Allopurinol for gout - "Allopurinol, where's my Allopurinol?"
This page on allopurinol for gout was last reviewed, or updated, on 13 April 2011. Some allopurinol brand names: ZYLOPRIM, LOPURIN, ZYLORIC, PURICOS, SYNOL. It's also available as a generic brand. Common allopurinol mispellings and mispronunciations. Allapurinol, Alapurinol, Allupurinol, Allopurinal, Alopurinol, Alopurinal, Allopuranol, Allipurinol, Allupurinal,Allpurinol. We include mispellings because mispellings on an RX (prescription) can lead to the wrong medicine being prescribed. Allopurinol for gout has been a long term gout treatment for over 40 years. It was introduced in 1963 and is at present, still the most widely prescribed drug for gout. It may well be eventually dethroned by febuxostat, a new gout drug.(See the new gout drugs pages). Allopurinol works by inhibiting the production of uric acid. It works in a similar way to cherries, possibly celery, and perhaps in the way that quercetin and berries such as strawberries, have been reputed to work. That is, by inhibiting the production of xanthine oxidase and therefore uric acid. It may reduce your uric acid levels by more than a low purine or other kind of diet.
But in this study the low purine diet out-performed it.
A low purine diet will reduce serum (blood) uric acid by about 1.0 -2.0 mg/dL (dL is a short form of deciliter). Always drink lots of water on a course of Allopurinol -
see the 'What to drink?' section for why.
Less uric acid production means less to excrete and less to potentially produce MSU crystals. So Allopurinol is used for over excretors too. And the body is probably less acidic and more alkaline (a higher pH level) when it has less uric acid. Allopurinol should not be started during a gout attack. But if it has been taken before the gout attack, continue taking it. This a because sudden changes in blood uric acid levels can worsen the gout attack. Therefore your doctor will wait for a period after the gout attack subsides before starting you on this one, or other long term gout treatments. Once started doctors recommend it should be continued. If discontinued, uric acid levels are likely to rise above 6.0 mg/dL and gout attacks begin again. Tophi may redevelop. If you take Allopurinol gout attacks may begin, whilst it's being taken. That's why low dose Colchicine or NSAIDs may be prescribed in advance of Allopurinol for about two weeks. They act prophylactically (i.e. advance prevention). This combination is quite common. Allopurinol can be prescribed for many kidney disease patients and for those with tophaceous gout, as long as a creatine clearance test ascertains how well the kidneys are functioning. The creatinine clearance test results will influence the amount of the allopurinol dosage, perhaps calling for a reduction to 100 - 200 mg daily. Dosage 100 mg daily gradually increased to 600 mg daily if necessary. Even to 800 mg in some countries. A usual dose is 300 mg daily. It will be prescribed at a level needed (hopefully) to reach the target serum uric acid level of about 6.0 mg/dL. Unless of course it causes the kind of side effects which mean it has to be stopped. Allopurinol requires only one tablet a day, so there's much less chance of forgeting to take a dosage. That's another factor that makes allopurinol for gout a "popular" medicine. Possible side effects include diarrhea, headaches, fevers, skin rashes (2% of users), mainly in people prone to allergic reactions, and others. The "side effect" to be extra careful of is a rare condition called allopurinol sensitivity syndrome. It affects less than 1 in 1,000 of those who take allopurinol for gout, (somewhat more if the patient has kidney disease), but the fatality rate has been numbered at 1 in 5 of those affected. It can be de-sensitized, but the success rate isn't 100%.
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