This page about allopurinol for gout was last reviewed, or updated, on 23 July 2018.
Some allopurinol brand names: ZYLOPRIM, LOPURIN, ZYLORIC, PURICOS, SYNOL. It's also available as a cheaper, but maybe less effective, 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 treatment for over 40 years. It was introduced in 1963 and is at present, still the most widely prescribed drug for gout. One of its advantages is that it's cheap.
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 production.
It may reduce your uric acid levels by more than a low purine or other kind of diet. One gout expert has reported that at a dose of 300 mg daily, it lowers uric acid to the target 6.0 mg/dL in 40% of those who take it. So you might need the stronger febuxostat, or a larger dose.
Low purine diet v allopurinol In this study the low purine diet out-performed it over 6 weeks, but not over 36 weeks.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.
But most likely allopurinol will reduce uric acid levels more than other natural gout remedies,such as diets and "miracle foods." But recall from the celery section (click on "Celery" on the NavBar button left), that James Duke PhD said he swapped allopurinol with celery seed extract and did not have a recurrent gout attack. So in his case celery appears to have performed better than allopurinol.
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 7.0 mg/dL and gout attacks begin again.Tophi may redevelop.
But once gout is controlled, you may be able to avoid taking a medication such as allopurinol for life, if you know enough about gout and if you act successfully on your knowledge. To do this at this stage, you must keep uric acid below 7.0 mg/dL.
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 of a prophylactic and a uric acid reducing medication is quite common in gout treatment.
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, from the standard 300 mg daily.
Allopurinol may well be eventually dethroned by febuxostat, (Uloric, Adenuric,Feburic), a relatively new gout drug that has reduced uric acid by more than allopurinol. But allopurinol is cheaper.
Allopurinol for gout dosage It will be prescribed at a level needed (hopefully) to reach the target serum uric acid level of about 6.0 mg/dL 100 mg daily gradually increased to 600 mg daily if necessary. Even to 800 mg in some countries, with some patients. The usual dose is 300 mg daily. Unless of course it causes the kind of side effects which mean it has to be stopped. There is a debate about whether 300 mg is enough.
requires only one tablet a day, so there's much less chance of
forgetting to take a dose. That's another factor that makes allopurinol
for gout a "popular" medicine.
Possible side effects include diarrhoea, (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 (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%.