Taking Allopurinol W/out A Prescription From Dr.

[Wrong Turn]

I am a chronic gout sufferer. I've had many, many, attacks. More than 100. About 20+ have been acute.

I had a uric acid test last year when I had a gout attack in my knee. My uric acid level was 600/ml, which is three times the normal amount.

I never had different doctors recommend allopurinol to me, because I always went to a different doctor, in a different hospital in different countries. (This is what my last doctor visit for a gout attack in America told me. My Dr. told me I should have started Allopurinol a long time ago.

My Question:

A friend of mine gave me a large bottle of 300 MG tablets of Allopurinol. (I could cut the tablet in half with a razor blade and take 150 MG per day.)

Is it safe for me take just take one 300 MG tablet per day with breakfast?

Do I really need to get another blood test(s) done to figure out the proper dosage?

Do I need to have my liver checked for toxicity?

Do I need to consult a doctor about taking Allopurinol?

Thanks in advance to anyone that can answer. I have the bottle, but want to make sure it's safe for me to take them.

Edited May 24, 2008 by Wrong Turn

[lopburi3]

Although it is a relatively safe medication you really should have some tests done on a regular basis as you don't want to find out there have been liver problems at a late stage.

The normal range of Uric Acid is 3.4-7.0 mg/dl so not sure what your reading of 600/ml

This medication is a preventave (to lower Uric Acid) and is not used during an attack.

I have been taking 300mg a day for 20 years and have not had a gout attack since starting it (and am very happy about that) - and last Uric Acid test was 4.1 (last week).

[Prakanong]

I get gout but am lucky enough to be able to control with diet and if an attack naproxen ans cochinel

I have quite a few friends on alupruinol - there are adverse effects with it.

I work in clinical trials with research Dr's - please do not self medicate with this - its not like one dose of antibiotic as its for life. See a clinician, have the uric acid done each month for 6 months.

It may well be what you need and as Lopburi say's I know guys who never get attacks after being on it but there can be adverse effects - a Dr costs nothing then you can buy OTC

[Wrong Turn]

Lopburi and Prakanong,

Thank for you the advice.

I am going to follow it.

I'll get some blood tests done over a period of time to see if I can find out my uric acid level.

Liver problems with Allopurinol:

I have read that a small percentage of people get liver toxicity from allopurinol.

I assume this is a liver test after you start taking it?

Thanks for the advice - I will follow it.

[Prakanong]

Yeah - LFA's - Liver Function Analysis - it does interfere with them

If you are on hypertension medication you have to be really careful with Allapurinol

A Dr tried to put me on it last November afer my yearly medical and one test result. Luckily I work where I do and my GP is also excellent. Three Dr's in all spotted I should not be on it.

Its not for everyone but if its OK for you as Lopburi says you will never get another attack but find out all you need to know first.

[Prakanong]

Just while I was in the shower I remembered a few other things

I am not 100% but I think the starting dose is 300 like you say but they try to titrate it down unlike most other drugs wherethey start low and go up

Should not say this as it identifies people but I work with a Dr who was head of all Polyclinics in Singapore and have had some talks with him about gout - he does not like prescribing Allapurinol - prefers the diet change and Naproxen (or other anti-inflammatory and Cochineel route)

Take care as it bloody hurts and can be disforming if left unchecked - I had a good pal on dyalisis at Christmas in Bumrungrad through it - not wanting to be scary but he left it unchecked for years

[Gary A]

People suffering from gout can feel it coming on. I used to start taking colchisine but that is indeed a poison and if you take it as prescribed, you better not be too far away from a toilet. It makes my stomach hurt too. The doctor told me to take it until I felt nauseous.

Then a MUCH better doctor told me that gout will cause permanent damage to my joints and alopurinol may help. I have been taking one 100mg tablet a day and if I feel a hint of gout coming on I take an extra half a tablet until it goes away. It works well for me and any side affects would be minor compared to not being able to walk.

[Wrong Turn]

Just while I was in the shower I remembered a few other things

I am not 100% but I think the starting dose is 300 like you say but they try to titrate it down unlike most other drugs wherethey start low and go up

Should not say this as it identifies people but I work with a Dr who was head of all Polyclinics in Singapore and have had some talks with him about gout - he does not like prescribing Allapurinol - prefers the diet change and Naproxen (or other anti-inflammatory and Cochineel route)

Take care as it bloody hurts and can be disforming if left unchecked - I had a good pal on dyalisis at Christmas in Bumrungrad through it - not wanting to be scary but he left it unchecked for years

You noted a couple of points, Prakanong:

1. change in diet.

I have almost completely eliminated cheese from my diet, take fish oil pills daily, and drink 4 liters of water per day. (I still drink beer 4 days per week or more).

However....I have had only 1 gout attack in the last few months (about 4-5 months). For me, this is good.

Maybe diet is working, maybe not. I also avoid olives, wine, and other foods.

Colchicine

When I first feel a twinge, I take 1 MG or .5 MG with food. I've read it's a poison, but have never had a side-effect from it. I don't have problems with it.

Dialysis if unchecked for years:

Was this guy on dialysis because of higher uric acid levels, and/or gout?

I need to know.

Kidney function is a part of the gout process.

Again, thanks for the info and I look forward to any opinions from people on Allopurine now, or in the past, or gout sufferers.

tq

[Sheryl]

WT,

Allopurinol can have serious adverse effects on both liver function and bone marrow. Granted, this only occurs to a minority of people, but when it does, it is very serious, potentially even fatal. Anyone taking it should therefore be under a doctor's supervision and having periodic blood tests to monitor liver enzymes and blood count.

It does not sound like your condition requires taking thuis or any other medication on any ongoing basis, if you only have an attack every few months. In that case, a better approach would be to take either an NSAID or colchicine when the attacks occur, maintaining dietary measures that you have already done to keep thie frequency with which this happens to a minimum. And of course get your uric acid levels checked periodically.

Regarding that, I too cannot make sense out of "600/ml". Uric acide levels are reported either as mg/dL or as umol/L. Upper normal range for a man is around 8.5mg/dL or 500 umol/L. Maybe it was 600 umol/L rather than 600/ml? In which case it was above normal but not by a magnitude of 4, even counting from the lowest end of normal.

Colchicine and NSAIDs also have potentially serious side effects but these are unlikely if used on an infrequent basis. As ide from serious side effects, colchicine can cause diarrhea and vomiting, in fact the usual protocol for using it in an acute attack is 1 mg every 2 hours until symptoms stop or diarrhea/vomiting occur. But in no case to exceed 7mg total ion a 48 hour period.

Always better to avoid chronic medications if you can control a problem with diet etc.

Regarding kidney damage, it can occur, altho it is often due not only to gout but also to high blood pressure and diabetes, conditions that often accompany gout. Keeping your uric acid levels, blood dugars (if diabetic) and BP within normal range will help prevent kidney complications.

Good luck

[Wrong Turn]

WT,

Allopurinol can have serious adverse effects on both liver function and bone marrow. Granted, this only occurs to a minority of people, but when it does, it is very serious, potentially even fatal. Anyone taking it should therefore be under a doctor's supervision and having periodic blood tests to monitor liver enzymes and blood count.

Thanks for this info. I'll consult a doctor.

It does not sound like your condition requires taking thuis or any other medication on any ongoing basis, if you only have an attack every few months. In that case, a better approach would be to take either an NSAID or colchicine when the attacks occur, maintaining dietary measures that you have already done to keep thie frequency with which this happens to a minimum. And of course get your uric acid levels checked periodically.

Yes, lately it seems to attacks are becoming less frequent. (I did have a mild attack last week.)

When I have an attack I take Endomathacin (anti-inflamm), and drink a lot of water. I take Colchicine in the initial stage (when I feel it coming on).

Regarding that, I too cannot make sense out of "600/ml".

I must have made a mistake. I've got the paperwork in a file. I'm wrong on this number but my uric acid level for the knee gout attack it was extremely high, according to my doctor.

Colchicine and NSAIDs also have potentially serious side effects but these are unlikely if used on an infrequent basis. As ide from serious side effects, colchicine can cause diarrhea and vomiting, in fact the usual protocol for using it in an acute attack is 1 mg every 2 hours until symptoms stop or diarrhea/vomiting occur. But in no case to exceed 7mg total ion a 48 hour period.

Always better to avoid chronic medications if you can control a problem with diet etc.

Regarding kidney damage, it can occur, altho it is often due not only to gout but also to high blood pressure and diabetes, conditions that often accompany gout. Keeping your uric acid levels, blood dugars (if diabetic) and BP within normal range will help prevent kidney complications.

Yes, I want to avoid daily/chronic medications as much as possible. NSAIDs are not good over the long-term. As for allo, I'll play this by ear and see what happens in the next few months, with the gout.

Good luck

I appreciate your info Sheryl, and everyone else's.

[Prakanong]

My last two yearly medicals have been around 9.6mg/dL and it was one reason the strange Dr tried to put me on Allipurinol without knowing my history - I am at the upper end but my GP who I see monthly thinks I must be able to tolerate the higher level without an attack - only one or two mildish twinges in the last 4 years - nothing that stopped me walking like the really bad attack I had in 2004.

I work with a lot of research Dr's who I can ask all sorts of questions of regarding health over lunch etc - none of them as well as my GP think I need allipurinol.

My pal who I mentioned who ended up on dyalisis at Bumrungrad at Chritsmas with kidney failure had severe gout for years - deformed elbow joints and knuckles etc. I used to ask why his Aussie Dr had never considerd allipurinol but he brushed it off - he may not have followed advice but I really do not know.

I know he was stuck in his hotel bed then next time I went down I was told he had been rushed to hospital.

Out of 9 of us working in Belgium and drinking together 6 of us developed gout at about the same time - age and diet I suppose but as I said my change of diet to mostly Asian has me luckily not having too many twinges - keeping very hydrated helps as well.