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Hi Nick,
Got a big smile out of the brand name, Zyloric (half way betweeen the first patented allopurinol called Zyloprim, and the new kid on the block, febuxostat, patened as Uloric. SO Zyloric covers all basis. But it is just allopurinol at a high price…buy the generic instead and save yourself or your insurance coompany some money.
For comparison's sake, 90 days of 300 mg. per day generic allopurinol costs me $10 retail (without involving the insurance company.)That said, I think 100 mg./day is far too low a dosage ESPECIALLY for someone who is expelling urinary gravel. Almost everyone on allopurinol takes 300 mg. as the “forever” dose. Since you run uric acid levels in the eights, I think is is especially important for you to increase your dosage. It seems those starting on lower doses get more aggravation with recurrent atttacks than those who dive right into the 300 mg. dose.
If I were you, I'd have a kidney ultrasound or MRI to check for large stones. Better break them up before a big stone starts to migrate down a small ureter. I have heard that even GOUT pain isn't that bad. Continue the water, and analyze the stones becasue if they ARE urate, you might want to alkalyze your urine.
Dianne,
I cannot agree with you more about THIAZIDE. It is horrific because its major function is to deplete the body of SODIUM and its concomitant water, thus lowering blood pressure (in order to dump sodium the kidneys must conserve uric acid for electrical balance.) I am CERTAIN that 20 years of thiazide for hypertension CAUSED my gout. I finally made the switch to LASIX (furosemide) which is supposed to have only 25% the effect on uric acid. I fully believe this because when I pee on thiazide it is all salt and when I pee on furosemide, it is almost all water…their mechanics are very different. Alas, the diuretic switch was only made after several years on relatively high dose thiazide and AFTER gout began.
Double alas, I am certain that whatever the cause, once you have gout you have gout and merely removing the causative agent is not enough to stop it…DAMMIT! So my knowing that thiazide CAUSED mine, doesn't preclude my needing allopurinol forever. I feel USED by a stupid medical profession, nothing unique there.
I cannot speak to sulfa drugs because I have little experience with them. If I use a rare antibiotic it is penicillin or a macrolide.
So let me add my caution to yours:
ANYONE TAKING THIAZIDE WHO GETS A GOUT DIAGNOSIS SHOULD STOP THE THIAZIDE! I might even go farther and say, anyone on thiazide should stop, period.
I would stop ALL diuretics but for the fact they are the ONLY class of drugs that lower my BP. Twenty-five percent of hypertensives are like me including almost all black hypertensives…but I'm white. We “low-renin” volume-driven hypertensives show NO effect from ARB's and ACEI's (except maybe incessant coughing) becasue all these drugs work to subvert the RENIN-ANGIOTENSIN pathway to hypertension.
Coincidentally, I too panicked about lupus because my facial rash was not on my lips but actually a classic BUTTERFLY rash. My ANA was also 320:1 thus HIGHLY suspect. But my subsequent Lupus panel (about exotic tests) was ALL negative…whew.
Dianne,
Are you running low serum uric acid numbers?
When you DO go back on allopurinol, don't play games with the 100 mg. dose again—start with the 300 mg.
Goutful,
was wondering if one dose of allopurinol could cause such a reaction by waking up the old urates and replanting them?
i am not sure what is going to change? i strongly suspect that my most recent attack was not related to the allo at all.
Having taken just one day's dose of allopurinol, I doubt that it had anything to do with your attack. It's the lowering of uric acid that causes flare-ups and one dose of allopurinol will lower your serum uric acid very little.
Yes, an injury to your foot may very likely have triggered an attack, inflammation from an injury is acidic and uric acid will precipitate into an acidic area if you are gout prone.
Since you have only taken allopurinol for one day, probably it is best you wait until this attack fully sudsides before starting daily allopurinol…but then DO NOT STOP.
If the pain is bad, consider taking more colchicine.
Nick,
I used to have kidney stones — many, and almost every day.
Have you ever had those kidney stones tested…are they urate?
Am I scared? Yes, I am! Gout can be controlled, but only if you treat it seriously!
Have you considered drug therapy?
Juliana,
So good to hear that your husband is getting exactly the results with allopurinol that we all expected.
Amazing he still gets the niggles from just a small amount of alcohol.
Hi goutful,
Once you start allopurinol, 300 mg (or 400 mg. to start) you stop it for NOTHING except for a hypersensitivity reaction. Going on and off allopurinol is a sure recipe for MUCH pain.
Go back on the allopurinol (the best you can do now.) It will not help your current attack but will stop the attacks in the long run. FOr now you need pain relief. Your choices are are prednisone and little miss colchicine (a couple colchicine a day) or MADAME Colchicine, a one day's dose of colchicne, one pill an hour, somewhere in the vicinity of 12 or 16 pills. I think the NSAIDS are too little too late so forget about ibuprofen, Aleve (naproxyn,) diclofenac etc.
My recommendation is MADAME colchicine and a day of severe diarrhea.
If you can lay your hand on some Indocin (indomethacin…Rx needed) or one of the codones, they would be second best to colchicine.
Gary,
I think the 400 mg. allopurinol is a very good idea. At this point the lower your average uric acid the less flares you will have and the quicker will be the process of urate removal from joints…at least that which will be removable. After all attacks stop perhaps 300 mg. is enough. Monitor your uric acid regularly, below 5.0 is very good.
I went on 400 mg. for aboput a year to start and NEVER had even a minor flare-up in that year. In fact more than a decade went by on the subseqyent 300 mg. without a peep, and I only started getting “twinges” when I tried 200 mg…learned my lesson.
A couple days of six packs is dangerous especially in the beginning stages of allopurinol treatment. But after a couple years, a six pack every couple days won't cause any problems, I know from experience. Weight control is ANOTHER issue however.
“with 88% of the causes of gout having nothing whatsoever to do with diet.” That's where I disagree with you. It's far more than 12%.
hans,
You are not disagreeing with me. I merely repeated the Wikipedia entry that veg guy reported in his second post. I have no idea whether the entry is correct or not, but just commented on it as if it was.
I think it might be quite a bit higher than that but the problem is that KNOWING that seems to do very few people any good. If we knew that a lot of cancer was caused by diet, how much good would it do us when we received our cancer diagnosis. Dietary controls for gout have shown themselves over the last 2 millennia as being of dubious worth at best, no matter WHAT the cause. It might be laudable to try to control an illness without drugs…it might also be deadly or crippling.
This fructose nonsense is just the latest fad to gain internet space for people with no knowledge of gout. So fructose has gone full circle in 20 years from being the sugar that we NEEDED to stay slim because it dissolved so slowly (I have a long memeory…people were buying packets of fructose and gobbling it) to the bad kid on the block and the cause of all disease. It is all just so tedious.
(Does fructose cause cancer and Alzheimer's yet yet or is that next year?)I believe the current wave of obesity is not the fault of sugar consumption but rather too many lard asses plopped in front of the TV as a respite from being plopped in front of the computer monitor while stuffing their other hole with too much food: sugar, meat, fat, greasy carbs, cheese on everything. I sometimes think the only exercise some people get is to go out and get more food.
Rest assured, fructose will go away and some NEW scourge will be found by some quacks to explain all our ills, just buy their books to find out which… $29.95 at Barnes and Noble.
If there are any doubters on the fructose/gout connection, the solution is simple: merely toss out your allopurinol and colchicine and give up all fructose. Easy/peasy. You will get your definitive answer within a year…perhaps you will get the answer several times.
A gout sufferer wants to have his serum uric acid below 6.0 mg/dL, better yet 5.0, and the best way to do it is to do it as cheaply and risk free as possible. You get the benefits of a 5.0 serum uric acid no matter HOW you achieve it.
Keeping that in mind, allopurinol is orders of magnitude cheaper and has been used far longer, since 1966, and thus is less likely to cause unforseen probelms after decades of use, it would seem that allopurinol is the far wiser first choice. Uloric was only approved last year and there is no way to ascertain any problems it might cause with daily use a decade from now.
In the unlikely event that one has problematic side effects from allopurinol, or cannot get enough SUA lowering, then there is always a second choice (actually a third, becasue cheap probenecid might be a logical second.)
A BIG consideration for Uloric users…who is going to pay the cost. It's about $2000 a year IF you can do the lowest dose. Multiply that by 20 years and you have a chunk of change.
p.s. For gouties, hot and sweaty feet is a LOT better than cold and sweaty feet. COLD = low solubility for urate = precipitation of crytals. I've never heard of either being casued by allopurinol.
Until I finish my summary of the research (which is difficult as the scientists do not seem to want to investigate alcohol in any terms that relate to normal human consumption), I'll have to fall back on faith.
Boy ain't that the truth. Even with heart disease, the number one killer in the United States, the issue is mitigated to non-existant. Study after study shows that drinking is SUPERB for avoiding and slowing heart disease but still you get the promulgated bullshit about one or two drinks a day MIGHT help and then a diatribe follows about how it can lead to liver disease and a life of wastrel perdition.
The one doctor who said flatly that research shown “the more the better” for heart disease with most benefits accruing after 4 drinks a day was PILLIORIED becasue he might lead America astray. Wasn't Queen Victoria Bristish, after all…how in Hell did the U.S. become the most Victorian nation.
Doctor: “Yes, alcohol is very beneficial but never have more than a glass of champagne every New Years Day.”
Hawghunter,
I never experienced fatigue, but other report some for a while when starting. Likely though, whatever is causing your fever is causing the fatigue…also PAIN is exhausting.
Let us know how your dance with Lady Colchicine goes. A popular tune is the Porcelain Throne Waltz. Some prefer the Johnny Trot (that's two slow steps OUT and three quick steps back IN.)!
Dietary causes account for about 12% of gout
That's where I prefer to leave it, with 88% of the causes of gout having nothing whatsoever to do with diet. So 9 chances out of 10 the best and only thing you can do to successfully treat gout is to use proper medications.
If a small fraction of the 12% is caused by fructose consumption, the rest of the 12% by ” strong association with the consumption of alcohol, sugar, meat, and seafood” why give it a second thought beyond the fact that excess fructose calories will make you fat.
Veg guy, you will never find the cause of your gout if you cannot find a hereditary link. Or, let me guess here, is there still a lingering doubt whether you have gout?
George,
Eventually with an attack that goes on and on, one has no choice but to toss out the common wisdom and just start the allopurinol anyhow, pain or no.
It is a shame that so many doctors are afraid to use what thousands of doctors for hundreds of years have used: high dose colchicine to stop a long painful attack. So you get the runs…there are far worse things (like foot pain.)
toofast,
If I used a chemical analytical approach I would say that beer CANNOT be very bad for gout.
But long hard empirical evidence has shown me that it IS a strong gout trigger. Whether is is due to the hops, the yeast, the alcohol, the wheat, the barley, the roasting, the dehydration effect, I cannot conjecture. But nothing is a stronger gout trigger than a 6 pack of beer. The darker richer beers, ales, and porters are the worst offenders.
But with allopurinol you CAN drink beer, but avoid a 12 pack or daily 6 packs. Wait a while though and give the allopurinol a month or two to take hold.
(You won't do yourself a lot of harm by ignoring the PRAL charts completely…but that's just my opinion. Leave the charts for those trying the non-drug route.
)Jeff, sounds good.
Probaly soon you will be able to keep the colchicine just for emergencies while you conmtinue with the allopurinol, 300.
Yep indocin is notorious for bleeds. I would never bike with it because it makes me quite dizzy and the dizziness is quick and sporadic…just enough to have me careen into a tree.
Eye bleeds are SO scary.
Me too, after 3 weeks of bronchitis after 2 weeks of booze. So a slow start and no weights.
But I was proud of myself: 45 minutes on the elliptical at cardiac rate (My old-fart cardio rate is 123 but I take it to 130.)
I am planning on paying the price gently by lying on my Laxy-Boy in front of TV tonight…and nothing else. Vampire Diaries, Burn Notice, 3 HUNGS, and Royal Pains! With DIET SODA…determined to lose 20 pounds of ugly me.
Hi Hawghunter,
Your doctor is mistaken about colchicine “cleaning your blood of UA.” It really has no such effect. Rather it interrupts the inflammation-acidity-uric acid precipitaiton in an ailing joint.
Yes, allopurinol, 300 mg./day, is probably where you will stay your entire life and after things settle down there will be no need for any dietary restrictions within reason…12 cans of dark beer and a fish fry will probalby still give a few throbs the next day. But eventually gout gets reduced to nothing more than popping a pill in the morning.
While things are settling down there is no reason not to continue using colchicine as needed and no need to restrtict to 1 per day. Often 2 a day going to 4 whenever you feel an attack coming on. This might be a consideration for a few months. Youlll soon learn to anticipate the laxative effect of colchicine.
Fevers are still part of the world…I just got over bronchitis. Perhaps yours is gout related, perhaps not. I doubt it's allopurinol, the earliest reactions are usually rashes, hives and the like.
Remember too, if you cannot get your SUA's down around 5.0 in the early days, there's no law that you cannot take 400 mg. allopurinol. It is TRULY a wonder drug.
Good luck.
Very few of us use BBB but metamorph swears by it, so I am sure he will weigh in on the dosage.
(I think he suggests a half liter, aka a pint, 2 cups, at one time…but don't hold me to it. So you won't be far off by trying that now.)
Let us know if it works for you.
Anything on your doctor calling in an Rx for colchicine?
jlew,
Any luck getting colchicine…about 30 tabs good, but 12 minimum? Won't your doctor call it in?
Indomethacin is a good gout drug, second to colchicine in the non-narcotic category but it is brutal on the stomach (and makes me dizzy.) I find ibuprofent the WORST for the stomach. You cannot beat colchicine for gout.
All this is for relief of pain. You will eventually be given a drug that keeps you from GETTING pain, usually daily allopurinol. It will be the only pill you need to take. It is not likely that allopurinol will casue pregnancy problems. You may not even need it during pregnancy…pregnancy is just LIKE that.
Hint: have you ever tried Inderal (propranolol) for migraine…it works like a charm for me.
You are on low doses of both drugs, but the drugs work welll together. If you stop the probenecid, I recommend 300 mg. allopurinol. If you stop the allopurinol, about 1,000 mg. probenecid should be considered a minimum to keep you below 6.0 mg/dL uric acid.
p.s. Your post did not show up on my computer until today.
jlew,
Less and more pain is expected depending on alalgesics, joint acidity, etc. The general situation is that the inflammation is acidic and the acidity causes MORE precipitaiton of uric acid and more pain.
If I were you, I would call my doctor and ask him, or his service, to prescribe 30 or 60 colchicine by phone. If you get them, let us know and we'll tell you how to take them for an acute attack.
Though not my cup of tea, you can find the black bean broth recipe on the board and try it…nothing to lose. Make the phone call first though.
Dianne,
I guess it would help if there was a simple sulfa-allergy skin or blood test but there seems not to be.
It seems the antibiotics are more of a problem than the non-antibiotics.
If I were you, I would stop all drugs and take nothing by Edecrin (non sulfa diuretic) for a month. Then stop and take Lasix (sulfa diuretic) 40 mg. day for a month. Compare the difference! If the marks continue for a full month with ONLY edecrin, I would forget the sulfa-connection. (Pray you don't have a gout attack for these 2 months!)
If worse comes to worse, you will have to judge whether you can live with the “red-spots.” If indeed it is sulfa caused just watch to see if the symptoms get worse.
(Having gone through a similar “red-patches” at ends where my mustache would be if I still had one. After chasing it for 10 years and trying every knows antifungal, antibiotics, cremes, orals etc., on a lark I tried nystatin cream…it worked like a charm, not only did they get less noticeable, they disappeared completely. Now I use it 3 times a week prophylactically before bedtime. It's worth a $4 tube…ask your doctor.)
ps. I am somewhat allergic to SULFITES in food and drink and my symptoms are always the same, an immediate stuffing of my nose…a classic histamine reaction.
axl,
You are not taking enough allopurinol for that level of uric acid. A minimum, IMHO, is 300 mg. Let us know your uric acid number when you get it. Your goal is 6.0.
Have you ever had foot pains without an obvious injury?
Best drug for raising HDL is high dose niacin, if you can stand the stuff.
axl,
As far as I can tell that aluron you are on is ALLOPURINOL (in Venezuela?) It is a uric acid lowering drug. Did you start it BEFORE or AFTER that UA of 12. Yes indeed, that is definitely “through the roof.”
If you started it after, then have another blood test soon to see its effects. What is the dosage of the medication? Your doctor is treating you for hyperuricemia which is a prelude to gout.
You neglected your total cholesterol and your HDL. These are very important in light of your terrible HDL. Nothing to do with gout though, only heart attacks.
Richard,
I'm glad things arre getting better. I wish your doctor would aquiesce in the 300 mg. allopurinol. Here's the kind of doctor psychology that I hate: “I am not sure of my diagnosis so I will prescribe only HALF an effective dose!” So instead of being right 50% of the time he is wrong 100%.
Is one of your BP meds hydrochlorothiazide? Any diuretics?
I will guess the scenario cavemen:
You will have a serious gout attack in the next two months becasue of that 8.0. It is both good and bad: GOOD in that it will confirm gout and get you on allopurinol; BAD in that it will hirt like Hell.
There are so many factors that cause our liver enzymes to go off kilter, many completely innocuous. In reality, probably doctors should avoid the test becasue they usually haven't CLUE ONE what aberrant results mean or what to do about them except to say: “Come in next month and we'll do them again.”
