here i go

[rucyrius]

after 1 month of 2 colchicine tablets a day… i have started 300 mg allopurinol.. for the first time…i'm a little nervous about a gout flare … my numbers have been as high as 10, but most recently 8… my doctor has told me that there is little chance of flare up .. thats why i have taken colchecine for a month in advance.. he told me he has treated thousands of gout patients in this way and has had great results… cross your fingers..

thanks

John

[rucyrius]

i forgot to add.. i'm also to continue to take colchecine for a month along with the allopurinol

[Richard Bell]

I was taking colchicine and Uloric for about two months but my testing showed my SUA level was still only down to 6.4 and I didn’t really feel improvemnet in my joints so my dose of Uloric was increased from 40mg to 80 mg. Within a day or two I was under a nasty attack that lasted sbout a week. Since then I have been improving by leaps and bounds and at last testing my SUA was 4.4 and it may even be lower by now but my next testing is still a couple of weeks away so I can’t say for sure. Point is, it’s always possible when you change a med or a dosage to have an attack but hopefully you’ll be lucky and your doctor will be right. Just don’t quit the alopurinol if you do get an attack, keep taking it and you will improve.

[Keith Taylor (GoutPal Admin)]

Wise words Richard,

I'm feeling a little guilty that I may have over-emphasized the risk of gout flare from allopurinol (or other urate lowering therapy). I wanted to make the point that allopurinol might not be an immediate solution to gout flares, so (as Richard says), keep taking it because it will work. The biggest reason for allopurinol failure is patients not taking it.

To clarify, on allopurinol, the risk of gout flares is reduced. There is a small risk of gout flares which gets less as weeks go by and disappears when all old crystals dissolve.

Gout flares with allopurinol are not compulsory, but uric acid testing is.

[Utubelite]

I have taken Allopurinol for 5 months now. Started with 150 mg and SUA levels of 9.2 Built up the dose to 300 mg in 2 months and got my SUA levels down to range of 3.2 to 4.3( average value of 3.7). I am on Allop 300 mg for 3 months now. I also took Colchicine 1 tab a day for first 2 months and then tapered it down to 1 tab alt day and then stopped it a month back.

So, my reduction in SUA has been drastic, from 9.2 to 3.7….but no gout flares on Allopurinol till date.

I do not know how it works but I guess some people get gout flares with change in SUA levels much more than others.

[Keith Taylor (GoutPal Admin)]

Utubelite said:

I do not know how it works but I guess some people get gout flares with change in SUA levels much more than others.

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I don't think anyone can be certain how it works exactly, as there are lots of factors.

Statistically, several reports show that gout flares decrease rapidly as uric acid falls.

Physically, it is complicated because a lot can happen once you go below saturation point, and this will vary from person to person. Where there are a lot of readily available uric acid crystals to dissoilve, then the very act of them dissoving will raise blood uric acid levels. This might leave half-dissolved crystals, and if there are enough of them, you could get a gout attack. This risk must be much lower with uric acid levels in the 3 to 4 range, compared to the 5 to 6 range.

Many people have deposits that have built up over several years, and become quite inaccessible. In these cases a sharp rise in uric acid level is unlikely, as relatively few crystals dissolve each day, and again the risk of a gout flare is low.

When lowering uric acid, by whatever means, it pays to be prepared for a gout attack, but there is no need to expect one.

[zip2play]

John,

Good for you.

I doubt you will have any gout flares but if you do they are usually not as furious as the unmedicated attacks. I started right on 400 mg. allopurinol/day and never had as much as a twinge.

Probably the 300 mg. dose is exactly where you will want to stay for years…I've been there more than a decade. (Lowering to 200 for several months trial caused some suspicious foot and knee pains…and a rise to 6.7 mg./dL SUA.) 

Any side-effects the first couple days?

[Author]

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