For those taking Allopurinol – how much water do you drink per day?

[NateA]

It was pointed out to me recently by a commenter on my blog that I may in fact be drinking too much water each day.  On a typical day, I put down anywhere from 4.5 to 6 liters of water (3 to 4 1.5 liter bottles).  I also drink 1 to 3 liters of Pepsi Max per day and put more water in to my system by eating various fruits throughout the day.

I do know that the Pepsi should be the first thing to go and I'm working on that.  I just need the caffeine to keep me awake at my sleep-inducing job and I can not drink coffee outside of the colder months.  I can thank my parents for my soda addiction, but at least I haven't been drinking the sugary sodas since flying the parental coop in the early 90's. 

I'd love to hear others thoughts on water intake while taking Allopurinol.  Thanks!

PS – I did search for this topic on the forum and didn't really find what I was looking for.  I hope this isn't a repeated subject……. 

[vegetarianGuy]

I have 1litre bottle next to my table. I drink it 3 times and additionally from the kitchen tap 3-4 glasses.

So 3.5 to 4 litres daily.

[cjeezy]

Probably about 3 liters.  I try to average between 75-100oz minimum per day

[Keith Taylor (GoutPal Admin)]

Yes, cjeezy, “about 3 liters” per day is about right, but there are some other aspects.

GoutPal Aside

There is a new diet fad among celebrities called the baby food diet. How fitting that it's being tried by Reese Witherspoon.

First, we need to speak of fluid intake really. All drinks are primarily water. Some people think the water content of food is relevant, but I doubt it unless you are on a strange diet.

I can find little in the way of official guidelines on fluid intake recommendations, so good resources would be appreciated.

So far I've learned that producing more than 2.5 liters urine per day is considered excessive. As gouties need to be at the top end of the scale, and accounting for other factors in fluid balance, 3 liters per day intake seems about right.

Second, though “per day” is a common guideline scale, “per hour” is more useful as a management scale. Accounting for sleep, sensible fluid intake lies in the 150 – 200 ml/hour range. But even this is not the whole story, as we may need to increase it to replace fluid lost from hot weather, sauna, or exercise. This is very dependent on individual circumstances. The International Marathon Medical Directors Association recommend 400 to 800 ml per hour during elite marathon running.

Finally, we need to consider the effects of excess fluid intake. The benefits to gout sufferers are decreasing the risk of kidney stones and avoiding higher concentrations of uric acid in the blood/joints. The risks are kidney damage from having to process excess water (and, for vigorous exercisers/sweaters, death through low sodium). It is not clear to me how and why kidney damage can occur, so again, if anyone has any properly researched resources, I'd appreciate the link (or email if it's copyright).

[Utubelite]

My doctor told me to keep an eye on color of the urine. If that looks turning more yellow, your water intake is low( except for medicine induced yellowness). The target is to keep the urine near to water color, a tad yellow,  and adjust water intake accordingly. So, after exercise, drink more water and so after the food.

It takes me 3 to 5 litres a day depending upon many factors like exercise, exposure to sun( or a/c), type of food taken etc. to keep the color in check. It is a roughcut method but I hink it works fine.

[Keith Taylor (GoutPal Admin)]

I've just realized I didn't address Nate's specific point about allopurinol.

Adequate hydration is vital for allopurinol takers because it's active metabolite, oxypurinol, is excreted via the kidneys. Urine that is insufficient, or too acidic, can cause oxypurinol stones to form. This should not be a problem if the guidelines I've mentioned, and Utubelie has clarified, are followed.

However the issue with excess fluid intake and allopurinol is unclear. I've seen reference to uricosuric drugs increasing the excretion rate of oxypurinol, but nothing about excess fluid. Perhaps there is a value in taking the 24 hour urine test when you are on allopurinol – not necessarily to measure uric acid excretion, but to measure oxypurinol excretion in an effort to assess it's net loss (if any).

[zip2play]

Counting my coffee, maybe 4 to 5 liters. Hot coffee and COLD water.

When drinking beer add a liter or two.

[ouch]

well first off I do not take any drugs yet for gout     but doctor was also very specific  the color of my piddle was a strong indicator of when I should be drinking more water.  Also the wiff.  If it smells amonioia like “”drink more water””.       I seldom take any medications  but I do know that always every time the pharma fellow fills any perscription for any ailment he always cautions me to drink extra water.  So is it a case of Allopurinol requires you to drink more water or is it just medication in general  that you should consume more water to counter balance the chemical you add to your body?  Or will extra water alone counter act some of the claims those pharma fellows make about allopurinol.  

If you haven't all guessed by now, I'm not a big pharma supporter.   Many times I fell the big drug companies may have a cure for many diseases  but its just not $$$ in their pockets to advertise or cure a disease.  

ciao  OUCH

[zip2play]

I doubt that taking allopurinol increases your need for water.

[trev]

Ouch- I understand your comments.

Anything I've read about diet factors say any meds are going to be acidic to the body.Gout is an acidic condition.

This may be counteracted by water intake to some degree. I took for sometime, a gout cure that req'd much added water and after a while I just tried to make do with the water. This wasn't, still isn't, too easy -as I forget to keep up the effort- rarely feeling really dry.

This is a BIG mistake with gout , to neglect water intake as a habit. I just did 5 pints of ale over the w/e and haven't had a twinge, amazingly, but I know to keep up the effort on H2O for a few days, at least, to compensate.

Further, in my search for the source of stomach discomfort, I was appraised of the additive Magnesium Stearate  (Beef or Veg source, the same effect) or Stearic Acid [and other psuedonyms] all add up to trouble – for the gut, at least. It smears the gut and converts to wax.

This stuff is a machine lube which has not been tested for EU safety afaik, but is listed in US carrier laws as to be notified (maybe for dust explosion hazard) but otherwise potentially bad for humans. it is included in small amounts be default in meds, herbals [that I took] and vit pills-

So, something else ,like fluoride, that is supposed to be 'OK' [blah blah] but for some , fails the test as to acceptabilty.

Stopping all the 3 offenders, as far as permissible, has eased my problem somewhat.

Take note , that we are all part of an 'average' – but the small deviations from 'normal' for individuals can be critical, if sensitive.

On average, we all and up dead, tbh!

Your rec'd advice as to incr. water shows some professionals in health, if on the secondary front, have awareness of 'across the spectrum' long term effects of drugs admin, and to me , is a good point to remember. AlloP , or not

[Edit: PS I don't take meds for gout either, and-

Yes! my 'standby' AlloP has Stearic Acid listed!]

[Keith Taylor (GoutPal Admin)]

ouch said:

…  So is it a case of Allopurinol requires you to drink more water or is it just medication in general  that you should consume more water to counter balance the chemical you add to your body?  Or will extra water alone counter act some of the claims those pharma fellows make about allopurinol.  

---

Many medicines, including allopurinol, are excreted in urine via the kidneys. Some people drink very little water, and the resulting low urine flow rate can lead to stones forming.

It's not a case of the medicines requiring more water. It is the case that these medicines make adequate fluid intake more important.

Gouties should already be drinking adequate water …

[pause for a sip]

… so they should not need to change habits when taking allopurinol.

[azasadny]

I drink 1 gallon (3.8L) of water a day…

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