These are common questions about allopurinol, the most prescribed urate lowering therapy (ULT).
The best allopurinol information is on the main gout website, in the gout medications pages within the Gout Treatment Help Section.
As well as the questions below, you should also refer to questions about all ULT gout medications.
- Why am I still having gout flare ups with allopurinol?
- Though this applies to all ULT, I’m including it here as this is the most common question about allopurinol, especially where the question is extended by “after many months” – e.g. “Why do I have gout pain after 7 months of 300mg daily allopurinol?”.
If it is still happening after 6 to 9 months, the chances are that your allopurinol dose is wrong. In the early months of allopurinol treatment, gout flares are to be expected (though not compulsory). Your doctor should have offered a choice of preventative gout pain relief, or a prescription so you have pain relief when required for the first few months of allopurinol treatment.
- Do allopurinol side effects cause a dry mouth?
- Dry mouth is not listed in allopurinol side effects, but a small number of people have mentioned it in the forum. Note that you can only truly determine if something is a side effect by repeatedly taking, then discontinuing allopurinol for at least a month at a time. This is not recommended with allopurinol, as you will lose all benefits if you stop taking it, though you might be able to take an alternative ULT.
- Is allopurinol for life?
- This question crops up every month, sometimes worded along the lines of “Can I ever stop taking allopurinol?” Like all urate lowering treatments, allopurinol might not be a lifetime gout medication, but you must continue uric acid testing for the rest of your life. If your uric acid levels are stable and below 6mg/dL, then it is sufficient to test once or twice per year. Otherwise, test every month – especially if you change dose, or undergo drastic lifestyle changes. When your test results, and complete absence of gout flares, show that all old uric acid crystals have dissolved, you can reduce allopurinol dose, possibly to zero, but restart if your uric acid tests show levels rising over 6mg/dL.
- Does allopurinol cause sun sensitivity?
- Sun sensitivity is not listed in allopurinol side effects, but a small number of people have mentioned itchy red spots and “prickly heat” in the forum. Cool showers may help, but take advise from your doctor before applying sun-block treatments. Note that you can only truly determine if something is a side effect by repeatedly taking, then discontinuing allopurinol for at least a month at a time. This is not recommended with allopurinol, as you will lose all benefits if you stop taking it, though you might be able to take an alternative Urate Lowering Treatment.
I have been taking allopurinol for 1 month and I am getting another flare up. This time in my ankle instead of my big toe. how long before i shoud have my dose changed?
Allopurinol, and all other uric acid lowering treatment, needs to be monitored carefully during the first few months of treatment until blood tests show a stable reading no higher than 5mg/dL (0.30mmol/L). Tests should be carried out every 4 weeks at first, and whenever dose is changed. This can be stretched to 2 or three months, then longer once stability is achieved. Anyone who has ever had a gout attack, or has a family history of gout, should get tested at least once per year.
If using allopurinol or febuxostat, blood tests should include liver function and kidney function.
If you have had gout several years before getting treatment, it is good to set your target level well below 5, e,g 2 or 3 mg/dL (0.1 or 0.2mmol/L) for a few months. This reduces the time to get rid of old crystals, and therefore reduces the time you are at risk of gout flares.
In the old gout forum, someone asked:
I am certainly unaware of any longterm problems with allopurinol, though I would always advise that any gout patient, or suspected gout sufferer, should have blood tested for uric acid. If they take allopurinol (or any other uric acid lowering treatment, including febuxostat) they should include liver function and kidney function tests at the same time.
If you are aware of specific longterm problems associated with allopurinol, please share the information here.