What my doctor told me about allopurinol!
I went to the doctor today and he told me not to take “allopurinol”during an episode of pain from my Gout. To only drink a lot of waterand take pain medicine. I have read on this site that you shouldstart or continue taking it during a painful episode. So has otherdoctors told you all to take it during an episode?I went off of my allopurinol and changed my diet and my uric acidwent down to 6.2. I stopped eating meat, shell fish, spinach,cauliflower, and mushrooms. So when my doctor and I were talkingabout me stopping allopurinol he said do not start taking it if youhave a painful episode wait until it is over.
Malia Berthelette on August 29th, 2007
That is consistent with the advice from two doctors I saw during mylast attack about a year ago. One in the emergency department ofthe local hospital, and my GP after he had an opportunity to consultwith a rheumatologist.
Their advice was that beginning allopurinol during an attack hadBeen known to make it much worse. They suggested first to use eithercolchicine to help the attack to subside, or an NSAID to just managethe inflammation.(plus pain meds) Once the attack was over they saidIt would be time to consider starting allopurinol.
I live in Alberta Canada. I’m beginning to suspect that there areregional and/or national differences in approach.
Allie Belletto on August 29th, 2007
My last and most severe attack was the one that I was diagnosed properly with gout. The Doc had prescribed Indomethacin for the pain and allopurinol for the long run. He told me to wait until the pain subsided before taking allopurinol. I then left for a 10 day golf trip. The indomethacin played havoc with my stomach - I even think it caused me to bleed internally. I stopped it after a few days because I thought it was stupid to have pain in my foot and pain in my stomach. In my micd (clouded by pain), I decided that since I was already in a major gout attack, so logically I could not trigger an even worse attack by taking the allopurinol. I began the allopurinol at that point, even though I was still in gout pain AND the Doc had told me to wait. Within three days, my foot was vastly improved. That’s my anecdotal evidence. It may have been coincidence that my gout attack was subsiding, but I don’t think so. I believe Walter or Arnold have described (in more scientific terms) in previous posts why it is OK (or even more sensible) to take allopurinol right away. I personally would not hesitate given my own experience, but you have to choose for yourself.
Jonas Laramore on August 31st, 2007
My rheumatologist prescribed allopurinol and cochicine when I firstseen him during a gout attack. Like most here I believe that you haveto start getting this stuff in your body asap. During a severe attack,4 doses of colchicine daily (along with my normal dose of 300mg ofallopurinol), 1600mg of ibuprofin 3 times a day, and oh so much waterare the only things keeping me from playing in traffic.
Terrance Molock on August 31st, 2007
I have heard of this from a few others..that almost as soon asthey started the allopurinol..it started working.Here again I thinkthis is really an individual thing..it would depend on what stage theattack is at..how long and how great the extent of the uric aciddeposits. I mean clearly there is a problem of too much uric acid..AND ifthe present attack is caused QUICKLY by too great an influx of uricacid..AND you’re gonna end up trying to reduce the uric acid..THENwhy not try and QUICKLY turn the tables..and reduce the amount ofuric acid.
I agree with you in that you’re in the middle of a terribleattack..AND NOT ONLY is your toe/foot toast..BUT SO is your gut..ANDYOUR other part..PLUS the pain med’s aren’t doin’ it like theyshould..whaddaya got to lose?
I still do think it best to wait for the attack to go..getstabilized..THEN start the allopurinol.If it’s a mild attack..andunderway..maybe well underway..then the allopurinol may make itworse..BUT if the attack is bad..and ya gotta do somethin’/ANYTHINGTHIS CANNOT GET WORSE..go for the “A”..
Terrance Molock on August 31st, 2007
If you can fix your gout by changing your diet..go for it!I and anAWFUL LOT of others wish they could too..
This diet plan almost never,ever works..
Hey..don’t get me wrong..BUT I have seen it simply NOT WORK..FAILmiserably,TERRIBLY,..on a personal level..and from a plethora ofinformation that I have read/heard from people.
A uric acid level of 6.2 in your case does not guarantee freedomfrom gout..mine has been considerablly less than this..leading toball breaking bouts of gout.
Just curious..you do really need blood level uric acid tests..andseveral of them..prior to an attack,during an attack,and after anattack..PLUS a reasonable state of health,diet,etc.,WITHOUT changes..
This will give you a baseline uric acid level to work with..fromthis level you can look at it and say..ok a level of such and suchgives me gout attacks..NOW that you have that level..you have toreduce this level by 20 to 30 %..AND you have to keep itthere..CONSTANTLLY..
I have read this..heard this from people over and over andover..during a gout attack..they get a test and it is artificallylow..because a lot of the uric acid is NOT in the blood solution..ithas precipitated out and is in crystal..or hard form.Said person goeson a crash diet..and I mean crash..and back to the Dr..TOO SOONafter..sure the uric acid levels have plumetted.Away they go..if theystay on this crash diet..there will be cell death..AND UP UP UP againgo the uric acid levels..OR if they eat..again UP UP UP go thelevels..the next thing they know is that time has ticked by AND theyare gout free..in the meantime the levels ARE NO LONGER LOW..they areHIGH..way too high..AND the evil uric acid is again being depositedback into the joints..COMES AN ATTACK..AND a lot of the uric acid isNOW AGAIN in crystal form..NOT in the blood..NOT showing up on theblood test.This can be baffling for the patient AND the Dr.Each timethis cycle repeats..the worse the problem gets.BIG problem..thiscycle can take years.
You..we as gout sufferers NEED a relatively stable,reasonabllyhealthy body,lifestyle,diet..DURING the time we are getting a handleon our uric acid levels.AND we need regular blood test monitoring.Iam NOT saying don’t drink..don’t eat meat or this or that..JUST thatwe need a stable uric acid level for us to look at and see the pointat which we suffer from gout.For me I know it is 4 or a bitabove..others.have no problem at 8..the reasons for this are notknown.Allopurinol is ALL that will keep mine at the required 3 orthereabouts..
Pay GREAT,GREAT heed to regular blood tests for uric acidlevels..every 6 months for someone on allopurinol..with stablehealthy,diet,lifestyle.A gout sufferer NOT on allopurinol..BECAREFUL of changes..you don’t want to find that you get tested RIGHTwhen your levels are low..again..stable reasonabllyhealthy,diet,lifestyle..I’ld say every 3 months..