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
Topical Cold Or Hot Application
Applying cold or hot water to inflamed joints may also be effective.
Studies and opinions on this are mixed. Soaking in cold water is most often recommended and considered most effective. Ice packs may also work.
Soaking in hot water is typically only recommended when inflammation isnt as intense.
Alternating hot and cold applications may also be helpful.
How And When To Take It
The usual dose of allopurinol is 100mg to 300mg a day. Follow your doctor’s advice on how many tablets to take, and how many times a day.
You’ll have regular blood tests to monitor your uric acid levels. If your uric acid level does not come down far enough, your doctor may increase your dose .
If you have kidney or liver disease, your doctor may prescribe a lower dose and will monitor you more closely.
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Diagnosis Treatment And Prevention Of Gout
BARRY L. HAINER, MD ERIC MATHESON, MD and R. TRAVIS WILKES, MD, Medical University of South Carolina, Charleston, South Carolina
Am Fam Physician. 2014 Dec 15 90:831-836.
Gout is the most common inflammatory arthropathy, affecting more than 8 million Americans.1 Gout accounts for approximately 7 million ambulatory visits in the United States annually at a cost of nearly $1 billion.2 Risk factors include genetics, age, sex, and diet.2,3 These factors may contribute to a high serum uric acid level, which is currently defined as a value of at least 6.8 mg per dL .4,5
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Oral corticosteroids and nonsteroidal anti-inflammatory drugs are equally effective in the treatment of acute gout.
To prevent recurrent gout, patients should reduce their consumption of high-fructose corn syrupsweetened soft drinks, fruit juices, and fructose-rich vegetables and fruits . Reducing consumption of meat and seafood, and increasing consumption of dairy products help reduce the frequency of gouty symptoms. Consumption of low-fat or nonfat dairy products may help reduce the frequency of flares.
A = consistent, good-quality patient-oriented evidence B = inconsistent or limited-quality patient-oriented evidence C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to .
Are There Home Remedies For Gout
- Take medications as prescribed.
- While a joint is hot and swollen, use a cane or similar support to keep weight off that joint.
- It may be helpful to keep the swollen joint elevated above the chest as much as possible.
- Ice packs can be helpful in relieving pain and reducing inflammation.
- Maintain adequate hydration to minimize the frequency and intensity of attacks.
- Drink cherry juice to decrease the intensity and severity of attacks.
- Avoid eating red meats, internal organs, yeast, shellfish, and oily fish because these increase the risk for gout.
While some medications are used to treat the hot, swollen joint, other medications are used to prevent further attacks of gout. With any of these medications, call a doctor if you think they are not working or if you are having other problems with the medication.
Medicines used to treat acute gout and/or prevent further attacks are as follows:
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What If I Forget To Take It
If you take allopurinol:
- once a day take the missed dose as soon as you remember. If you do not remember until the following day, skip the missed dose.
- twice or more a day – if you do not remember until your next dose is due, skip the missed dose and take the dose that is due.
Never take a double dose to make up for a missed dose.
If you often forget to take your medicines, it may help to set an alarm to remind you. You could also ask a pharmacist for advice on ways to help you remember to take your medicines.
Whats The Outlook For People With Gout
Untreated gout can lead to permanent joint damage. The buildup of uric acid in the joints and soft tissue is called tophus. Some people with gout can also develop other health problems, such as severe arthritis, kidney stones and heart disease. Its important to discuss your symptoms with a healthcare provider.
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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.
How Does A Doctor Diagnose Gout
If you have sudden or severe pain in a joint, you should talk to your primary care provider . Your PCP may send you to a rheumatologist, a doctor who specializes in gout and other kinds of arthritis.
Healthcare providers consider several things when confirming gout:
- Symptoms: The provider will ask you to describe your symptoms, how often they happen and how long they last.
- Physical examination: Your provider will examine the affected joint to look for swelling, redness and warmth.
- Blood work: A test can measure the amount of uric acid in your blood.
- Imaging tests: You may have pictures taken of the affected joint with X-rays, an ultrasound or MRI.
- Aspiration: The provider may use a needle to pull fluid from the joint. Using a microscope, a team member can look for uric acid crystals or a different problem .
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Foods As Gout Remedies
Black bean broth is rich in anthocyanins, which are natural anti-inflammatory agents found in tart cherries and black beans. A common gout pain remedy, black bean broth has been found effective by many readers of GoutPal.com 1. Easy to make, the recipe from GoutPal.com follows 1.
Use turtle or soy beans. Rinse 200 grams beans and remove any grit or other debris. Cover with 2 liters water and bring to the boil. Reduce heat, and simmer for 90 minutes. Strain the liquid, which is what you drink, and throw away the beans. Allow to cool, and gulp down about 1/2 liter of the broth. Take this at the first signs of a gout attack.
Tart cherry juice has been found to be very effective as an over-the-counter treatment for gout. An anti-inflammatory rich in antioxidants, cherries can be consumed not only as cherry juice but in raw or canned form and will reduce painful gout symptoms.
- Black bean broth is rich in anthocyanins, which are natural anti-inflammatory agents found in tart cherries and black beans.
- An anti-inflammatory rich in antioxidants, cherries can be consumed not only as cherry juice but in raw or canned form and will reduce painful gout symptoms.
Home Remedies For Gout
Because of the rise in health care costs and the popular inclination to try natural home remedies to prevent the need for prescription drugs and surgeries, many people are turning toward alternative remedies to treat gout. A number of these home remedies have been acknowledged for treating gout. But, are they effective or not? We will present a number of them below and discuss their likelihood of success.
1. Apple Cider Vinegar
Apple cider vinegar is used to treat gout because its acidity relieves the acute pain associated with gout and other types of arthritis. The vinegar increases the bodys alkalinity and has anti-inflammatory properties. Some individuals also add honey to the apple cider vinegar because of honeys anti-inflammatory properties.
The bad news is that you take the concoction by the spoonful, and apple cider vinegar isnt exactly known for its amazing taste. To be most effective, you need to take up to two tablespoons of apple cider vinegar three times a day. Scientific results are lacking in evidence that apple cider vinegar really works. There was a study in Japan in 2010 which looked at different diets to improve alkalization of urine to increase the removal of uric acid from the body. Apple cider vinegar was in one of the diets, but was not tested alone.
Success stories are hit or miss with apple cider vinegar and the treatment of gout. We give it two stars.
2. Ginger Root
3. Baking Soda
4. Lemon Juice
5. Epsom Salt
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Why Treating Gout Takes A 2
Gout treatment takes a two-pronged approach:
Medicines For Gout Attacks
The main goal of treatment during a gout attack is to decrease pain and swelling. Some medicines are safe for people with kidney disease, and some are not. Talk to your doctor about which medicines make the most sense for you to try.
Nonsteroidal anti-inflammatory drugs
NSAIDs are medicines that decrease pain and swelling. Some NSAIDs are available over-the-counter, like ibuprofen and naproxen sodium. Stronger NSAIDs like indomethacin and celecoxib must be prescribed by a doctor. Taking NSAIDs can lead to kidney disease over time or make kidney disease worse. NSAIDs may not be recommended when you have kidney disease even for the treatment of gout attacks.
Colchine is a medicine that can relieve pain. Your doctor may recommend taking colchine during a gout attack, or low doses of colchine every day if you have chronic gout. Colchine may not be recommended for people with kidney disease. Talk to your doctor about whether colchine is right for you.
Corticosteroids, also known as steroids
Steroids are strong medicines used to decrease swelling and pain. Steroids are usually only given for gout if you cannot take NSAIDS or colchine. Steroids can be in the form of a pill or given as an injection. Talk to your doctor about whether steroids are safe for you.
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How Do Doctors Diagnose Gout
- This is the most important diagnostic test. It is the ultimate method of being certain of a diagnosis of gouty arthritis, as opposed to other causes such as an infection in the joint.
- A needle is inserted into the joint to withdraw a sample of fluid for testing.
- The fluid is examined under a microscope to see if there are gout crystals or signs of a bacterial infection present. Sometimes other crystals can be found in the joint fluid, such as calcium pyrophosphate, which is caused by an entirely different condition called pseudogout .
- Gouty arthritis is sometimes diagnosed based on the typical clinical presentation without a joint aspiration.
- A doctor may obtain a blood sample to look at cell counts, uric acid levels, kidney function, etc.
- Unfortunately, the level of uric acid in the blood cannot be reliably used to make a diagnosis of gout. It is normal in approximately 10% of people during an acute attack of gouty arthritis. Moreover, uric acid levels are elevated in 5%-8% of the general population, so the presence of an elevated level does not necessarily mean that gout is the cause of an inflamed joint. Interestingly, the uric acid is typically lowered during a flare of inflammatory gouty arthritis. Therefore, the optimal time to measure the uric acid is after a flare has resolved when acute inflammation is not present.
What Is The Fastest Way To Get Rid Of Gout
- Nonsteroidal anti-inflammatory drugs : These can quickly relieve the pain and swelling of an acute gout episode. They can shorten the attack, especially if taken in the first 24 hours.
- Corticosteroids: These drugs can be taken by mouth or injected into an inflamed joint to quickly relieve the pain and swelling of an acute attack. Corticosteroids usually start working within 24 hours after they are taken.
- Colchicine: An anti-inflammatory medicine that works best if taken within the first 24 hours of a gout attack.
Medications for reducing uric acid levels: These are usually prescribed after an acute attack ends to reduce uric acid levels in the body to prevent future attacks.
- Colchicine: Regular and low doses of colchicine may be given along with other medications below to prevent flare-ups.
- Allopurinol: It reduces uric acid production in the body.
- : It reduces uric acid production in the body.
- Probenecid: It acts on the kidneys to help eliminate uric acid.
- Pegloticase: This is a medication that is injected every 2 weeks. It reduces uric acid quickly and used when other medications fail.
Lifestyle and home remedies to treat acute gout and can prevent recurrent attacks:
- Limiting or avoiding alcohol consumption and drinks sweetened with fructose
- Limiting intake of foods high in purines, such as red meat, organ meats, and seafood
- Drinking plenty of fluids
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Dont Stop Taking Your Uric
To effectively treat gout, you have to take urate-lowering therapy consistently. If you are having frequent flares and you want to treat the disease, you need to dissolve those deposits, Dr. Mandell says.
If youve already had an attack of gout, you are more likely to have others. Over time, gout attacks can become more frequent, last longer and involve multiple joints. Eventually, you can have joint damage.
Your doctor should take blood tests to check that your uric acid levels remain at the target. People with gout should know their uric acid level, Dr. Mandell says.
In the past, doctors advised their patients with gout to avoid foods high in purines, which the body metabolizes into uric acid. Steak, shellfish and seafood were all off-limits. However, research hasnt shown any dramatic benefit of adopting that kind of restrictive diet.
The idea that youre going to stop eating red meat and your uric acid level is going to plummet to the point where the crystals dissolve is very unlikely, Dr. Mandell explains. A heart-healthy diet is never a bad idea. But to ultimately stop future attacks, you need to stick with medication.
This article was adapted from Cleveland Clinic Arthritis Advisor.
What Else Can Be Done
Presumably your doctor did not prescribe the most common gout treatment, allopurinol, because it might interact with warfarin and raise the INR. Another gout drug, colchicine, may also interact badly with warfarin . Nonetheless, there are other steps you might take to decrease your risk of another flare-up with its attendant gout pain.
Research on mice demonstrated that an old medication, olsalazine , can bring uric acid down effectively . Your doctor might be willing to prescribe it.
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The Four Stages Of Gout
Gout is best understood by seeing it as having four phases or stages :
Stage 1: High uric acid
Elevated uric acid without gout or kidney stone, this stage has no symptoms and is generally not treated.
Stage 2: Acute flares
This stage is marked by acute gout attacks causing pain and inflammation in one or more joints.
Stage 3: Intercritical periods
These are periods of time between acute attacks, during which a person feels normal but is at risk for recurrence of acute attacks.
Stage 4: Advanced gout
This is a stage of chronic gouty arthritis, in which there are lumps of uric acid, or tophi , frequent attacks of acute gout, and often a degree of pain even between attacks .
Figure 1: Stages of Gout
Figure 2: Illustration of Toe Joint with Gouty Tophus. normal toe joint Urate crystals, shown in white, at the “bunion joint,” represent a gouty tophus.)
Figure 3: Progression of Gout
What Should Be Considered When Taking The Medication
Especially during the first few months of treatment, uric-acid-reducing medications may even increase the risk of gout attacks. The reason for this is that any uric acid crystals already present only break down gradually. When this happens, small particles of the crystals may be washed into the joint, where they then cause an inflammation that leads to a gout attack. That happens quite often. It is thought that it can take up to two years for the body to get rid of all uric acid crystals.
To prevent gout attacks during this time, low-dose colchicine is often also prescribed for the first six months. That effectively reduces the risk of those kinds of attacks. But even if one occurs, it’s not necessary to stop taking the uric-acid-reducing medication.
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