Reluctance to prescribe 300mg+ Allopurinol per day

[Luke Haymond]

I am in the early stages of allopurinol dosing. I have just recently bumped my dosage from 100mg to 200mg perday. My initial UA level was 7.2, after two and a half weeks of 100mg Allopurinol my UA was 6.7 and I plan to get blood analysis to see the impact of the 200mg perday dosage in two weeks. I am in the midst of a flare as I type this – but colchicine and indomethacine seem to be addressing (I hope I haven’t jinxed myself). I have only this morning run across several posts stating that MD’s are reluctant to prescribe 300mg/day or more?

1) How commonly are forum members facing resistance
2) Is there a resource for physicians by geographic area that are supportive of the guidance Keith provides here on this site…. from a selfish standpoint – recommendations in the Atlanta area?

Thanks

Luke

[Keith Taylor]

Hi Luke, were those posts about doctor’s reluctance to prescribe safe doses of allopurinol here or on a different website?

If they are old posts, they might not be relevant. However, there are still a lot of doctors around who haven’t yet read the latest professional guidelines.

The American College of Rheumatology are very clear on this. There is no such thing as a standard allopurinol dose, except that the first dose should be 100mg daily. After that, gout patients must be ‘treated to target.’ That means that allopurinol dose must be increased to bring uric acid down to safe levels, with regular personal follow-up to ensure safe levels are maintained. For the majority of patients, the safe level is 5mg/dL. For some gout patients with other health problems, they might have to settle for 6mg/dL.

Therefore, standard doses for allopurinol are a thing of the past. However, in my case – 3 and half years ago – 3 our of 4 doctors I consulted were not familiar with the equivalent UK guidelines.

My view on that is, it is our duty as enlightened gout sufferers to point doctors towards the latest professional guidelines. In my opinion, it is sufficient to ask them to look at the latest guidelines from whichever professional rheumatology organization is most relevant to your country. Other gout sufferers might react more strongly. It depends on your relationship with your doctor. My approach is to not mention the Internet, but to say something on the lines of “A friend told me about rheumatologists guidelines that say 5mg/dL is the maximum – do you know where I can find out more about this?” I’d love to hear how other gout sufferers approach this.

All that matters to me, Luke, is that you get uric acid safe, you get blood tests within a month of a dose change, and you get blood tests at least once a year once your uric acid is stable.

I wouldn’t worry too much about other forum members experience. What really matters is that you have a relationship with your doctor that allows you to safely control gout. If we have to educate her, then so be it.

I’ve often thought about trying to build a database of good gout doctors. Unfortunately, it relies on lots of members sharing their experiences in enough detail to be useful. As the patient-doctor relationship is very personal, I cannot see that happening. My related idea is to produce some high quality gout treatment booklets that I could ship to doctors, and create a record of those that endorse the safe personal approach to uric acid control. At this time, I do not have the resources to create such booklets, or to distribute them. When I get my gout sites back to where they used to be, I’ll definitely think about this again.

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