Allopurionol substitute?
My husband was diagnosed with gout after several episodes. After onemonth on Allopurinol his blood test showed a reduced uric acid andthe Allopurinol was increased & added Colchicine. After anothermonth his blood tests were so abnormally high (Liver functions,triglycerides, cholesterol, sugar, etc.) that he was taken off ofAllopurinol. Blood test 10 days later showed all of his numbersstarted to go down. Now we are waiting for the next blood test tosee what another month without Allopurinol will do, but the bigquestion is if there is an alternative to getting the uric acid downwithout Allopurinol. He continued on the Colchicine. His blood testsreally looked scary.
Sabina Shamel on September 20th, 2007
I don’t want to sound rude but your post doesn’t make much sense tome.
1. If his uric acid level was down after one month why was his dosageof allopurinol increased? A reduced blood level of urate is what isexpected from taking allopurinol and, based on the level of urate inthe blood alone, it does not make sense to change anything. If it isworking why change anything? Obviously, therefore, you are nottelling us the whole story.
2. Second, why were so many blood tests ordered. I have heard oftesting after three months but I have never heard, or read, aboutneeding to test every month. That is unless your husband is suferingfrom something else too and they want to be sure that they do notdamage some other system that they have to critically watch.
3. The use of Colchicine for a daily dosage, specifically as aprphelactic drug, is not done anymore. Allopurinol will stop goutand Colchicine should only be used to alter or stop a bad attack.Non Steroidal Anti Inflamation drugs should be taken during a badgout attack, along with Colshicine and that is to stop the pain andinflamation. From what you wrote, it is possible that he has been inthe middle of an attack now for more than three months, and if so Iam truly sorry for the both of you as I have had attacks that lastthat long and it is not fun at all.
4. The blood tests you mention may be a problem but they are notbeing caused by the allopurinol. If he has impaired liver function,that was there before the allopurinol went in and one or two monthsis not enough time to do any damage at all.
What is abnormally high?What were the numbers before allopurinol was started?What are they now that you think that they are getting back to wherethey should be?What is the test that shows “liver functions” to be abnormally high?
To be honest here, I do not believe your post. Either you are notunderstanding the situation or you are not derscribing the situationas it is. You are suggesting that your husband is having an adversereaction to allopurinol that was diagnosed from blood tests alone andagain, just from those blood tests, the allopurinol treatment wasdiscontinued.
Finally, how much allopurinol and how much colchicine was he put on?
If he had started on 300 mg of allopurinol a day without othercomplicating factors, his gout attacks would be gone by now and hewould be well on his way to recovery.
Angel Schilk on September 21st, 2007
FYI: Blood tests were as follows:Uric Acid March/04 @ 8.9 MG/DL May/04 @ 7.3 (normal!!!)GGT 3/04 @ 42 U/L 5/04 @ 128 (!)ALT 3/04 @ 37 U/L 5/04 @ 183 (!)AST 3/04 @ 26 U/L 5/04 @ 110After we stopped the Allopurinol the GGT dropped to 70, ALT to 105and AST 56. They’re still above the limits, but it was only 10 daysafter stopping. Obviously, the Uric Acid went up and was 10.4.Next blood test is scheduled for 7/15. I don’t know why all thoseblood tests were done, but till now, T.G., he’s never been ill, sowe just supposed that the dr. was being thorough. As it turned out,his cholesterol, triglycerides, glucose were also too high & theblood results gave us a rude awakening.
You asked about the other numbers:Triglycerides = was 486 dropped to 232 after 10 daysCholesterol = was 336 dropped to 268 after 10 daysHoping after these 4 weeks it will drop more. They are all still toohigh, but the jump was startling. Even you can see the differenceafter he stopped Allopurinol. Do you think it was coincidental??? Webrought the results to a gastro dr & he thought the Allop. was theproblem. They even sent my husband for stomach ultra sound. TG it’sokay.
Dosage of Allopurinol started with 100 mg daily & after the firstattack was over, it was increased to 200 mg (which was in April).Colchicine .10 mg daily. He took an Rx. anti inflammatory at theheight of his attack.
Sorry if you thought that my post “doesn’t make much sense”, butthat’s the fact of the matter!
Finally, his gout is under control, but the dr has him still takingthe colchicine. He will re-evaluate after next blood test.
Sssoo, back to my original question - Does anyone have anysuggestions as to how to reduce the uric acid without the miracledrug, allopurinol??? We would really appreciate your suggestions.
Sabina Shamel on September 23rd, 2007
An answer to your question is that Indomethecin-not spelled properly-will increase the rate of excretion of uric acid but it has somepretty dramatic side effects too. The worst, I believe is gastrointentinal problems. Colchicine is terrible for affecting thestomache too and the way it treats my system (stomache and GI track)I would not be surprised at all if there were dramatic changes goingon in my blood chemistry.
The problem with evaluating the results you post is that it is notusual procedure to take the tests and to track things like that andtherefore it is something that there is no good data for. If it isnormal or not to have such a rise immediately after startingallopurinol is just not something I have read about, although Icertainly have not read anywhere near all there is to read aobut it.
The part that worries me the most is the triglycerides and I can’tfigure out how allo could affect that. I’m not saying it doesn’t butI just don’t understand what the mechanism would be. If it induced anallergic reaction it might start doing crazy things but you didn’tmention skin rash, swelling etc. The other interaction known to be aproblem sometimes is when too much alcohol is consumed when takingallo….
I was harsh about my reply because I thought that you were trollingto bait us allopurinol takers. Sorry, but it does happen here.
The other side of gout regulation is diet and there are many articlesand many more wives tales-nothing implied on that- about what worksand what makes trouble, but if he is not having gout now, I wouldsuggest he stop taking anything for gout and let his systemequillibrate for a month and then take the test again and then,resume allopurinol. If the indicators spike again it must be the alloand i have no idea why or what you can do about it. The problem withthe numbers you posted is that you also don’t seem to have a historyon those same numbers and it is therefore hard to konw what, ifanything, is going on.
I bet it is more likely that the high triglycerides are related towhy he go the gout attack in the first place and that the reductionin the numbers was from the cessation of the gout attack and not fromtha allopurinol.
Oh well.. Gotta go now. keep us informed, it is an interestingsubject and one we all need to be sensitive to.
Elisa Kovach on September 23rd, 2007
In reply to your request for a substitute for Allopurinol, Probenecid is also widely used to lower Uric acid. It works a little differently than Allopurinol and is known as an excreter. It helps your body to excrete excess uric acid. You might want to ask your doc about this. As for Indomethacin (spelled correctly), this is a common non steroidal antiinflammatory used for those with Gout and other inflammatory problems. It can cause serious GI problems in some. As far as I know, its function is to reduce swelling only and would have little or no effect on Uric acid levels. For info purposes only, I am a 41 yr old male who has had Gout for 16+ years. I am quite familiar with all the various meds used in its treatment. I have permanent joint damage from this as well. I have had problems with the various Cox-1 and Cox-2 inhibitors (Anti inflammatorys) causing stomach problems. Colchicine also makes me very ill and I cannot take it. I have absolutely nothing against Allopurinol, but if you can’t take it, Probenecid may be a good substitute. I hope this is of some help.
Angel Schilk on September 24th, 2007
Thank you for your reply. We will ask our dr about Probenecid whenwe go there with the new blood results in 2 weeks, meanwhile, isthere ANYTHING non prescription (food/herb/health food) that isknown to get the uric acid down?
Jonas Laramore on September 25th, 2007
None thats commonly or even uncommonly known. I’m sure we’d all be onit if it existed.
Elisa Kovach on September 26th, 2007
I can’t vouch for it, but I found the link below on the web. It sells some herbal pill to control Uric acid. Personally, I have not had any luck with using herbal remedies or alternative medicine. My wife is chinese, and I have tried a wide variety of herbal concoctions. The chinese love their herbal remedies and they may work for other things, but they haven’t helped me with Gout. Some people swear by herbal stuff, and many think that they are a crock of Sh. I think everyone has to make of their own mind.
Sabina Shamel on September 27th, 2007
I have thought about the blood tests that your husband got and ithas concerned me greatly. I have come to a conclusion and feelcompelled to put into writing what I believe is going on. Well, Idon’t know what is goiong on but I’m sure the tests are telling you alot more than allpurinol is a problem for him.
I believe that your husband has an incipient failure mechanism goingon in his system. The meaning of incipient, as I understand the useof the word, is something that is about to happen but has not yetactually happened.
It is a very early warning of something that you will not like. A fewpossibilities are onset of diabetes or perhaps a liver failure mode.I really don’t know what it is and I’m certain that the allopurinolwas not the cause of the problem but it may have uncovered a problemlong before that problem manifested into the whole system on its own.
I hesitated to write this but feel that since I honestly think thisis what is going on, it is something you should at least think about.My #1 guess is early onset of diabetes. Not fun but manageable ifcaught early. They can be certain if that is going on so if you havenot already, please inquire about it.
Angel Schilk on September 29th, 2007
Thank you for your advice. We are waiting for the next set of bloodtests to see what they will reveal. Now we have a series to compare.Thanks again.
Terrance Molock on September 30th, 2007
Probenicid is an older drug..still around..not used nearly as muchas it used to be.Hey..if you need it and it works for you..go forit.The idea was good when they divided gout into overproducers/underexcreters..and gave them all probenicid(most under excreters)..withallo they initially gave it to overproducers and said almost allothers were under excreters.It was then discoverred that allo had aLOT less side effects..BUT produced the same results.Probenicideliminates..flushes the uric acid out..this is not always such a goodidea.With allo.. allo STOPS the final stage at which the uric acid ismade..so you don’t even have to elimnate it.Allo seems to be the drugof choice now for both overproducers and underexcreters.Interestingly probencid is making a bit of a comeback inemergency treatments..sometimes patients get probenicid to startgetting rid of the uric acid AND allo at the same time!
Jonas Laramore on October 1st, 2007
We did miss ya! Hopefully all is well again!
I think you are right in your analysis relating to the time frame inwhich you decide you want to treat your gout properly. I’ve had onelittle twinge and a slight soreness. Nothing more…
Angel Schilk on October 2nd, 2007
Thank you all for your input regarding the medication. We aren’t100% sure if the allopurinol did indeed cause my husband’s adversereaction, and are therefore waiting for the blood tests next weekfollowed with a dr visit. We’ll ask the dr about everyone’ssuggested substitutes.