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I am about to finish my first week of 100mg doses of Allopurinol.? Tomorrow I am to increase up to 200MG.? Should I take 2 100MG doses at different times of day, like morning and night or take the 200mg dose at once?? What is most effective and how do you folks take it?? Eventually I will be 300MG, do I take all at once or spread it out.? I forgot to ask the Doctor.
Allopurinol?is converted to oxipurinol (oxypurinol) that has a half-life of around 15 hours?[FDA], 18-30 hours on other studies and 24 hours is taken as a typical value.?So a single dose will work ok for 24 hours; serum levels may continue up for 48?hours, so if you miss one dose it is not critical.
I take 300mg on a single dose at any time on the day,?basically when I remember (14 months for now and never missed one).?
The general rule of thumb is take up to 300 mg at one time, and over 300 mg as a split dose.
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I have this minute returned from my doc, and got easy agreement to go from 600mg to the max 900mg. Yippee
600mg got me to 0.27 mmol/L (about 4 and a half of your lovely mg/dL). Due to vacations, I got a different doc this time, and either he has more sense, or I had my explanations rehearsed and ready. No trouble getting him to agree to the max, and my target of 0.20? mmol/L (3.4 mg/dL) for a few months to continue shrinking the tophi. Sensible fellow even arranged kidney and liver function tests with the next uric acid test. I love it when a good plan comes together.
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There are those who will say I will never get rid of all the urate, but it will not be for want of trying.
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It's enough to make you smile
Sounds great Keith!!? I took my first 200MG dose today and next week will go up to 300MG for two months and then get tested.? So far no further attacks though my main sore spot is still sore in some positions and I'm rather afraid to wear shoes still!? I did notice an ache in my other foots heel.? Can't say if it's the ol' Gout for sure, if it is, it's not near the pain as previous attacks.? I have been taking a colchicine here and there when I feel a few pings of pain.? Keeping my fingers crossed for no serious attacks in these first few months of Allopurinol…!?
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I have been drinking a few glasses of red wine here and there but still have not had beer in months.? That may change tonight.? I'll just keep it to only a few and load up on extra water…
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So far no side effects that I can pin on the Allopurinol as being “bad”.?
Wow Keith, 900 mg.
You will be our guinea pig.
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Suprpising, since not so long you were very quietly but very firmly resisting allopurinol. <wink>
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Now here's your task (if you choose to accept it< Mission Impossible theme playing>): prove me a liar when I say that tophi removal is a near impossibility because of the deft way that the immune system walls off urate. I feel pretty strongly that tophi will persist even with a serum urate of zero. The ball is in your court. (If it works for you, I'll up my allopurinol too.)
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Well, best of luck to you.
Yes, I choose to accept the Mission.
Apart from the crap that is ruining my joints, which is the real reason for my insistence on allopurinol to the max, I have 3 noticeable tophi. A small pea sized one on the left knee, a small collection of grape pip sized ones near my left elbow, and a wobbly mass of varying density about the size of half my thumb near my right elbow.
I was a little surprised that my uric acid levels were only 7 at the start of my treatment, but that was during an attack, and I had lost quite a bit of weight on hospital food. Previously I have been around the 9 to 12 mark. Not very scientific, but I can no longer afford uric acid test strips, so everything now is dependent on doctors tests ? as it should be.
There should be a month scale on the bottom of that chart: April | May | June | July
I still have over 3 weeks to go before I get the results of 900mg dose, when I will report back on any tophi reduction.
All of this is from my obsession with Lower Uric Acid Gives Faster Gout Cure. I cannot explain what held me back from starting allopurinol, except that I was convinced for a long time that I could fix my gout simply by losing weight. A bang on the head brought me to my senses. Never a truer example of “what doesn't kill you makes you stronger”
zip2play said:
?I feel pretty strongly that tophi will persist even with a serum urate of zero. ?
As I said in an earlier comment to your post, I agree with you. Please, put on your thinking cap and help me out!
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As I woke up this morning it hit me: There is quite bit of “good stuff” written about gout and uric acid and monosodium urate and a hell of lot more “mumbo jumbo stuff”. While it seems quite natural and easy to me (having been a chemist in one of my past lives) to see uric acid turned into MSU which make up those tophi, (Mother Nature is a hell lot better bio-chemist than we are), I can't see for the life of me how MSU is turned back into UA. I haven't seen/found any body yet to “mumbo jumbo” about THAT. It got to be UA (not MSU) to get transported by the blood to the kidneys for them to get rid of it. ?Right???
Sooo, how do we get rid of tophi??? I know, I got rid of some it by having a doc scraping the living daylight of the bones of my index finger, but my big toes still look like a disaster area. (I can/could provide pictures if no one believes me.)
I spent hours today, reading about MSU and UA. You almost got to have a PHD to understand their “mumbo jumbo stuff”.
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So, Zip, if you still got any time left between your six packs, can YOU tell me????
Having spent similar hours tearing out what little hair I have on a similar quest, I came to the conclusion that we can just keep it simple by referring to urate. This can be pure uric acid (UA), or combined with sodium to form monosodium urate (MSU). Crystals of both compounds usually exist in gout, and it does not really matter which form the urate takes. The important thing is to get rid of it by lowering urate level to dissolve the crystals – UA or MSU doesn't really matter.
There may be some significant differences when studying kidney stones, but from all I've read, for gout control the difference between MSU and UA is not significant.
But, I've never been a chemist, so I could be fooled by the mumbo jumbo.
Keith Gout Advisor said:
?but from all I've read, for gout control the difference between MSU and UA is not significant?.
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“? is not significant…”That's where I very much disagree. It's MSU that make up the tophi, not UA. And my tophi are still there. It's UA that goes through your blood, not MSU.
hansinnm said:
Keith Gout Advisor said:
?but from all I've read, for gout control the difference between MSU and UA is not significant?.
“? is not significant…”
?That's where I very much disagree. It's MSU that make up the tophi, not UA. And my tophi are still there. It's UA that goes through your blood, not MSU.
I do not think your final sentence is right, but I could be suffering from mumbo jumbo overload. Surely the serum uric acid test includes both uric acids – the non-ionized UA and the ionized MSU???
From this, the reason that there is little or no non-ionized UA in tophi is to do with the pH of the fluids in which tophi are found, or originate. Studies of kidney stones – the equivalent of tophi in urine – seem to dwell on the non-ionized UA form, as this is predominant when pH is less than 5.75 (from Walter G Barr, Uric Acid, on PubMed). pH can't get that low in blood or synovial fluid, so the prevalent sodium ion attaches readily. I can''t find any data on how long it takes for UA to ionize to MSU, but does it really matter?
Allopurinol gets rid of tophi. Who cares about anything else?
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By the way, the Barr reference contains some hideous nonsense about normal uric acid levels, which is the main reason it does not get a link. And the answer to who cares is (among others) me.
Keith Gout Advisor said:
hansinnm said:
Keith Gout Advisor said:
?but from all I've read, for gout control the difference between MSU and UA is not significant?.
“? is not significant…”
That's where I very much disagree. It's MSU that make up the tophi, not UA. And my tophi are still there. It's UA that goes through your blood, not MSU.
?1) I do not think your final sentence is right, but I could be suffering from mumbo jumbo overload.
2) Surely the serum uric acid test includes both uric acids – the non-ionized UA and the ionized MSU???
3) From this, the reason that there is little or no non-ionized UA in tophi is to do with the pH of the fluids in which tophi are found, or originate. Studies of kidney stones – the equivalent of tophi in urine – seem to dwell on the non-ionized UA form, as this is predominant when pH is less than 5.75 (from Walter G Barr, Uric Acid, on PubMed). pH can't get that low in blood or synovial fluid, so the prevalent sodium ion attaches readily. I can''t find any data on how long it takes for UA to ionize to MSU, but does it really matter?
4) Allopurinol gets rid of tophi. Who cares about anything else?
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By the way, the Barr reference contains some hideous nonsense about normal uric acid levels, which is the main reason it does not get a link. And the answer to who cares is (among others) me.
Keith, you are walking on very thin ice. Get off before you break through and drown.
Ad 1) Prove it to me. I have spent hours to find out, but no such luck.
Ad 2) First, if UA and MSU were both part of the mg/dL number then we'd be in deep doo-doo. To my knowledge, the reagents used in the tests to check a specific item in the blood are specific for that particular item.
And let me tell you again: URIC ACID (ACID) in not the same as MONOSODIUM URATE ([acidic]SALT) which is not the same as SODIUM URATE ([non-acidic]SALT). I am not going into Sodium urate since we ain't gotten any of that in our system (at least, I don't think so.)
Second, what are you talking about: “non-ionized UA and the ionized MSU”?? Do you know the difference between non-ionized and ionized? I am not going to give a chemistry lecture here. (Any one interested, Google it!)
Ad 3) UA does not ionize to MSU. It just exchanges one or two Sodium atoms for one or two Hydrogen atoms (while in an ionized state for which they have to be in the proper medium.)
Ad 4) Allopurinol DOES NOT get rid of tophi (not as such) .
?All it does, is preventing our metabolism to turn purines into uric acid and thus helps our metabolism to deal with the effects of too much UA in our system.I thought I knew the difference between ionized and non-ionized – otherwise I would not have written what I did. I'm not looking for a lecture, just an explanation if I got it wrong. Or are you saying only Google can give me an explanation?
Keith Gout Advisor said:
I thought I knew the difference between ionized and non-ionized – otherwise I would not have written what I did. I'm not looking for a lecture, just an explanation if I got it wrong. Or are you saying only Google can give me an explanation?
No, I am not saying only Google can give you an explanation? Google is the easiest and fastest way of getting an explanation without going back to college and taking a course in basic chemistry.
You “thought you knew the difference between ionized and non-ionized”. Please, tell me what it is, without consulting Google and I'll give you an explanation why/where you are wrong (in your previous comment on Aug.22,)?
hansinnm said:
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You “thought you knew the difference between ionized and non-ionized”. Please, tell me what it is,
Hans, the posts I made on 22nd are exactly what I think the difference is. Do you think I just conjured it up to annoy you?
I guess I'd better explain why I think what I think, cos it don't look like I'm gonna get any help unless I crawl (before you blow, remember the humor that NEVER comes across properly in the written word).I think an ion is a charge due to an imbalance of electrons and protons. I also think that is what determines if something is classed as an acid or base (alkaline). I believe that when salts are formed, a bond is made between the acid and the base which balances out the negative and positive charges. I assume that this state is what is meant by non-ionized, i.e. protons and electrons in the salts are equal.
Now, if those memories of high school science and assumptions are wrong, I would love an explanation of why they are wrong. I know I can spend time searching for the answers, but I would expect members of this forum to save me some time. I have no doubt that Internet is full of the same crap about basic chemistry as it is about basic gout. In my defence for being too lazy to research it, I was not the one who raised the subject in the first place – if I had done, I would have created a separate topic. 🙂
OK, back to my knowledge and my explanation of why I wrote what I wrote about ionized and non-ionized states. As I'm not allowed to use Google, I cannot remember if acids are positive and bases negative or the other way round. I'm sure if I go for a walk I will remember, but I don't have time as my wife is finishing work soon and she needs me more than you do.
When I apply my limited knowledge of chemistry, to uric acid I see that in it's pure form it has a proton/electron imbalance. I call this ionized UA. When it combines to become monosodium urate, I see that as the non-ionized SUA. I recall from my studies of organic chemistry that, unlike inorganic chemistry, the bonds are far from permanent. I also recall that heat and pH are primary factors in the stability of the bond. I have an inkling that there may be other factors, but your Google ban prevents me from looking (I hope your ban is only temporary, Hans – I can't live without my Google 🙁 ).
That is why I refer to uric acids in the way that I did. That is why I think of UA and MSU as two states of the same thing. That is why I thought I knew the difference between ionized and non-ionized.
There is no point in discussing the rest if that is wrong, but you can be sure that, once you have pointed out the error of my ways, I shall tackle your original questions and subsequent comments.
Please be gentle with me – I've had a particularly hard day following a particularly hard few months.
Keith Gout Advisor said:
hansinnm said:
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You “thought you knew the difference between ionized and non-ionized”. Please, tell me what it is,
Hans, the posts I made on 22nd are exactly what I think the difference is. Do you think I just conjured it up to annoy you? “Hell, NO”
??I guess I'd better explain why I think what I think, cos it don't look like I'm gonna get any help unless I crawl [You don't have to crawl. Mother Nature does a hell lot better job on you than I ever could!] (before you blow, remember the humor that NEVER comes across properly in the written word, (yeah, I know, but you and I are trying our best, don't we?).
I think an ion is a charge due to an imbalance of electrons and protons.?Kind of but not quite. Per Webster: ion 1: an atom or group of atoms (molecule) that carries a positive or negative electric charge as a result of having lost or gained one or more electrons. 2: a free electron or other charged subatomic particle. I also think that is what determines if something is classed as an acid or base (alkaline). I believe that when salts are formed, a bond is made between the acid and the base which balances out the negative and positive charges. It's not that simple. You could take a 50 lb bag of uric acid and a 50 lb containre of sodium hydroxide and dump them together and nothing would happen, unless you dumped that bag of uric acid into water and also dumped that bag of NaOH in another drum of water and put them together (and you have to do a few ?more abracadabras to get Monosodium urate.) ?I assume that this state is what is meant by non-ionized, i.e. protons and electrons in the salts are equal.?so are protons and electrons in acids and bases when they are not ionized.
Now, if those memories of high school science and assumptions are wrong, I would love an explanation of why they are wrong. I hope I explained it enough, if not, then I permit you (am I not nice?:smile:) ?to consult Professesor Google. I know I can spend time searching for the answers, but I would expect members of this forum to save me some time. I have no doubt that Internet is full of the same crap about basic chemistry as it is about basic gout. In my defence for being too lazy to research it, I was not the one who raised the subject in the first place ? if I had done, I would have created a separate topic. 🙂
OK, back to my knowledge and my explanation of why I wrote what I wrote about ionized and non-ionized states. As I'm not allowed to use Google, I cannot remember if acids are positive and bases negative or the other way round. I'm sure if I go for a walk I will remember, but I don't have time as my wife is finishing work soon and she needs me more than you do.
When I apply my limited knowledge of chemistry, to uric acid I see that in it's pure form it has a proton/electron imbalance. NO,NO. ?Uric acid, in it's pure form, has NO? proton/electron imbalance.
?I call this ionized UA. It is NOT ionized in its pure form. When it combines with what? to become monosodium urate, I see that as the non-ionized SUA.
Monosodium Urate is NOT non-ionized SUA. MSU is one of the salts of Uric acid. I recall from my studies of organic chemistry that, unlike inorganic chemistry, the bonds are far from permanent. Not when it comes to MSU. Those bonds are so strong that it can and will ?stay for years or ever attached like a barnacle to your bones. (That's why I agreed with Zip on his statement concerning ? tophi.) I also recall that heat and pH are primary factors in the stability of the bond. I have an inkling that there may be other factors, but your Google ban prevents me from looking (I hope your ban is only temporary, Hans ? I can't live without my Google 🙁 ). Please, don't cry. It tears my heart out. I DID lift the ban on Google, as you know.
That is why I refer to uric acids in the way that I did. That is why I think of UA and MSU as two states of the same thing. NO, THEY AIN'T, as, I think/hope, I have sufficiently explained. That is why I thought I knew the difference between ionized and non-ionized. Would you say that NaCl (regular cooking salt) and HCl (hydrochloric acid) are “two states of the same thing”??? If you need convincing, just lick some salt out of your hand and some hydrochloric acid (if your hand will cooperate with you)? and YOU tell ?me!!! (Let me know before you do and I'll make sure you won't find me when you or your henchmen cross the ocean to come after me.)
There is no point in discussing the rest if that is wrong, but you can be sure that, once you have pointed out the error of my ways, I shall tackle your original questions and subsequent comments. Have fun!!!
Please be gentle with me ? I've had a particularly hard day following a particularly hard few months.
Sorry, Keith, that I got you tangled up in one of my character faults: stickler for accuracy. But it is ALL YOUR fault. I never thought you could/might be wrong! (And you can paint the emoticon yourself, since you robbed us of them.)
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I shall try my damnedest to be “gentle with you”. I hope I was.
In a discussion on organic chemistry, the best you can come up with is sodium chloride and hydrochloric acid
??!!Don't be thinking of training to be a teacher
.I remembered the missing factor regarding the stability of the bond. Vital but forgotten. It holds all the answers, yet you are adamant that “Those bonds are so strong that it can and will ?stay for years or ever attached like a barnacle to your bones“
So come on, Hans. Earn your smilies and explain that one. Proper references this time please.
I think it is not necessary to differentiate the particular attachments the urate ion has made, whether with an H+ or any number of Na+. Both forms are present and the quantity of one versus the other depends on the concentration of H+, i.e. acidity.
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I am certain that what is flowing in the bloodstream and what is settled out in old tophi contain both the acid and the monosodium urate, and even the disodium salt. All are equillibrium solutions.?Only the relative quantities of? components?change. I think all we might say is that at normal body temperature, MOST urate in the bloodstream is the weak acid and MOST urate in tophi exists as the monosodium salt.
They cannot be sure even when testing how much of each exists because the mere action of chemical reagants is exttremely likely to change the mix and any testing solution used is going to be vastly different from plasma.?Thus the only thing they can be really sure of is the total urate content.
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There's a long old discussion of solubilities of the various forms of urate but, alas it is a Springer Link and thus $$$$ to read. As I vaguely recall the solubilities of urate forms do not differ much between UA and MSU.
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I have? taken to referring to serum urate and urate deposits?and I think that is as good a term as any other. It's about as clear as the subject will allow.
Keith (Gout Admin) said:
In a discussion on organic chemistry, the best you can come up with is sodium chloride and hydrochloric acid
??!!Just being facetious to show the difference between a salt and an acid where a sodium ion was replaced by a hydrogen ion (just like in UA and SMU.)
Don't be thinking of training to be a teacher
.Not in ?million years, if I still got that many left!?
I remembered the missing factor regarding the stability of the bond. Vital but forgotten. It holds all the answers, yet you are adamant that “Those bonds are so strong that it can and will ?stay for years or ever attached like a barnacle to your bones“
So come on, Hans. Earn your smilies and explain that one. Proper references this time please.
Reference is ME. Those tophi have attached themselves like barnacles to my feet and are still there after many years and 6 months of Probenecid and 14 months of Uloric.
zip2play said:
I think it is not necessary to differentiate the particular attachments the urate ion has made, whether with an H+ or any number of Na+. Both forms are present and the quantity of one versus the other depends on the concentration of H+, i.e. acidity.
I think it IS “necessary to differentiate the particular attachments the urate ion has made”. The acid and/or urate in the blood and in the synovial fluids may (and probably) are in an ionized state, however, I strongly doubt that the tophi are in an ionized state. If they were, they would come and go as they pleased.?AND THEY ARE NOT! That's where my disagreement with Keith comes in.
I am certain that what is flowing in the bloodstream and what is settled out in old tophi contain both the acid and the monosodium urate, and even the disodium salt. All are equillibrium solutions.?Only the relative quantities of? components?change. I think all we might say is that at normal body temperature, MOST urate in the bloodstream is the weak acid and MOST urate in tophi exists as the monosodium salt.
I tend to agree with you here, Zip.
They cannot be sure even when testing how much of each exists because the mere action of chemical reagants is exttremely likely to change the mix and any testing solution used is going to be vastly different from plasma.?Thus the only thing they can be really sure of is the total urate content.
This is where I have great doubts. What are they testing? Are they testing all three, the acid, the mono and the disodium or only the acid? That number: mg/dL, what does it cover?
What is so difficult for an experienced bio-chemist to determine the % of UA, MSU, and DSU in a solution, be it blood serum, synovial fluid or what ever liquid medium??? This has been my gripe. NOWHERE can I find/get the answer.?
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There's a long old discussion of solubilities of the various forms of urate but, alas it is a Springer Link and thus $$$$ to read. As I vaguely recall the solubilities of urate forms do not differ much between UA and MSU.
Read this: http://www.jbc.org/content/1/2/177.full.pdf ?ON THE SOLUBILITY OF URIC ACID IN BLOOD SERUM.
I have? taken to referring to serum urate and urate deposits?and I think that is as good a term as any other. It's about as clear as the subject will allow.
zip2play said:
There's a long old discussion of solubilities of the various forms of urate but, alas it is a Springer Link and thus $$$$ to read. As I vaguely recall the solubilities of urate forms do not differ much between UA and MSU.
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zip2play, I love you
Not only do you make sense in all your post, but that paragraph actually got a response from Hans with a link to what he has been reading. OK, it's from 1905, only 106 years ago, but that is when Hans was in his prime.[ducks for cover]
I'll wait until I'm sober before I respond properly
Keith (Gout Admin) said:
…. OK, it's from 1905, only 106 years ago, but that is when Hans was in his prime.
[ducks for cover]
I'll wait until I'm sober before I respond properly
Yeah, you better sober up, because those critters in 1905 are still doing their tricks!? in 2011, just like they did more than 4000 plus years ago!!! Welcome to reality.:snile:
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