What Are The Side Effects Of Allopurinol
Common side effects resulting from the use of Allopurinol may include nausea, upset stomach, diarrhea, or drowsiness. Contact your doctor or pharmacist if you experience any of these effects or if they get worse.
Allopurinol has been associated with skin rashes which are typically mild but are sometimes severe and a sign of a more serious issue. You may not be able to distinguish a mild rash from a rash that could be a sign of a severe skin reaction. Seek immediate medical attention if you notice any rashes while taking this medication.
Ask your doctor or healthcare professional for full medical advice on the risks and benefits involved with using Allopurinol as this is not a complete list of possible side effects.
What Are The Potential Side Effects
Unless youre allergic to cherries, its unlikely that youll have an adverse reaction. However, its important to eat everything in moderation and cherries are no exception. Its possible to have diarrhea if you drink too much cherry juice or eat too many cherries.
How much is too much cherry juice? Thats hard to say, as it depends on your own digestive system. As mentioned, one glass a day should be enough to treat gout without producing any side effects. If you have any adverse reactions, make a note of them and speak to a healthcare provider about it.
If you want to add more cherries into your diet, you can do so in a number of different ways. You can:
- drink tart cherry juice
- add cherries to yogurt or fruit salad
- blend cherries or cherry juice up in a smoothie
Allopurinol Proves Noninferior To Febuxostat For Gout Relief
Allopurinol may finally start to get the respect that many rheumatologists feel it deserves as a first-line urate-lowering treatment for gout, following results of a randomized trial showing that it was noninferior to febuxostat both in the overall trial population and in patients with stage 3 chronic kidney disease .
Dr James O’Dell
In the multicenter, randomized, double-blinded comparison trial that used a treat-to-target strategy, allopurinol met the primary outcome of noninferiority to febuxostat for preventing gout flare during the observation phase of therapy, reported James O’Dell, MD, chief of the division of rheumatology and vice chair for education in the department of internal medicine at the University of Nebraska Medical Center in Omaha.
“Both agents were well tolerated, with or without CKD. Most importantly, both agents were highly effective when used in a treat-to-target protocol in getting patients to target urate levels,” he said in an oral abstract presentation during the American College of Rheumatology 2021 Annual Meeting, which was held online.
And although febuxostat contains a boxed warning about the risks of cardiovascular adverse events with its use, there were no signals for increased cardiovascular toxicity with febuxostat compared with allopurinol, the investigators found.
The trial is the first to compare allopurinol, a decades-old drug, with febuxostat, approved in 2009, in a treat-to-target approach, O’Dell said.
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American College Of Physicians’ Guideline Antiquated
The results of the study “will hopefully teach doctors how to treat gout better by encouraging them to use higher doses of gout medications safely than they’re actually using at this time,” commented Donald Thomas Jr, MD, in private practice in Greenbelt, Maryland, and an associate professor of medicine at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
Dr Donald Thomas Jr
Thomas, who moderated a media briefing where O’Dell discussed the results of the trial, said that he had recently read the 2017 gout guideline by the American College of Physicians , which he called “antiquated.”
The ACP recommends the use of corticosteroids, nonsteroidal anti-inflammatory drugs , or low-dose colchicine to treat patients with acute gout. They also recommend “against initiating long-term urate-lowering therapy in most patients after a first gout attack or in patients with infrequent attacks.”
The guidelines recommend that clinicians discuss potential benefits, risks, costs, and personal preferences before starting patients on urate-lowering therapy in patients with recurrent gout attacks.
The 2017 guidelines also state, however, that “vidence was insufficient to conclude whether the benefits of escalating urate-lowering therapy to reach a serum urate target outweigh the harms associated with repeated monitoring and medication escalation.”
Revised Dosing Recommendations And Use In Renal And Hepatic Impairment
Concurrently prescribing colchicine and inhibitors of cytochrome P450 3A4 or P-glycoprotein increases the potential for colchicine toxicity .2,5 The US Food and Drug Administration reported that of 117 cases of fatal colchicine toxicity at therapeutic doses , more than half occurred in patients who were taking clarithromycin at the same time.2 However, a possible role for renal impairment or prolonged colchicine dosing cannot be excluded in these cases.
Fatal and non-fatal colchicine toxicity has occurred in patients taking colchicine and concomitant erythromycin, cyclosporin, statins and calcium-channel blockers, including verapamil and diltiazem.2,12
Box 2Colchicine prescribing considerations2,5,15,18
Risk factors for colchicine toxicity
- Renal or hepatic impairment
In renal or hepatic impairment:
- avoid colchicine if possible
- if no alternative therapy exists for patients with creatinine clearance < 30mL/minute, extend the interval between colchicine treatment courses to 2 weeks during an acute gout flare
- patients should not take strong CYP3A4 inhibitors or P-gp inhibitors at the same time as colchicine
To reduce the risk of serious drug interactions
In patients with normal renal or hepatic function, colchicine therapy should be stopped, or the dose reduced, when a strong CYP3A4 inhibitor or P-gp inhibitor is prescribed.
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How Much Should You Take
Despite the fact that research strongly suggests that cherry juice can treat gout, there isnt yet a standard dosage. The amount of cherry juice that you consume should depend on the intensity of your symptoms.
The Arthritis Foundation suggests eating a handful of cherries or drinking a glass of tart cherry juice per day, since the available research noted improvements in people who drank a glass every day.
However, its always best to talk to your doctor before pursuing any treatment, as they might be able to give you more specific directions on dosage.
Medication Options For Uric Acid Lowering
It is important to note that whenever starting a uric acid lowering treatment, there is a risk of precipitating a gout flare. A plan should be in place for management if this occurs. This generally can be avoided with the co-administration of prophylactic medications along with the uric acid lowering therapy.
Probenecid may be given to patients with decreased clearance of uric acid by the kidney and normal renal function. In general its use should be limited to patients under the age of 60. Probenecid acts by inhibiting reabsorption of uric acid in the proximal tubules of the kidney. Starting dose is at 500 mg to 1000 mg daily and increased to 1500 mg to 2000 mg as needed. Occasionally higher doses are needed. Probenecid may precipitate renal stone formation and good oral hydration should be encouraged. Probenecid is contraindicated in patients with renal stones and in patients with urate nephropathy. Probenecid given inappropriately to patients with hyperuricemia due to overproduction of uric acid can cause renal stones and urate nephropathy.
- useful in patients with decreased renal clearance of uric acid
- can only be used if creatinine clearance > 40 cc/min
- must have 24 hour urine for uric acid < 800 mg/dl
- can be used in renal failure
- increased risk of renal stones
- pegylated porcine uricase
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The Link Between Gout And Alcohol
The link between gout and alcohol has long been assumed with doctors advising their gout patients to stay away from the beverage. Drinking alcohol regularly can cause some serious repercussions to gout sufferers, especially those who drink beer.
Due to indulgent lifestyles becoming more common, the number of gout cases over the years have increased too.
If beer is your alcohol of choice, consider lowering your intake as soon as possible.
Its been strongly associated with gout attacks as not only does it contain alcohol but it also has the highest level of purines than any other alcoholic beveragesomething that your doctor told you is the probable cause of your gout. Its also very high in brewers yeast which is known to worsen gout pain.
In one study, they found that patients who consumed a 12-ounce serving of beer per day were almost two times more likely to have gout compared to those who dont drink alcohol.
Another extensive study found that two to four beers a week increased ones chances of developing gout by 25 percent. The more beer they drank, the more likely they were to suffer from a gout attack. Too much alcohol increases uric acid production and makes it difficult for the body to get rid of.
Hard liquors have the same effect though not as severe. Spirits like vodka and whiskey raise the risk for a gout attack but only half as much as beer.
Wine drinkers are not safe either.
Existing Concerns About Colchicine Dosing And Toxicity
Vomiting and diarrhoea commonly occur when colchicine is repeatedly dosed at 1-hour or 2-hour intervals for acute gout.1,3 These are the first signs of colchicine toxicity, and may precede rare adverse effects including muscle damage, neuropathy, multiple organ failure and bone marrow suppression.4 Patients with renal or hepatic impairment may be particularly susceptible to severe colchicine toxicity .2,5-7
Increasing awareness of toxicity led prescribing guidelines to recommend lower colchicine doses and extended dosing intervals.8-10 Case reports and expert opinion suggested that the treatment benefit could be maintained at lower colchicine doses, but no data from controlled trials were available until recently.1,11
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Hot And Cold Application
One of the simple home remedies for gout is the oldest and something you probably have been using for years. You will want to try applying hot or cold towels to the affected joint. Keep the towel or ice for 10-15 minutes and you should notice improvement. Ice works better for most patients while a hot towel works for some. Elevate your joint to force blood return to the heart which decreases inflammation even faster.
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How Much Alcohol Can People With Gout Drink
Each gout patient is different, so its hard to determine what the safe limit for alcohol is. Its best to monitor your alcohol consumption and limit yourself to amounts that work best for you.
Lifestyle is an important factor for living with gout along with diet, medical condition, family history, age, and sex. If you find that beer is a common trigger for you, consider lowering your dose to minimize instances of gout attacks.
If taking alcohol out of your lifestyle is not an option, you should still lower it to avoid those crippling gout attacks. Thankfully, there are medications now that can help prevent and treat gout symptoms. Aside from maintaining a rigid diet low in purines, you should also be taking gout medications such as allopurinol.
Make sure to speak with your doctor about taking medications while drinking alcohol.
There is no hard evidence to prove that alcohol reduces the efficacy of allopurinol, but its still best to get the proper dosage to help you achieve low enough uric acid levels. If you still cannot lower your uric acid levels, then you may need to make drastic lifestyle changes such as cutting out alcohol altogether.
During a gout flare up, you should be avoiding alcohol as it could make it worse. Your gout is already experiencing a buildup of uric acid crystals. By drinking alcohol, you are only adding to the buildup and overworking your kidneys resulting in kidney stones and lumps under the skin.
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What Increases Your Chances For Gout
The following make it more likely that you will develop hyperuricemia, which causes gout:
- Being male
Who Is At The Risk Of Developing Gout
Anyone can suffer from gout. However, the condition occurs early in men as compared to women. It tends to affect women after menopause, making men over three times more likely to suffer from this inflammatory condition.
In addition to this, people are at a very high risk of developing gout if they have either one or more underlying medication conditions, such as
- Stiffness and
On average, the gout attack would last for about two weeks or more, depending on the severity of the condition. Surprisingly, in-between the flares one may not have any symptoms.
After youve had your first gout attack, you might experience the subsequent episode of gout frequently. However, if not treated using effective gout medicine, the pain and inflammation will last longer and become even more frequent.
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What Should I Do If I Forget A Dose
Take the missed dose as soon as you remember it. If you are taking colchicine on a regular basis and it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
However, if you are taking colchicine to treat an attack of gout that happened while you were taking colchicine to prevent gout attacks and you forget to take the second dose, take the missed dose as soon as you remember it. Then wait at least 12 hours before taking your next scheduled dose of colchicine.
Risk Factors For Gout
Gout is more likely to occur in:
- Men. Men have a seven to nine times higher risk of gout than women, although the risk increases for women after menopause
- People with a diet high in purine-rich foods such as red meat, organ meats , seafood . Processed foods , refined carbohydrates and beverages high in fructose or sucrose also contribute to gout
- Certain ethnicities
- People who overindulge in alcohol, particularly beer and spirits
- People with certain medical conditions , and with some medications or treatments .
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Oral Gout Medicines Dont:
- CONVERT URIC ACID: KRYSTEXXA is the only gout treatment that controls by changing uric acid into a water-soluble substance called allantoin that your body easily gets rid of through urine.
- SIGNIFICANTLY LOWER YOUR URIC ACID LEVEL IN 24 HOURS: After just one IV treatment, KRYSTEXXA starts to lower your uric acid level enough to begin dissolving years of uric acid crystal buildup and .
- DISSOLVE YEARS OF GOUT BUILDUP IN JUST MONTHS: It can take more than two years for oral gout medicines to dissolve even a small amount of uric acid crystal buildup. KRYSTEXXA can dissolve most of it in about 6 months.
What Medication Options Are There
The drug allopurinol is the most commonly used uric-acid-lowering medication. It restricts the breakdown of purines and so reduces uric acid levels. The medication is taken after a meal with plenty of fluids.
It’s recommended that treatment be started with a low dose of 100 mg which is gradually increased until uric acid levels are below 387 micromoles per liter , or 6.5 milligrams per deciliter . If the levels go above that limit, uric acid crystals may form in the blood.
For people with mild gout, a dose of 200 to 300 mg allopurinol per day is usually enough. 400 to 500 mg may be needed to treat severe gout. The maximum dose is 800 mg per day, but that is only rarely necessary.
After the treatment has been started, doctors will first check every three months to see whether the uric acid levels are low enough to stop crystals from developing. Less frequent check-ups, for example once a year, are enough at a later stage.
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How Much Will I Take
The usual dose is 1 tablet , taken 2 to 4 times a day.
You’ll usually take colchicine for just a few days. Your doctor will tell you how long to take it for.
For familial Mediterranean fever
Doses can vary between 1 and 4 tablets , taken once a day.
Your doctor will probably recommend taking this medicine long-term.
Why Do I Suffer From Gout
One word: hyperuricemia. Or, in other words, increased uric acid in your blood. This is the reason why your joints are painful and inflamed. Uric acid is a normal product in your body it is a substance that breaks down purines in your body which are found in certain foods that we eat, in addition to being found in human cells. When your body overproduces uric acid, youre at risk for developing gout. But, why would your body overproduce uric acid?
The triggers of hyperuricemia include:
- Excessive alcohol consumption
- Eating large amounts of red meat and shellfish
- Drinking sugary sodas
It is these types of triggers that can create the hyperuricemia, which can result in gout. When you overproduce uric acid, your kidneys have to work harder to flush out the extra uric acid out of your bloodstream, as they would normally do.
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How Can I Manage My Gout And Improve My Quality Of Life
Gout affects many aspects of daily living, including work and leisure activities. Fortunately, there are many low-cost self-management strategies that are proven to improve the quality of life of people with gout.
For gout in particular:
- Eat a healthy diet. Avoid foods that may trigger a gout flare, including foods high in purines , and limit alcohol intake .
CDCs Arthritis Program recommends five self-management strategies for managing arthritis and its symptoms. These can help with gout as well.