Allopurinol is the most commonly prescribed drug for the prevention of recurring gout attacks. It comes under the class of drugs called xanthine oxidase (XO) inhibitors. XO helps to convert purines into uric acid. So if this reaction can be prevented or slowed down (e.g. by taking allopurinol) then less uric acid will be produced and blood uric acid levels will fall.
The problem with the drug is that it only works while it’s being taken. Once stopped, the inhibition of XO also stops, so your uric acid levels can rise again, which is why allopurinol is usually taken for life.
Allopurinol is generally started between 2 and 3 weeks after a gout attack has abated. The recommended dosage is between 100mg and 300mg per day usually in one oral dose. But for some people higher doses of up to 800mg per day may be required initially.
And it may take some months before your doctor arrives at the correct dosage for your particular case; perhaps starting off with 1 x 100mg tablet per day. The objective is to get your blood uric acid down, and stable, below 6mg/dl.
When taking allopurinol for the first time you may experience a gout flare. But don’t be alarmed, this happens in around 75% of cases, so you won’t be alone.
The flare happens because there is a relatively fast reduction in blood uric acid levels that partially dissolves existing uric acid crystals, so that the now smaller crystals are able to move from the cartilage into the joint cavity where they inflame the soft synovial membrane.
When this happens don’t stop taking your allopurinol…
Why You Shouldn’t 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 it’s 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 you’d be continually setting your recovery back to day 1 each time you did.
Don’t stop the medication, but do contact your doctor. They will usually reduce your allopurinol dose or prescribe a non-steroidal anti-inflammatory drug (NSAID) 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 it’s 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, you’ll reap the benefits.