Newly diagnosed with gout, no symptoms and was prescribed uloric..

Hi rustygecko,

You are correct, I am from the US and do have private insurance.. was it obviously? Any who, thanks you for responding, I am new to the site and wanted to seek advice after reading some helpful posts.

I forgot to mention that I am overweight, obese. I have a sit all day desk job and try to take 250 steps an hour (helpful watch). I do not do any physical labor and just started walking / jogging for 30 minutes 5-6 times a week. I am keeping hydrated with plain water. Oh, I live in California and it does get hot here.

My concern is that I will start to experience flares once I start taking the prescribed medicine... Do you know or have experienced this?

Thanks again.

I also read about the different stages of gout. I asked my PA and she said, "no, you have gout".. she didn't mention anything about the four stages.... I guess she confirmed that after I said that gout runs in the family..

Let me know your thoughts.

I don't know what a PA is.

According to the definition of gout by the medical system in the UK - you don't have gout. You may however be going that way.

I'd say the car crash hasn't happened yet, but you are driving too fast and a bit drunk. If you change your behaviour the accident may be avoided :-D 

Rusty, thank you so much for the response and information. I apologize for the late response.

After two months, I went back to get my uric acid test again. For the last month, I have drastically changed my diet and intake and have lost 10+ pounds. My results for my UA remains the same, even after 2 months of changing my ways. I was on spironlactone since March 2017 and stopped taking it upon posting my initial concern. I read that spironlactone contributes to increasing uric acid levels hence the reason I stopped taking it. Have been clear of spironlactone for a month and still no change in my UA level. I have not started taking uloric or Allopurinol but am considering it now but I am scared I will get a flare(s).

Uloric, my doctor provided it as a trial.. 7ct to try it out but actually prescribed my Allopurinol but as I've mentioned above, I have not started them yet.

My doctor is now asking if I have started taking it and I have not. Do you think it would be best to start taking it? I know you've mentioned that you would wait 6 months; I've done one month so far, should I continue trying this new way of eating more healthy or just start on uloric/allopurinol?

Thank you in advance!!

Hi Icki

I’m glad you appreciated my information.

Urolic (that’s the US name), has a higher rate of death than allopurinol. It is however expensive, allowing the producer to entice prescribers. Look at the doctor giving you a free trial - why would he do that? Because the drug company gave it to him. He will then allocate you to his “tria” for the drug company and for recruiting you to the “trial”, and writing the occasional three line report or ticking some boxes he’ll get the easiest $1000 he’s ever got - but for the drug company they have you for maybe 50 years.

The doctor also feels good that he’s a leading edge doctor prescribing the latest drug.

Note that in Europe where most of what drug companies do in the USA is illegal, allopurinol is the drug of choice for non Asians - why? It’s old and cheap and it works and it’s well understood.

The problem with both Uloric and allopurinol or any drug which reduces blood urate - it may trigger gout attacks as the stores of mono sodium urate are flushed out.

As I said, I take allopurinol it works. There were teething problems (it troubled my stomach at one point - solution - hid it inside a piece of banana), but even that resolved - don’t know why. Also it made me very tired in the first month (solution - take at night - slept like a log).

Now a couple of years down the road I’m tophi free, tingling hands free, no pains in big toes and it’s a non issue.

Whatever you choose good luck - and drink water. 

Hi rusty,

Thank you again for your response and happy holidays to you!

I told my doctor about my concerns and she suggested that I can start taking uloric. But it's expensive. I plan to start taking allopurinol this week in hopes that it will lower my levels and not cause a flare/s. I wanted to ask you. When you first started allopurinol, did it cause flares for you and prior to taking allopurinol, how frequent were you having flares if any? And what was your dosage when you first began?

I sometimes still question if I should even take the medication.. or get a second opinion. I've based my conclusion on two blood tests, first one done in September and second just last week and my levels remained at 9.5 even with diet and exercise.. if you were in my shoes, would you start allopurinol? My doctor prescribed 300mg..

Thank you,

Also, why do you say allopurinol is the choice of drug for non Asians? Are Asians taking other routes?

There is a well established allergy with Allopurinol associated with a genetic variation in Asians (e.g. HLA-B*58:01 allele). Uloric does NOT create allergic reaction to this population, so is preferred.

The reason Uloric or Allopurinol can cause a gout attack is Uric acid builds up in your tissues when you have a high uric acid levels. When the production of Uric acid falls dramatically (when you take Uloric or Allopurinol), and the Uric acid in your tissues is released and causes a gout flare. If you continue to take Uloric, the gout flare will eventually subside. If you continue to take Uloric, you shouldn't have future flares. Uloric is more powerful than Allopurinol.

The patent on Uloric expires in May 2019 so it should go generic and be priced comparably to Allopurionol at that time.

I find that taking high potency Bromelain (GDU 2500 - 3000) with colchicine dramatically improves its effectiveness.

I hope it goes well for you.

There are many references to support the assertion that Uloric is stronger than allopurinol, but here is one from MDmagazine: "we found that in most commonly used doses, a significantly higher proportion of patients receiving febuxostat (most common dose, 40 mg/day) achieved a target sUA of <6.0 mg/dl and <5.0 mg/dl compared to those receiving allopurinol ..."

Yes, I am aware of these. But they seem to be saying that against a dose of 300mg they are more effective. But of course all one has to do is increase the dose of allopurinol. Febaxostat does have the advantage that most of the action is happening in the liver, and not in the kidney, and the liver is bigger and more resilient which I’d guess is advantageous.

Dosing of Allopurinol is more complex than simply increasing the dose arbitrarily until the patient achieves the target sUA. Standardized doses are created specifically to balance the effectiveness of the drug, and the risks and side effects associated with its use. Using dosing outside the standardized ranges creates risks for patients for which there are no studies or research to provide guidance on potential risks.

Allopurinol is tested and approved up to 800mg day. The reason that the standard dose tends to be 300 is the size of the tablets (300 and 100).

 Allopurinol (and Fabaxostat) is supposed to be increased “arbritrarily” until the right dose is found that blood tests indicate the urate is low enough. In the U.K. the NICE has issued guidance that doctors should be more proactive in lowering blood urate. Most I suspect give out the pills and forget about the patient. The blood is supposed to be retested regularly.