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I have had 2 gout flare ups in my life, both in the joint of my big toe on my right foot. The first was 8 years ago. The uric acid blood test came back “negative” but I don't remembers the actual level. My second gout flare up is happening right now. I'm on prednisone because I can't take NSAIDs and it is helping. My uric acid blood test came back at 7.0. My doctor wants to put me on allopurinol at 300mg. He says I will need to take it for the rest of my life. I don't like to take medications unless I really need to take them. My question is, is it really necessary to take allopurinol for the rest of my life after having just two flare ups with eight years in between? Is there a less drastic way to approach this? I am not overweight (BMI=23) and I've always been pretty careful about what I eat. I just don't know if I should trust my doctor. Thanks in advance for any advice.
I suppose it depends on the pain you can take and your lifestyle requirements ,Fred.
Dr's also vary- some reluctant to prescribe early, others bang straight in. depends how caring/worried about being sued to a large degree.
What do you feel? This matters – and from your comments it seems you would rather wait. This can be done- as I do it, with a 100mg AlloP in the drawer as a talisman. Like the Colchicine, I prefer not to use it- but it's nice to have it there!
I'm having a 'flare' right now (5 years in) but not needing to work, can take it suitably easy- even if keeping outdoors activity down somewhat. I hope to scrape through. It's not a 'Big One'
That is the future you may face, without meds. – so if you go for them successfully (no side effects etc) life can be easier & less painful, for sure. Many on here support this line.
With the amount of history you have, by most standards, it could be seen as too early to medicate – so I would hold off to see how things develop , whilst trimming diet and lifestyle- seriously.
Chances are you will scrape by, but only IF you do this successfully!
Lay off alcohol and known triggers ( if you know yours, if not you will find out).
Try Black Bean broth (this site), it can be helpful at start up times. Colchicine is useful too.
Work out a plan with your Doc.- hopefully he will value your self interest.
[PS: SUA of 7.0 is only just in the 'danger zone' for known gouties -esp. if you don't suffer from High BP.]
FredM said:
I have had 2 gout flare ups in my life, both in the joint of my big toe on my right foot. The first was 8 years ago. The uric acid blood test came back ”negative” but I don't remembers the actual level. My second gout flare up is happening right now. I'm on prednisone because I can't take NSAIDs and it is helping. My uric acid blood test came back at 7.0. My doctor wants to put me on allopurinol at 300mg. He says I will need to take it for the rest of my life. I don't like to take medications unless I really need to take them. My question is, is it really necessary to take allopurinol for the rest of my life after having just two flare ups with eight years in between? Is there a less drastic way to approach this? I am not overweight (BMI=23) and I've always been pretty careful about what I eat. I just don't know if I should trust my doctor. Thanks in advance for any advice.
I would not get caught up too much with the 8 year gap thing. Gout will creep up on you over years and can silently do it's dirty work. I went the AlloP route straight away because I am not overweight and my diet has been excellent for many years. So there was not much room for improvement on that side. Also diet will only take you so far with regards to Gout.
You did not mention your age. I am in my 30s and do not fancy shot out joints or worse. So I am not taking any chances. If I was older say in my 60s-70s then maybe my outlook would have been different with regards to AlloP.
I am no medical professional but here is my opinion based on my own research and my personal belief system.
It is a complete joke (and no suprise!) that your doctor wants to put you on allopurinol for the rest of your life. This is exactly the proof that doctors and the greedy pharmaceutical industry are one the same. If the doctor cared about your health (like I do, and I don't even know you) I would give you indomethacin to numb the pain while I put you on a strict diet while flushing the uric acid out of your system. I have controlled my gout (almost to perfection, depending if I want to or not) by a pure natural/whole foods diet. I'm not a hippy by any means but taking synthesized medication for the rest of your life is NOT good and NOT natural. I would suggest you to see a alternative medicine doctor or don't see any doctors at all. All of the information you need is online.
I have also been placed on allopurinol before, back when I was in desperate times, stupid and willing to take anything to make me normal again, I have thus changed my mentality entirely on gout and my life. I remember I searched allopurinol while I was on it and one look of the side effects was enoughf or me to throw the bottle away and never look back.
here is a passage from wikipedia:
Side effects of allopurinol are rare, though significant when they occur. A small percentage of people develop a rash and must discontinue this drug. The most serious adverse effect is a hypersensitivity syndrome consisting of fever, skin rash,eosinophilia, hepatitis, worsened renal function and, in some cases, allopurinol hypersensitivity syndrome. Allopurinol is one of the drugs commonly known to cause Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis, two life-threatening dermatological conditions.
Allopurinol can cause severe pancytopenia if given with azathioprine or mercaptopurine, due to inhibition of xanthine oxidase which metabolizes these drugs. It can also cause breast enlargement in both males and females.
Allopurinol can lower blood pressure in mild hypertension
Now, taking this medication for the rest of your life, I'm almost positive you will suffer these ill side-effects, you should ask your doctor about side effects if you're taking this forever.
Monaco AlloP is a cheap med so it's not like Pharma companies are minting $s from it like some other newer drugs. Anyway AlloP has been around for decades so it's not some new untested kid on the block. From your own wiki link it say “Side effects of allopurinol are rare“. So if you win the lottery ie. you are not in the minority who react badly to it then you should be happy.
I have controlled my gout (almost to perfection, depending if I want to or not) by a pure natural/whole foods diet.
My friend if you had controlled it so well then you would not be here
Come back in 20 years and then we will truly know if your diet worked 
Let me tell you something about diet. I am in ym 30s and have been vegetarian for a decade eating very healthy food. Going gym regularly and doing plenty of cardio exercises. Mountain biking etc. I am fit and not overweight. Don't drink or smoke. Still I got hit by Gout 4 months ago. So diet can make matter worse or better but it won't fix Gout the way you are imagining.
vegetarianGuy said:
You did not mention your age. I am in my 30s and do not fancy shot out joints or worse. So I am not taking any chances. If I was older say in my 60s-70s then maybe my outlook would have been different with regards to AlloP.
I'm in my late 30s. I'm concerned about using meds long term. On the other hand, it sounds like living with higher than normal uric acid levels can cause other problems besides gout. I have always been careful about diet and weight so I'm wondering if I can really have much of an impact in that way. If I have to be on the meds long term, I'd like to do it at the lowest dose possible. Would it be reasonable for me to question my doctor on the dosage? Maybe start lower and monitor it. Then raise if necessary to bring uric acid levels into a normal range? Any other alternatives I should discuss with my doctor?
I appreciate the diversity of opinions. This forum is great.
FredM said:
vegetarianGuy said:
You did not mention your age. I am in my 30s and do not fancy shot out joints or worse. So I am not taking any chances. If I was older say in my 60s-70s then maybe my outlook would have been different with regards to AlloP.
I'm in my late 30s. I'm concerned about using meds long term. On the other hand, it sounds like living with higher than normal uric acid levels can cause other problems besides gout. I have always been careful about diet and weight so I'm wondering if I can really have much of an impact in that way. If I have to be on the meds long term, I'd like to do it at the lowest dose possible. Would it be reasonable for me to question my doctor on the dosage? Maybe start lower and monitor it. Then raise if necessary to bring uric acid levels into a normal range? Any other alternatives I should discuss with my doctor?
I appreciate the diversity of opinions. This forum is great.
Look Fred I am the kind of guy who never took pain killers. I became vegetarian 10 years ago as part of clean healthy living change. I was always fit and active but became even more fit. On the whole maintained an excellent natural diet rich in fruits and vegetables. Didn't touch any animal products. Still to my shock I ended up here last year with suspected Gout (confirmed now).
Now you think I like taking meds daily?
Absolutely not but the alternative is worse. I am an active guy who likes hiking, walking and going gym. Last one year has been VERY depressing for me. I have no choice but to go on AlloP as there is no alternative for me to treat this problem. I am very scared which is why I spend so much time here and on Google researching this disease.
Yes sure start with 200mg/dl and see if that brings your SUA to under 6mg/dl or start with 300mg/dl and when levels fall to under 6mg/dl then see if 200mg/dl can continue to maintain those levels.
This is interesting, I've actually heard from my doctor that her patients whom she prescribed allopurinol to actually had to come back because of attacks. Perhaps they eat a lot of food from the 'don't even touch list'.
Maybe we can research to see what allopurinol actually originated from and eat from that natural source? have you considered that veggieguy?
monaco said:
This is interesting, I've actually heard from my doctor that her patients whom she prescribed allopurinol to actually had to come back because of attacks. Perhaps they eat a lot of food from the 'don't even touch list'.
Maybe we can research to see what allopurinol actually originated from and eat from that natural source? have you considered that veggieguy?
AlloP causes more attacks initially. That is normal known and fully understood part of the treatment. Let me give you a crude example. Say you have a shirt covered in shit. It will stink right? You then shrink wrap it in plastic. Now the shit does not smell bad as it is covered and sealed for now. What AlloP does is equivalent of opening the shrink wrap again and washing the shit away
So yes when you initially re-open the package it will stink up the place ie. more Gout attacks initially but once shirt has been been washed clean then Gout would have been tamed.So AlloP = washing powder/ washing machine
All your Eastern remedies = staring at the stinky shirt hoping the stare would clean it
AlloP probably originated in the lab. If a natural cure really works then it gets clinically tested and becomes part of Medical science. Everything else like Tiger's private parts for example are just folklore and bull crap.
If you are on AlloP and continue eating trigger foods like organ meat and stuff. Drink lot of beer etc then yes problems will occur as you are adding more shit into the mix and diluting AlloP's effectiveness. Damn I sound like AlloP salesman now
Interesting example vegetarianGuy. The Allopurinol way of working is understood but how the body reacts still seems to be confusing. There are many people who report so many attacks when they take Allop( you are an example of it), while many people report no attack with Allop(like me). I do now know where are the differences. There is for sure something else in the equation not known at this time.
It would be interesting to see what some experts have to say on it like zip2play or goutpal etc. In my first attacks 10 years back, I was given Allop on the 3rd or 4th day, when I had full blown attack and a lot swollen foot. The swelling and pain went away within 2 days and I did not get any attack for next 10 years though I stopped Allop after few months. It was all against the book rules for Allop but worked for me.
The action of allopurinol is quite clear. At the right dose, it stops virtually all uric acid from purines from food, and about half the uric acid from purines from our own body tissue (purine metabolism). It can do nothing about uric acid that is dissolving from uric acid crystals. This explains why doubling the allopurinol dose will not double the decrease in blood uric acid. It also explains why allopurinol takers should not worry about food. They should avoid dehydration, excessive vigorous exercise and needless muscle building.
Every gout sufferer taking allopurinol (or other uric acid lowering treatment) has a different amount of uric acid pooled in crystals, a different rate of crystal dissolution, a different rate of excreting dissolved uric acid, a different immune reaction to partially dissolved crystals, and a different pain tolerance. Some suffer with gout flares at the start of allopurinol treatment. Others don't.
Gout flares from allopurinol are a risk, not a necessity. There is a much higher risk of a gout flare if you do nothing to lower uric acid. There are serious health issues related to long term untreated gout, so doing nothing is a very unsafe option.
There are alternatives to allopurinol, including non-drug options, especially where the underlying cause of high uric acid is treatable. However allopurinol is most effective in almost all cases (though the new febuxostat is of similar effectiveness). It is safe in most cases, but the small risk of severe reaction should be eliminated by starting with a small dose. Any treatment is only valid if current uric acid level is known, then monitored frequently to adjust the uric acid lowering therapy so that levels are managed properly.
It is extremely unlikely that anything LIKE allopurinol is available naturally. The body take purines (mostly xanthines and guanines) from food and oxizes it with the enzyme xanthine oxidase…as the name implies.
)The beauty of allopurinol is that it is almost IDENTICAL to xanthines and fools the xanthine oxidase to attack IT and change it to a rather soluble product that the kidneys can readily excrete. It keeps the xanthine oxidase busy NOT making so much uric acid.
It's not Big Pharma that is pushing allopurinol as VG correctly said because you can treat your gout with 300 mg./day for the princely sum of $40 PER YEAR, in the United States WITHOUt insurance. Try treating yourself with cherry juice and you'll spend 20 times that amount.
What it boils down to is if you have faith in the non-drug claims…and there are THOUSANDS…then try them. If the pain recurs your choices are to try something else and then something else, and then something else. If you are very lucky and persistent one of these may work. But remember, THAT method, too is FOREVER.
If nothing works, you get sick of the regimentation, or you have the atttack from HELL that makes you consider jumping from a high window or sawing off your foot, the allopurinol is waiting at the pharmacy.
Remember also that controlling pain is not the same as controlling gout. The extreme is someone who spends his life on a morphine drip to treat gout: he will feel no pain but the progression of the disease will destroy his joints. Analgesics are fine when we need them but that is NOT the way to manage gout.
For me the choice was easy. I spend every day controlling my weight, I spend every day at the gym trying to fight the muscle loss of aging, I spend every day keeping my drinking to manageable levels. If I had to also fiddle with purine intake, cherry juice, black bean broth, no meat, no shellfish, etc., I'd go NUTS.
Oh, and I did have the crippling attack from Hell bedridden for 9 days, so my choice was easy.
Thank GOD for allopurinol…15 (or 20?) years and no attacks.
DRUGS FOR LIFE – NO.
I am 58 years old, had my first attack in my early 40’s. Both sides of the family have a history of gout. The first attack was the most significant pain I had ever felt in my life; I was on an all protein diet. I was asked to go on medication after that attack, and chose to change my diet. I have been eating veg/fish now for over fifteen years with regular exercise I have been more or less fine. Stress drives my attacks, about five years ago I got a prescription for Colchicine and using that and some fairly significant doses of over the counter pain killers I was fine; with some stomach problems after two or three days. Last year I had a string of attacks as winter came on and some deadlines loomed. I tried Chinese medicine first, then decided to go on allopurinol. I have never been sick and have had no need for medicine, at the same time I am fairly resilient so as various ‘side effects’ hit me (mostly dry skin and rashes) I rolled with it for a week or so and it usually cleared up. With various small flare ups the doctor wanted to double my dose, I decided to sit it out (managing with a bit of colchicine) and within two months was clear of any attacks. That held for four months. Then I notice sharp pains in my breast and swelling. I figured it had something to do with my exercise routine so ignored it for a month, being sure not to rub or bang my chest while exercising. A month later with a nipple too sore to roll over without waking up I went to the doctor. He took me off allopurinol immediately and sent me in for a breast cancer exam. I was examined and autopsied I have no indications of cancer; but I have a swollen left breast for the rest of my life and ongoing pain. Not sure where this is going to lead me…If given the chance to do it all over again, I would have never taken the meds. I’d rather live with the pain. Acupuncture by the way brings immediate relief, although it is no cure. I tried an herbal regimen ‘cure’ but it was expensive and not very effective. I have gone to the acupuncturist in the midst of a full on flare up and went hiking the next day… Woke up at 4am with a flare up, had a bit of food two colchicine, a slightly stronger prescription pain killer and I am off buying a cane today as its a busy day, two deadlines in hand, one overdue; the stress. ; )
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