Can Allopurinol Cause A Gout Attack

Worries That It Might Prove Unfounded In Randomized Trial

Initiating allopurinol during an acute gout attack doesn’t adversely affect the resolution of the attack, according to results of a new placebo-controlled, double-blind study.

The acute gout attack resolved after an average of 13.4 days in patients who received placebo and 15.4 days in those taking allopurinol, but the difference was not statistically significant , Erica H. Hill, DO, San Antonio Military Medical Center, San Antonio, Texas, and colleagues reported in the Journal of Clinical Rheumatology.

Action Points

• Allopurinol given during an acute gout attack does not adversely affect the resolution of the acute episode.
• Urate-lowering therapy during an acute gout attack should be accompanied by appropriate acute management.

Most patients in both groups had very low Physician Global Assessment scores, and patient-rated pain scores were relatively low for both groups even early into the study.

The results support the 2012 American College of Rheumatology guidelines recommending that urate-lowering therapy can be started during an acute attack, provided patients receive effective acute management.

The analysis included patients with gout who were randomized to receive either placebo or allopurinol for 28 days. The drug was initiated at 100 mg daily for the first 14 days and then increased to 200 mg daily for the next 14 days.

In addition to the study drug, all patients were given prophylactic colchicine, except one placebo patient who took meloxicam.

Side Effects Of Allopurinol

According to Drugs.com, noticeable side effects of allopurinol are uncommon, but as with all pharmaceuticals there are unseen side effects. The noticeable ones include skin rash, diarrhea, nausea, drowsiness and itching.

The unseen side effects include increases of overall acidity in the body, which puts extra burden on your kidneys, liver and other organs. Although allopurinol has been used relatively safely for over fifty years, these unseen side effects do take a toll on your overall health, and so The Gout Killer recommends that you AVOID all pharmaceuticals as much as possible, while being monitored by your health care practitioner of course.

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Can Allopurinol Cause Problems

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with allopurinol. You will find a full list in the manufacturer’s information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

If you experience any other symptoms which you think may be due to the tablets, speak with your doctor or pharmacist for further advice.

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Why Does Allopurinol Increase Gout Attacks At First

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Taking Allopurinol For The First Time

When taking allopurinol for the first time you may experience another gout flare . But dont be alarmed, this happens in around 75% of cases, so you wont be alone.

It isnt exactly clear why this happens, but one thought is that, as the allopurinol produces a relatively fast reduction in blood uric acid that partially dissolves existing uric acid crystals, the now smaller crystals are able to move from the cartilage into the joint cavity, where they inflame the soft synovial membrane.

But when this happens dont stop taking your allopurinol

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Managing Patients With Gout

Management of gout, covering acute attacks, long-term management strategies, risk factors, dietary choices and urate-lowering therapies.

Gout is the most common form of inflammatory arthropathy and estimated to affect 1 in 40 people in the UK.1

The rising prevalence of gout is attributed to longevity, comorbidities and lifestyle factors such as obesity.2

Arthritis Research UK and the British Society for Rheumatology have highlighted the following issues that contribute to suboptimal management of gout in primary care, despite effective treatments being available:

• uncertainties about initiating urate-lowering therapies
• not reducing urate levels sufficiently to prevent further attacks
• failing to address patient risk factors
• patient compliance.

This update outlines the latest recommendations on acute and long-term treatment of gout.

How To Use Allopurinol

Take this medication by mouth, usually once daily or as directed by your doctor. Take this medication after a meal to reduce stomach upset. If your dose is more than 300 milligrams a day, you will need to take several smaller doses during the day to get this amount .

It is best to drink a full glass of water with each dose and at least 8 more glasses of fluid a day. If your doctor has directed you to drink less fluid for other medical reasons, consult your doctor for further instructions. Your doctor may also instruct you on how to decrease acid in your urine +oral/details” rel=”nofollow”> ascorbic acid/vitamin C).

Dosage is based on your medical condition and response to treatment. Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day.

For the treatment of gout, it may take up to several weeks for this medicine to have an effect. You may have more gout attacks for several months after starting this medicine while the body removes extra uric acid. Allopurinol is not a pain reliever. To relieve pain from gout, continue to take your prescribed medicines for gout attacks as directed by your doctor.

Tell your doctor if your condition persists or worsens.

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Why Does Allopurinol Cause Gout Attacks

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How Should This Medicine Be Used

Allopurinol comes as a tablet to take by mouth. It is usually taken once or twice a day, preferably after a meal. To help you remember to take allopurinol, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take allopurinol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor will probably start you on a low dose of allopurinol and gradually increase your dose, not more than once a week.

It may take several months or longer before you feel the full benefit of allopurinol. Allopurinol may increase the number of gout attacks during the first few months that you take it, although it will eventually prevent attacks. Your doctor may prescribe another medication such as colchicine to prevent gout attacks for the first few months you take allopurinol. Continue to take allopurinol even if you feel well. Do not stop taking allopurinol without talking to your doctor.

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Talk With Your Doctor

If you are taking allopurinol and still experiencing gout flares, talk with your doctor. Your doctor will be able to offer treatment options that best meet your individual needs and may help you prevent future gout flares. You may want to download and complete the Gout Flare Questionnaire before your appointment.

*For all eligible patients 18 years or older who are legal residents of the United States or Puerto Rico. First 30 days are as little as $0 only for eligible patients. Maximum savings of $65 on the first fill and $50 on refills. Please see complete Terms and Conditions for details.

NOTE: This article was not written by a medical professional and is not intended to substitute for the guidance of a physician. These are not Hikmas recommendations for gout flare prevention, but rather facts and data collected from various reliable medical sources. For a full list of resources and their attributing links, see below

Why You Shouldnt Stop Taking Your Allopurinol

At least one study has shown that uric acid levels can rise rapidly when the medication is stopped and can reach pretreatment levels within a week, irrespective of how long the patient had been taking allopurinol.

And its possible to have multiple gout flares, whilst you are taking allopurinol, until all gout crystals have been dissolved and your uric acid levels are under control, which may take some time.

So if you were to stop taking your allopurinol every time you had a gout attack youd be continually setting your recovery back to day 1 each time you did.

Dont stop the medication, but do contact your doctor. They will usually reduce your allopurinol dose or prescribe a non-steroidal anti-inflammatory drug to help reduce the inflammation and pain. They may even do both.

And if NSAIDs are ineffective or inappropriate for you, they may prescribe colchicine instead, a powerful drug that works by reducing the number of white blood cells flooding into the affected area so helping to reduce swelling and relieve pain.

I know it can be soul-destroying to be taking a medication which seems to trigger the very thing its meant to prevent! But to reach your goal of finally getting your uric acid levels under control you have to stick with it. Once your doctor has found the correct allopurinol dosage and you have your uric acid levels under control, below 6mg/dl, youll reap the benefits.

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Allopurinol Oral Tablet Cost

As with all medications, the cost of allopurinol oral tablets can vary. To find current prices in your area, check out GoodRx.com.

The cost you find on GoodRx.com is what you may pay without insurance. The actual price youll pay depends on your insurance plan, your location, and the pharmacy you use.

Keep in mind that you may be able to get a 90-day supply of allopurinol oral tablets. If approved by your insurance company, getting a 90-day supply of the drug could reduce your number of trips to the pharmacy and help lower the cost. If youre interested in this option, check with your doctor or your insurance company.

Before approving coverage for allopurinol oral tablets, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.

If youre not sure if youll need to get prior authorization for allopurinol oral tablets, contact your insurance company.

Who Can And Cannot Take Allopurinol

Allopurinol can be taken by adults and sometimes children.

Allopurinol is not suitable for certain people.

Talk to a doctor or pharmacist if you:

• have ever had an allergic reaction to allopurinol or any other medicine
• are of Han Chinese, Thai or Korean origin
• have problems with your liver or kidneys
• currently have an attack of gout
• have thyroid problems

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Does Allopurinol Treatment Worsen Acute Gout

Its possible that using allopurinol oral tablets can trigger acute gout .

Gout attacks occur when theres too much uric acid in your blood. Gout attacks are temporary flare-ups of severe pain and swelling. They start suddenly and keep coming back over time.

Experts dont fully understand why some people who take allopurinol have gout attacks. But the risk seems to lessen if your doctor starts you on a low dose of allopurinol.

To learn more, see Gout attacks in the Allopurinol oral tablet side effects section above. You can also talk with your doctor.

Allopurinol And Other Treatment

Gout patients often worry about allopurinol and other treatments or diet effects. You should always discuss this with your doctor, especially if you are being treated for other health problems. You should also read labels carefully, especially the section called contraindications. I have included some common concerns in my Allopurinol And Other Issues pages, but you should always seek medical help if you have specific concerns, as it is impossible to cover every combination.

Allopurinol and other xanthine oxidase inhibitors are the subject of many recent and ongoing research programs. For example: Pacher, P. A. L., Alex Nivorozhkin, and Csaba Szabó. “Therapeutic effects of xanthine oxidase inhibitors: renaissance half a century after the discovery of allopurinol.” Pharmacological reviews 58, no. 1 : 87-114.

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Allopurinol Oral Tablet Side Effects

Allopurinol oral tablets can cause mild and serious side effects. The following lists contain some of the key side effects that may occur while taking allopurinol. These lists do not include all possible side effects.

For more information about the possible side effects of allopurinol, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be concerning or bothersome.

Note: The Food and Drug Administration tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect youve had with allopurinol, you can do so through MedWatch.

Treating Gout: Allopurinol Found Safe During Acute Attacks

When treating a patient with gout, lowering uric acid levels too quickly can cause adverse events, such as triggering an acute attack. This has led some physicians to caution against the use of Urate Lowering Therapy until an acute attack subsides.1-4

However, a new study may dispel these claims. After comparing patients taking allopurinol, an xanthine oxidase inhibitor used for ULT, with a placebo given during an acute gout attack, researchers found a negligible difference in the amount of days the attack lasted .5 The two groups noted little difference in their experience of pain, as well.

Over the course of 4 weeks, patients with crystal-proven gout by athrocentesis were treated with standard prophylaxis of cochicine and nonsteroidal anti-inflammatory drugs. Some patients also received corticosteroids and/or analgesics. Allopurinol or placebo was initiated at 100 mg daily for the first 14 days and then increased to 200 mg daily for the next 14 days. The treating physician determined therapy for the acute gout attack, wrote the authors.

The mean serum uric acid level did lower in the allopurinol group , yet both groups reported a significant drop in pain by day 3 or 4 of treatment. Pain remained similar between the two groups from onset of the attack through to the resolution.

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Why Does Allopurinol Increase Gout Attacks At First: You Need To Know This

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• How thousands of people have stopped gout pains

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