Allopurinol Side Effects

[Al O’Purinol]

I have been having gout attacks since I was 25. When I was 33 I was finally diagnosed with gout and started taking allopurinol. Around the same time I started getting pain in my hands & wrists. I thought it was the allopurinol but the rheumatologist assured me that that was not the case, and it was probably RSI.

I've been taking allopurinol for 7 years now and still have the so-called “RSI”, and then I read on your site that possible side-effects are “Hands or feet numb, tingling, painful or weak”. So I decided to go on a low-purine diet and stop the allopurinol to test if it caused my “RSI”. I've been doing this for a week now without any change in my hands. So my question is: do you know how long it takes for this allopurinol side-effect to wear off?

[Keith Taylor (GoutPal Admin)]

I'm sorry, but I do not know about this side-effect.

More importantly, what are your uric acid levels during the time you have been taking allopurinol?

And what dosage have you been on?

To make any guess about what is going on here, it is vital to compare changes in uric acid levels with dosage of allopurinol over the time you have been taking it.

If any other readers want to look at this, please start with my allopurinol side effects page.

[Keith Taylor (GoutPal Admin)]

thanks for your quick response!

 

I was taking the regular 300mg until Jan 2007. I then thought I had a pretty healthy lifestyle and with help from my GP I quit the Allopurinol for 3 weeks. Because it was winter and “healthy lifestyle” did not mean low-purine lifestyle, I had some joint pains during those 3 weeks (no real gout attacks) and my uric acid went up to 70 or 75 (65 is the norm?). So I went back on the Allopurinol but only a 100mg dosage, which worked out fine – except that I still have the pain in my hands!

 

I hope this gives you more insight!

[Keith Taylor (GoutPal Admin)]

Wow, it's not often I get praise for a quick response. You've just been lucky!

I hate trying to second guess a qualified rheumatologist who has access to all your test data, but something here does not seem right to my unqualified brain.

I have heard of the idea of an “allopurinol holiday” before (unfortunately I can't remember where). The idea is that, having carefully monitored uric acid levels over a number of years, and being certain that no uric acid crystals remain in joints or body tissue, then allopurinol may be discontinued for a while, subject to regular uric acid blood tests.

The crucial point here is that uric acid must have remained low enough for all existing uric acid crystals to have dissolved. There is no exact formula for this. On the scale that I think you are using (mg/L?) this would mean a level sustained below 55 for at least a year, possibly longer. Sorry , I can't remember the length of time involved. There may not even be a standard length of time, as getting rid of all the uric acid crystals will depend on how many crystals there are, how low your uric acid levels fall, and how long you sustain the low level.

Despite the common advice, purines from food are only a small proportion of the amount of uric acid in the blood. Most of it occurs from cell death that is a part of normal human metabolism. Conditions that can make this worse include obesity, starvation, dehydration and other trauma such as surgery. This over-production is the most common cause of excess uric acid, but kidney problems causing under-excretion of uric acid is also very common.

Allopurinol only lasts in the body for about a day, so as soon as you stop taking it, you are exposed to whatever uric acid levels your body naturally produces. As soon as you stop taking allopurinol, you run the risk of increasing uric acid level to the point at which crystals form. This point varies from person to person, and I do not have enough expertise to know if crystals have started to form in your case. The only way that I know to test for this is to analyze fluid from an affected joint – a process known as arthrocentesis.

This is normally done to diagnose gout in the first place, but I see no reason why it cannot be used to establish whether, or not, uric acid crystal have started to form again.

Quite frankly, I cannot understand how or why the medical profession do not make these simple tests more readily available. As far as I know, the results are fairly conclusive as to the existence of uric acid crystals. If you are not certain of the existence of crystals, how can you manage allopurinol dosage? Pain, numbness, swelling, redness or any other typical sign of gout are absolutely no measure of this. Why? Because uric acid crystals cause one or more of these symptoms when they form and when they dissolve. My article “Allopurinol Medication: The Gout Cure That Can Hurt” is crucial reading in this matter.

Unfortunately, this does not really answer your original question, but I do not see a way for anybody to answer that without clear proof that the discomfort you are experiencing is not due to uric acid crystal activity. Surely, with your history of gout, that is much more likely than RSI. Is there a reason why your rheumatologist is suggesting RSI?

I'm at a loss as to what to suggest next. I'll have a think about it and get back to you if anything else occurs to me.

Can any other readers suggest a way forward?

[Keith Taylor (GoutPal Admin)]

I have been concerned with the possibility that the pain this gout sufferer experiences is due to gout. This is fairly common, as allopurinol is rarely monitored properly, and so gout continues to cause pain much longer than it should.

My concern today, is that there is a perfectly valid explanation for pain caused by allopurinol.

Though this is rare, it is an acknowledged side effect of allopurinol, though it's rarity renders research via the Internet difficult.

I have determined that allopurinol can induce a condition called xanthinuria, especially if you do not drink sufficient water. One of the symptoms of xanthinuria is pain in the hands.

Further research on PubMed reveals a small number of studies related to allopurinol and pain. Those that I have checked indicate that if pain is allopurinol induced, then stopping taking it will relieve the condition. One case indicates 7 weeks, but these cases are very individual, and time will vary from person to person.

It is almost impossible to generalize with this type of rare allopurinol side effect. However, it would appear that this type of reaction (as opposed to hypersensitivity) will go away in a fairly short period of time if you stop taking allopurinol. The problem remains in identifying allopurinol as a definite cause.

[Keith Taylor (GoutPal Admin)]

I first suffered gout 4 years ago (aged 64) and took 300mg allopurinol for the first 3 years – side effects for me were severe diarrhoea and rapidly developing cataracts.  I stopped taking allopurinol just over a year ago and remained gout free until I had a very severe attack a few weeks ago.  I visited my GP and asked for a check on my serum uric acid levels but was told that uric acid levels were no longer checked since allopurinol prevented uric acid crystals from forming!!  He seemed quite dismissive when I said I would like to try to limit my gout attacks with changes to my diet and I was not happy to recommence allopurinol treatment.  How can I keep a check on my progress if the NHS no longer offers serum uric acid level checks and I can't afford private treatment?

[apcoach]

What country are you in?

[Keith Taylor (GoutPal Admin)]

Val Brown said:

 I visited my GP and asked for a check on my serum uric acid levels but was told that uric acid levels were no longer checked since allopurinol prevented uric acid crystals from forming!!

---

Val, I'm so angry that I can barely type for my fingers shaking.

Allopurinol only stops uric acid crystals forming if the dosage is right. It is vital to accompany allopurinol treatment with frequent uric acid tests to ensure that the dose is achieving the correct uric acid level.

Name and shame the b*st*rd. I am sick and tired of NHS employees wasting my hard earned money on making gout sufferers worse.

The only thing I can suggest as a way forward is to call NHS Direct on 0845 4647. Unless you live in Yorkshire, and I'll send the boys round.

By the way, I think you are new to the forum. I'm not normally this vicious, but this type of treatment by people who really ought to know better really upsets me.

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