My starting allopurinol guidelines describe the correct way to start and stop taking allopurinol. In essence, you should start taking allopurinol as soon as gout is diagnosed. In most cases, you will continue to take it for the rest of your life, but see the guidance on “allopurinol vacations” below.

Starting Allopurinol Purpose

I wrote Starting Allopurinol to help gout sufferers discuss their pre-treatment expectations with their doctor. Also, for completeness, I’ve included longer term expectations. Because this supports the Purpose of GoutPal.com. By encouraging Gout Patients to engage with their doctor’s uric acid treatment plans.

Specifically, this article applies to step 3 of your gout patients plan. Or step 4 at the latest. But don’t worry if you’ve already started taking allopurinol. Because every case is different. So all GoutPal plans encourage you to retrospectively discuss your concerns with your doctor. Then take whatever remedial action suits your unique circumstances.

If this isn’t exactly what you are looking for, I suggest you consider the starting allopurinol related links below.

Starting Allopurinol Preparation

Recent gout research has identified certain genetic profiles that indicate a high risk of Allopurinol Hypersensitivity Syndrome (AHS). If you fall into the high-risk ethnic groups, your doctor should arrange genetic screening tests prior to choosing allopurinol as your uric acid lowering medication. Please see Minimize Allopurinol Side Effects for more information.

Whichever uric acid lowering treatment applies, you and your doctor should agree on a target uric acid level (note that this is encapsulated in professional guidance from rheumatologists, but often overlooked in practice). The target level should normally be 5 mg/dL.

For most gout sufferers it is better to aim for at least one year with a lower target. Because that helps get rid of old uric acid deposits as quickly as possible (Effect of Urate-Lowering Therapy on the Velocity of Size Reduction of Tophi in Chronic Gout). For this reason, I started with maximum allopurinol dose. As I wanted to resolve visible tophi as quickly as possible. So this is something you and your doctor might consider.

For some gout patients, there might be medical reasons to restrict uric acid lowering medications. In this case, it might be necessary to accept a target higher than 5 mg/dL. This must be managed by your doctor on a case-by-case basis.

Finally, before starting allopurinol, you must be prepared for pain control for at least six months. As explained in step 2 of your Gout Patients Plan.

Starting Allopurinol Dosing

Allopurinol should be started as soon as possible. Every day of delay means more destruction of joints and damage to organs. Skin, kidneys, and heart are most commonly damaged, but you will see in the gouty tophi guidelines that all organs are at risk. Specifically, ignore common bad advice to wait until your gout flare has subsided before starting allopurinol. Initiation of allopurinol at first medical contact for acute attacks of gout makes it quite clear that starting allopurinol dosing should not be delayed.

Allopurinol should be started at no more than 100 mg per day. This dose is rarely effective in achieving target uric acid levels. But it will reveal if you are susceptible to adverse reactions without danger. After two weeks, your doctor should confirm the lack of side effects with further blood tests for liver and kidney function.

The dose should then be increased to reach your target uric acid level. Blood tests for uric acid, liver function and kidney function should be repeated periodically and the allopurinol dose adjusted accordingly. Tests are likely to be monthly at the start of treatment, but less frequent once uric acid levels stabilize. You need to be tested at least once per year for the rest of your life.

Allopurinol Dosing Results Chart
Get the right allopurinol dosing for fastest gout recovery.

Ending Allopurinol Dosing

There is a strong case for suggesting that, once started, you should never stop taking allopurinol. However, this “allopurinol for life” approach is a safe fallback. So your circumstances might suggest a different approach.

Certainly, you should not normally stop taking allopurinol once started except for clearly defined medical situations. There is a body of opinion that believes allopurinol should be stopped during a gout flare. This is absolutely wrong. The only time you should stop taking allopurinol is if you experience the serious adverse reactions that are listed on your product label information.

Allopurinol Dosing Vacation

Some authorities suggest that, with good ongoing monitoring and management, it is perfectly feasible to stop taking allopurinol for many months once it is established that all old uric acid deposits have dissolved. As techniques improve for measuring uric acid deposits, it may well be that future recommendations are for short periods of uric acid lowering treatments whenever deposits are detected inside the body.

Please note that, at the moment, this type of monitoring and management is beyond most medical practitioners. However, if you feel that you are a candidate for an “allopurinol vacation” you should discuss this with your doctor, referring to Using serum urate levels to determine the period free of gouty symptoms after withdrawal of long-term urate-lowering therapy

Starting Your Allopurinol

Many gout sufferers are apprehensive about starting allopurinol. But you can allay your fears by checking the key actions:

  • Ensure you have your gout pain control plan.
  • Identify if you are in an allopurinol hereditary risk group. If so, arrange your genetic screening test.
  • Agree uric acid targets (debulking and maintenance) with your doctor before starting allopurinol.
  • Start allopurinol at no more than 100 mg per day.
  • Arrange blood tests for monitoring uric acid treatment progress and safety.

Remember that my plans present your steps logically. But you and your doctor can arrange your own sequence to suit your circumstances. If you have already started allopurinol and missed any key actions, discuss them with your doctor. Because doctors have the expertise to adapt logical plans to match your personal situation.

Share experiences of starting allopurinol in the gout forum. Or tell me your story using the feedback form below.

Leave Starting Allopurinol to browse the Allopurinol guidelines. Or return to Gout Progression Phase 5: Start Uric Acid Cure.

Starting Allopurinol Comments

GoutPal visitor responses and associated research include:

Starting Low Dose Allopurinol

Richard asked:

I see many references to starting allopurinol below 100 mg daily. Then titrating the dose very slowly to achieve target uric acid level. But splitting pills seems messy and inaccurate.

I explained to Richard that there is a long history and established practice of using compounding pharmacists to supply any medicines at any dose the physician deems best for optimum treatment. Clearly, this is something that your doctor can arrange. Though there will be cost implications for non-standard preparations. As this is a common situation, a team of pharmacists in New Orleans Louisiana have recently studied the practicality of making allopurinol available in liquid form[1]. Because this makes fine adjustments to allopurinol dosing much easier. They also address some common concerns about allopurinol shelf life. So they tested the liquid allopurinol suspensions to show that they are stable “for 180 days in the refrigerator and at room temperature, thus providing a viable, compounded alternative for allopurinol in a liquid dosage form, with an extended beyond-use-date to meet patient needs.”

Please remember: to find more related pages that are relevant to you, use the search box near the top of every page.

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Other posts that include these terms:

Starting Allopurinol Spelling

Like many medicines, allopurinol is often misspelled. Though spelling is often overrated, it pays to take extra care with medicines, as a misunderstanding might cause treatment problems in the unlikely event of a similar sounding drug being taken mistakenly.

Additionally, bad spelling or using brand names can make searching for information difficult.

I have now moved spelling tips to the allopurinol facts page. So see Allopurinol facts for Zyloric.

Starting Allopurinol References

  1. Pramar, Yashoda V., Tarun K. Mandal, Levon A. Bostanian, Giang Le, Tommy C. Morris, and Richard A. Graves. “Physicochemical Stability of Compounded Allopurinol Suspensions in PCCA Base, SuspendIt.” International Journal of Pharmaceutical Compounding 24, no. 5 (2020): 413.

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