Allopurinol for life?
It would seem then, that some maintenance dosage ofallopurinol is likely going to be necessary and thatalthough it is possible to go off allopurinol entirelythose who do so are likely to have the uric acidlevels rebound but would presumeably be able to resumetheir use of allopurinol at that time.
Somewhat akin to those who end their high levels ofwater intake, the higher test results or theperception of an attack beginning would induce them toresume the high water intake, but there does not seemmuch of a liklihood of any particular damage from thealtered routine.
Sabina Shamel on September 19th, 2007
I agree with your analysis.
I am trying to keep up my water intake but find it very hard to do.Hopefully I can get my serum urate to the 3 range and then reduce theallopurinol and as you say, alter behavior as necessary.
By the way, since going on allopurinol, I have resumed my old habitsof shrimp, meat, beans etc with no apparent problems….Beforeallopurinol I would get a flareup within 1 hours of eating shrimp.
Sanjuana Manser on September 19th, 2007
Are there any studies that actually show thatAllopurinol must be taken forever?Most medical studies don’t follow patientsfor more than 26 weeks anyway.Is there really some sort of complete lossof benefit if one stops taking Allopurinol?Do uric acid levels immediately go rightback up if someone goes off Allopurinol?
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Sabina Shamel on September 20th, 2007
I have not found anything that satisfies me about how muchallopurinol you need to take every day. The following is my analysison which I am living my life.
There is good sense here from a chemistry point of view. Theimportant thing to make sure of either before or as you start takingallopurinol is what is your serum urate level. It should be at orvery near 7 which, for humans at 98.6F is saturated. Many people willregister much higher than 7 and they will have no gout symptoms butthis is because they do not have the trigger that makes uratecrystallize. Why uric acid crysatallizes in some of us, and whocreated God, are two things I don’t know anything about and have longago decided that I didn’t need to know.
When you get a gout attack your serum urate level will go to 7, evenif it was 14 before the attack, because your dissolved urate levelwill come into equillibrium with the solid urate in the crystals andyou stay saturated. Because of the pain and because you know whatmakes it worse, in terms of diet, you then drink water and you stopmost of the purene intake and thereby reduce the overall serum uratewhich allows the crystals to come back into solution and stop hurtingyou. Repeated attacks will leave residual crystals that will hurt youfor many years and the more attacks you have, the more crystaldeposits there will be to bother you in the future. Moreover, therecan be and almost always is, bone loss and joint damage from repeatedattacks on the same area and this can cause permanent crippling ofthe feet.
The allopurinol you take is not enough to stop all formation ofurate, or of uric acid. It only reduces the amount by about 30% whichis usually enough. According to two rumatologists I have talked to,they will sometimes go as high as 900 mg per day for three to sixmonths but this is not common. It is however common for them toperscribe 600 mg per day for three months and this is usually enoughto break the sodium urate crystal formation grip that gout imposes onyou.
They both like to taper back to 300 and are both reluctant to let apatient go down to 100 mg a day but they sometimes do it if there areside effects from allopurinol.
Now to the chemistry. If you take it for a year, I am on 300 mg andhave been there now for 6 weeks, and during that time your serumurate falls to say 3, then I would advise looking into reducing yourallopurinol intake. You can monitor your progress with bi annualurate tests. Remember this, you will not go down immediately whenyou start allopurinol because for every reaction that allopurinolstops from going to uric acid, there will be another uric acidmolucule that becomes available from your fatty tissue and the fattytissue uric acid can go into the serum uric acid level and keep youat 7. In other words, your serum urate level will probably stay at 7for the first 6 months or for a year before finally stabelizing andthen decreasing as more and more of the fatty tissue stored uric acidcomes into the system.
If your uric acid level gets to 3, you are not going to have a goutattack no matter whether you are taking allopurinol or not. If itremains at 3 you will not get gout. However, it is not easy tomonitor it and you should check it often.
My mom went from 300 a day to 150 a day and within about 6 months ofthis, she got her first twingers of gout. Her Urate level rose duringthis period form 3 to 7. She immediately went back to the 300 a dayregime and the gout left her.
Thus, it is my opinion that you will have to take some alloppurinolfor the rest of your life but the amount can probably be reduced onceyou stabelize your serum urate at 3 or below.