Lil help needed on ALLOP..

[jr poll]

New guy to forum. 6’4″ 250# and I have what my daughter calls, “THE Gout”. From what I understand (now) from experience and this board is I’ve had gout for approx 6 yrs. Started off with numbness in left wrist and aches in left ankle. Doc’s did the whole 9 yards with X-Rays, MRI’s etc..Y’all know where I’m going with that. Finally doing research on my own, I figured it had to be gout. Asked my NEW doc to do the blood work and YEP. Gout. Levels are over 9, pushing 10 on 2nd test. Going back a few yrs, I cant remember having a month without some type of pain. Mainly, in Left Ankle and Left Wrist, but some in R Ankle. It’s been so bad at times that cutting my arm and leg off with a chainsaw, starting a fire, and sticking my stubs in to solder them seemed less painful.

So Here’s my comment and then my question:

Doc put me on Prednisone for 2 weeks until this “batch” is gone and then wants me to start Allop 100 for one week and then up it to 200. Also taking Meloxicam with the Allop.

From what I’m reading on this board from many posters is to go straight to Allop 300. I’m all in if that’s the case. Better than stubs in the fire..

What say you? Also, anyone have info on this Meloxicam?

[Keith Taylor (GoutPal Admin)]

The latest advice on allopurinol is to start it straight away. It used to be thought that you should wait for the gout flare to go down, but this is outdated: Start Allopurinol Quickly, But Carefully.

Start with 100mg. After 2 weeks get uric acid blood test with kidney function and liver function tests. If all OK, increase the dose every 2 weeks until target uric acid level is achieved. Absolute max for target uric acid is 5mg/dL. I strongly recommend getting uric acid as low as possible for at least 6 months to reduce the time to get rid of old uric acid crystals. This means going to the max dose for allopurinol. Your doctor seems to understand the dangers of uric acid crystals, so he should be supportive with this. If not I can give you references to studies that show why it is the best way.

Meloxicam is similar to ibuprofen, naproxen, indomethacin, diclofenac, and many more. These are Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). They reduce inflammation, and they are often very useful during the first few weeks/months of uric acid lowering treatment. Until you get rid of most of the old crystals, you are at risk of a gout flare, so Meloxicam should reduce the risk of flares. Another reason for maxing allopurinol dose in the early stages. Once you have gone 6 months without a flare, you can slowly reduce allopurinol, but never let uric acid rise above 5mg/dL.

[Cujo]

For me 100 mg daily of Allopurinal is enough to reduce UA to 5-6 mg/dL. Maybe you should test your blood and observe how much of a dose you need?

[jr poll]

GP

Thanks for that info. Your Plan of Action is spot on with what my Doc is saying from what it seems. She wants me on Allop 100 for one week, bump to 200 and then have another test in 2 months. She also has me starting the Meloxicam for the first 6 months with the Allop. Sounds like my new Doc understands whats going on…Thats a big step. Forgot to mention my age on initial post. 42.

Cujo

Plan of Action is to test blood every 2 months until we get an idea of dosage. Then test every 3 months for maintenance. I understand this is something I will have to stay on top of FOREVER. After my last 4 “batches” that won’t be a problem. Once you have the BIG ONE twice, ITS GETS YOUR ATTN.

Appreciate the quick responses..

[Keith Taylor (GoutPal Admin)]

That sounds really good, @jr-poll. I hope your doc also understands the need to get down to 5. Many settle for a small reduction in uric acid, but only 5 or below is safe.

Great progress. Please keep us updated.

[jr poll]

Hey Y’all

This past weekend I sent my Doc the article “Start Allopurinol Quickly, But Carefully” that Keith Posted above. At 9am this morning, I got a call from Her Nurse. She told me I had the “GO” to fill my 100mg of ALLOP for one week with the Meloxicam. I did not have to wait until my Prednisone ran out.

POA is to cx the Prednisone (for now) take 100mg ALLOP for a week with the Meloxicam, then bump the ALLOP to 200mg.

I filled the Rx’s and took my first ALLOP.

Was also told to come in for a UA test in 2 months.

I have been drinking at least 3 liters of water a day for a week to get ready for this. In my mind, the more I pee the more of that crap is escaping (not very scientific, but it makes me feel better to think thats the process).

Again, thanks for all the information and knowledge.

J.R.

[Keith Taylor (GoutPal Admin)]

Welcome to the allopurinol club, @jr-poll. 🙂

You’ve reminded me of something for allopurinol takers – good hydration is still important. Allopurinol byproduct (oxypurinol) is excreted via the kidneys. This is not usually a problem, but sometimes, with prolonged dehydration, oxypurinol kidney stones can form. I don’t think this is a big risk, but it pays to stay hydrated.

No need to be scientific about hydration. 2.5/3 liters per day is good. Perhaps more in hot weather and when exercise makes you sweat. The easy test is pee color. If it isn’t light in color then drink more.

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