Have been taking 300 mg daily allopurinol for over a week now

[Kevin Cochrane]

Hello, just joined up, finding this website and it’s advice is what finally convinced me to stop playing around with diet and get on allopurinol. I have been suffering for 17 years now, my last blood test revealed a uric acid level of 416 umol (sorry, can’t get the proper backwards ‘u’ to work on my laptop) which, in Canada is considered a ‘normal’ level which has been a big part of why my gout has never been taken very seriously by me or any doctor I have dealt with here until recently. Fortunately, I met a doctor at a walk in clinic here who had no problem issuing me a prescription for indomethacine, colchicine (which is what I have been taking for about 5 years now to deal with flare ups) and a 300 mg daily dosage of allopurinol. I started taking the allopurinol on November 11, 2015 and while my gout hasn’t really flared up to a worse level, thanks I think in part to the indomethacine, it hasn’t really started subsiding either. Now, based on my research and reading other people relating their problems here I don’t expect an overnight cure but I am curious if anyone can estimate when I might start seeing light at the end of the tunnel. My allopurinol prescription runs for 90 days and at that time I am to take another blood sample and see where my level is at. I haven’t really modified my diet short of avoiding what my triggers are which most definitely seems to be anything to do with tomato juice or sauce and I have been taking some cherry concentrate pills and may start drinking cherry concentrate in my drinking water as well which didn’t seem to do a lot of good. I think due to my job which involves a lot of standing in one place operating mobile crane trucks and the cooler weather which chills me after a few hours that really seems to aggravate my symptoms most of all. I have swelling/pain in my right foot and it has been dragging on now for over a month and I am getting frustrated. Any support or input would be appreciated, thanks everyone for now and for anyone reading.

[Keith Taylor]

Hey Kevin, great first post.

I’m pleased you are finally taking control of your uric acid, so I hope I can help you do this successfully.

I’m not happy with your treatment plan, but it’s better than nothing, and something we can work on to improve. Before I can do that, I have to turn the tables on your main question (“I am curious if anyone can estimate when I might start seeing light at the end of the tunnel”) and ask you: “How long do you want it to take?”

There is no simple formula to say how long it takes to get rid of gout permanently. We do know that uric acid crystals mostly dissolve when uric acid falls below 300 ?mol/L [hint: copy and paste mu from the table in the right side bar, or type μ ]

In good uric acid lowering treatment plans, you have 4 phases:
1) Titration – increase allopurinol dose to achieve target uric acid for phase 2
2) Debulking – maintain low uric acid until 6 months have passed without a gout flare
3) Stabilizing – reduce allopurinol dose to achieve no higher than 300 ?mol/L. You might need to go a little lower to account for cold working conditions, but this is something to consider later.
4) Maintenance – monitor with annual blood tests for the rest of your gout-free life.

For safety, all blood tests should include liver function and kidney function tests, as well as uric acid.

So returning to the question of how long it takes, I hope you can see why I ask how long you want it to take. In the following list, I’m going to give you some facts that your doctor should know. I can see you’ve been badly let down in the past. I hope, with the facts, and a clear idea of what you want to achieve, you can train your doctors to give you better treatment. Each of the 4 phases is variable, and though you can’t easily forecast the duration, you can certainly lengthen or shorten them:

1) Titration is much quicker if you opt for the minimum period between tests. That is 2 weeks. I can accept up to 6 weeks, but anything beyond that just says to me that somebody isn’t taking gout recovery seriously. It’s not necessarily wrong, but is 11 wasted weeks what you want?
2) Debulking is much quicker if you get uric acid as low as possible. There is no lower limit for uric acid. The main problem is persuading doctors that it is healthiest to aim for a very low target. If you need help persuading them, I can dig up some facts and figures about the dangers of allowing uric acid crystals to hang around longer than necessary.
3) Stabilizing isn’t much of an issue really, though it can be done quickly or slowly according to patient preference.
4) Maintenance. The whole point of the above is that by reducing the first 3 phases, you increase this 4th phase. Gout-free happiness for more years.

And the short answer is – get below 300 and my rule of thumb is one month for every year you’ve had high uric acid. Get below 200, and you can probably halve that. This is totally unscientific, but should give you a ball park you can work with.

As for diet, forget it! Gout is not an eating disorder. Just eat a healthy balanced diet (i.e. good for your heart etc), and let allopurinol take care of everything else.

Kevin, I hope this helps you get the gout treatment that suits you best. It’s a bit long-winded, so if I need to clarify anything, please ask.

[Kevin Cochrane]

Thank you very much for your reply Keith, sorry I didn’t reply sooner to this. I have been able to stay off indomethacin now since the 25th and started taking 2 tablets of colchcine (0.6mg) daily on Saturday, November 21/15. As of today, Nov. 30, I am pretty much pain free, with as good of flexibility as I have managed over ten years anyways. I will definitely take your advice and bump up the next blood work exam, I just met and set up with a new doctor on Friday, Nov. 27 and she seemed very co-operative so I am sure I can get a blood test done soon and see where I am at. I will keep you posted as to my progress but for now, I do seem to be returning back to a more normal state. The flare up set in severely Oct. 18 so it did drag on for some weeks.

[Keith Taylor]

No worries about rushing to reply, Kevin. Sometimes I have trouble posting as quick as I would like.

Everything sounds nice and positive. It’s nice to see things moving forward.

[JCA]

Hi

I am 46 and have had gout for about 15 years now but only about one flare up, or two at most, each year until 2015. Last year I probably had it about 4 times including once in the days leading up to Christmas – I know diet does not bring on instant attacks but I am guessing the indulgence of things I don’t usually eat didn’t help.

With it being previously manageable I took cherry extract and doubled the dosage along with either some Alieve or Ibuprofen at the first signs. Unfortunately this time it is a really bad episode. I am hoping to continue to control my goat with diet, which hasn’t been great in the past – partially because of my embarrassing but very real needle-phobia! I was looking to minimize beer drinking, cutting down red meat to once a week maximum and eating a lot more fresh fruit and veg.

Other than the obvious (and telling me to man up over my phobia) are you able to offer any dietary advice and would you imagine it would work.

Thanks in advance for any help and the great resource that this site is for us got sufferers.

Jason

[Keith Taylor]

Hi Jason,

Diet can certainly work in some circumstances. Gout diet is just another form of gout treatment. For some people, it is all they need. But, just like any gout treatment, it all comes down to controlling uric acid.

If you really cannot get a blood test, it obviously limits your options. Some people use uric acid test kits at home. Even that needs a finger prick. If it sounds like you could cope with it, it might be a way forward, but not ideal.

I’m quite worried, because 15 years is a long time for uric acid crystals to accumulate. They get increasingly dangerous as time passes. In your position, I would talk seriously to someone about that phobia. There’s nothing that can’t be overcome with patience and understanding.

Obviously, I can give general advice about healthy eating for gout. I just worry that it would be pointless if your real cause of gout is genetic. I’m happy to help you improve your diet, even if you can’t test if it is helping your gout.

Anyway, Jason, have a think about this, and tell me how I can help you best. I am continuing to reply in this forum when I can. However, my priority is posting in my new gout forum, where you will get faster responses.

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