ANY side effects for that matter. I have not heard the l;ethargy complaint from anyone before.
If it DID occur, I would switch to dosing before bedtime, when drowsiness is a PLUS.
Is it possible that you are trying to operate on too little sleep and the allopurinol drowsiness is a coincidence, or else that the effect is there but very slight except in people who are sleep deprived.
Taking it a few days a week:
1. You CAN get away with it if you are judicious because its first metabolite, oxypurinol stays around for a long time and is very effective at lowering uric acid…but if you cut your days in half, you will have to double the dose to keep oxypurinol levels the same.
2. If it oxypurinol that is making you lethargic, then there's no point fiddling your dosage because oxypurinol concentration changes ever so slowly from day to day.
How much sleep do you get in an average day?
I cant relate directly. I started 100mg Allopurinol a few weeks ago and that combined with starting Zocor (cholesterol) which also can cause drowsiness I slept like the dead for the first couple weeks (but woke up fine).
The side effects have now abated for both drugs and I sleep normally.
One thing to consider is splitting the pill in half and taking part in the early evening with dinner and the rest at bedtime. That would help stave off the drowsiness in the morning until you get used to it. Yes your evening will be less productive, but it would be only temporary until you are fully adjusted. Pill splitters can be bought in any pharmacy.
Lastlky, if you feel you have to make a change, moving to a lower dose and taking it every day is far better than taking a higher dose irregularly.
We've all mentioned dose adjustments in some way, but I forgot to emphasize the most significant point – you need to get blood uric acid below 6mg/dL (preferably 5) and keep it there.
If this takes a few weeks, then so be it, but best for your long-term health if it is sooner rather than later. Slight lowering is pointless – it must be below 6.
Thanks for the input everyone. I'm beginning to doubt the relationship between my drowsiness and Allopurinol since it doesn't appear common. I get between 5 and 6 hours of sleep a day and I take Allapurinol right before bed. I also do moderate to heavy workouts most nights at work. I'm usually pretty fatigued and sometimes it's worse than others. I'm willing to write this off as just a summer thing.
I'll be getting my blood test today and if, as GP says, it's below 6, I may take a week off just to see how I feel. Perhaps some lower dosages if I notice a difference.
I did find it odd that I was immediately prescribed 300mg as opposed to what is usual on this forum but I was desperate to get this under control and went with it. I'm considering changing my health plan to a more self directed one so I can exhibit more control and perhaps filnd a sympathetic specialist. Getting tired of getting the guilt trip every time I see a doctor as if it's more my fault than anything.
Have no fear on the dosage. I am a firm believer that the 100>>200>>300 eventual progression is just staving off the inevitable. It's done for the very rare case of hyperesensitivity that will likely show up on the first dose. It ususally results in an extra attack or two or several that could have been avoided. A dose of 300 mg. is very common becasue that is the dosage that has been found to WORK.
My first dose of allopurinol was 400 mg. (I was surprised when I checked back…I had forgotten those first couple years at the 400 dose.)
I mean, after all, when you go in with a severe sore throat, what doctor will start you off with ONE penicillin tablet a day? Or ONE aspirin to cure pain?
My test results after one month are in. My serum uric acid dropped to 6.4. Looks like dropping my doseage isn't an option yet. I'll check it again in a month.
Unfortunately, something called Creatinine went high since last month. I did some brief googling and it seems that number could be indicative of kidney damage. I'll be calling my doctors office tomorrow to see what my next step is.
Anyone have experience with allopurinol and a high serum creatinine? We'll see what the doc pulls from her RFC (response flow checklist) tomorrow.
Just got a note from my Dr. A rare side effect of Allopurinol is increased creatine. We'll be checking it again this weekend and if it is still high, I'll have to discontinue the Alllpurinol.
Bummer. I guess this is going to get complicated.
snaporaz,
How high was your creatinine? It can go high simply becasue you had a large meat consumption the day before, or had a hard workout resulting in muscle breakdown. Was you BUN (blood urea nitrogen high?)
You will probably need to have your creatinine clearance measured (a urine gathering test) although your probably first order of business is to have creatinine RE-measured after a day of little or no meat. It sounds like that''s what you have in the cards. Remember, labs make mistakes…OFTEN!
Let ius know.
I usually have some muscle group feeling sore from working out so maybe, hopefully, this is related. I won't be working out for a few days so maybe the next test will drop. Will also watch my meat intake. Next test is Monday.
My creatinine measured 1.47 with a given average of .6-1.30. Looking back at my chart, it seems the previous two tests were running highish. So it's not much of a change in fact.
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