Starting Allopurinol - when can I expect an attack?

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Nothing is working any more so am resigned to taking this drug. I gather that i can expect a gout attack as the crystals start to dissolve. I need to time this as well as i can for office days and not my out and about days.

So, when can i expect a likely flare up - within a few days or a few weeks of starting my 100mg dose? Any guidance would be good as if I take it now and get a flare in 5 days that will be a disaster. If I get a flare in 9 days that is manageable. I have steroid tabs to take if I get an attack and they might be able to dampen it down mind... Dicolfenac and the others dont really touch them any more...

Thanks for any advice .

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  • Posted

    Never been in that situation so can't advise on that basis, and wouldn't it be best to ask the doctor or pharmacist?

    Do I gather you have recently had an attack, but do not have one currently, and just got back a bad blood test so you're finally going on allopurinol?

    I see the plasma half-life is just a couple of hours, so I'm guessing that whatever it's going to do would come pretty quick, but that's just a guess. I also see, "Normal serum urate levels are usually achieved in 1 to 3 weeks", but that's not when it starts, that's when it ends, it sounds like.

    I also note that 100mg is a small dose, so it may do little for a while and then they'll try a larger dose. Again, just guessing.

    Good luck.

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    • Posted

      My understanding is that Allopurinol takes a year to work. The crystals take ages to disperse from the tissues once more normal blood urate level s are slowly achieved? And they can kick off and scream as they decompose!

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    • Posted

      A year "to work", but that's like how long to finish, I would think, your question is more like how quickly they begin to work.

      Which, I suppose, is going to vary.

      FWIW the celery seed that I have found so effective has never triggered an attack.

      My urate levels stay just at - or just over - the acceptable levels, but that's a pretty big improvement for me from where they've been.

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    • Posted

      What is the simplest way to verify that my joints have MSU crystals or not? How can I be sure I have managed to dissolve them completely?

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    • Posted

      There is a test which involves sticking a fine needle into the joint, extracting liquid and looking it under a microscope. This is rarely done as its not without a small risk and will only tell you what you can guess anyway.

      Once the level of blood urate is down, the lower the quicker it will happen - the crystals will dissolve back into the blood and over weeks or months will resolve. From memory most people it takes under 3 months but a few percent take up to 15 months (haven't read this for years but it's something like that - mostly it's quick but for a few it isn't).

      Once the crystals are liquid again they're flushed through the kidney.

      Two of the reasons people don't follow treatment - and only 30% follow the treatment is a) the treatment initially causes gout symptoms which can be treated with colchecine b) people think they have no gout so they stop treatment - leading to a build up of urate over a period and more gout at some point.

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  • Posted

    If you do not have hypertestion, I highly recommend that you drink 1 teaspoon of baking soda mixed with 1 glass of water every after meal.

    I have been taking this for almost 6 months now and it allows me to even eat regular portions of pork, beef, chicken and fish and I did not have a gout attack so long as I take the baking soda mixed with water.

    God bless you.

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  • Posted

    In the UK you would be given colchicine to be used as prophylaxis against an attack during the first few weeks - probably one in the morning and one at night would be sufficient. Drink plenty of water. 100 mg is probably not enough to do the trick so have your blood uarate checked in a few weeks.

    Only a very few % have a problem with allopurinol so stick with it, as the objective is not to stop the gout, but to stop the damage to your heart and kidneys etc caused by high blood urate. NB one of the side effects of allopurinol is to reduce cholesterol levels.

    Drink more water to help your kidneys flush the urate.

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  • Posted

    Be prepared for a violent attack, mine started around the 7 - 8 day mark. Not trying to worry you but get as many painkillers as you can. Try vinegar cider in water I think it helped, but I would have tried anything.

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  • Posted

    I was given naproxen to take alongside the allopurinol for the first couple of weeks. Taking the two together prevented a flair up. The dosage was then doubled at my next checkup, but that didn't cause any problems and I didn't need naproxen then. I'm due another blood test now to see what my uric acid levels are like.

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  • Posted

    Thanks for the date range Adam - this is what I was looking for - actual experience.

    I have tried everything home made and natural - from cider vinegar to celery seeds to various cherry stuff and still take them all regularly with Vit C. They helped in the early days but I basically have constant gout now in my feet. My ankle was glowing red on the weekend and I have been on 3 dicolefenac a day for 10 days now - yet still it comes and goes. Got up this morning to a painful left foot.

    I think I'll request colchicine as prophylaxis before I start taking the Allopurinol - just cant be losing a few days work as self employed again. Nightmare, And of course my gout is pretty constant so they say not to start Allopurinol but I'll have to - some say its no big deal to do that in fact...

    I found the steroids are the only thing that can actually tackle a flare up - the other drugs are barely effective and very slow acting. Cant take steroids regularly though but good to know I have a pack.

    Thanks for all responses.

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    • Posted

      My experience.

      I started allopurinol about 5 years ago (and took colchine for first few months as well).

      My dosage of allopurinol was increased over time. Once started - do NOT stop taking it.

      **Critically, I have no side affects and have no gout attacks.

      **

      My impression is that RustyGecko makes valuable contributions to this forum. We have no connection.

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  • Posted

    Same here mate

    Since starting Allopurinol 2 months in. I had the attack from hell. Now I have attacks, changes big toe to big toe and all the joints imaginable almost every week, bearable but still no fun.Its starting to wear me down, I wish I could give you better news.I am written off sick. I find all the medication I have taken doesn't touch the pain.

    Chin up mate, just pre pairing you for what might happen

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  • Posted

    I had an attack of Gout and was in severe pain unable to put my foot to the ground. My GP took blood and urine samples and packed me off for Xrays to my feet and hands. I was found to have gout in the fingers of both hands and in the toes of both feet. I was then put onto Allopurinol 100mg and luckily haven't had any furthur bouts of gout thank goodness. There is another pill she has told me about and will prescribe if I have any furthur problems Colchicine 500mg this is for an Acute attack the most tablets she would prescribe is 12 but they can cause diarrhoe, the Doc told me they have to be taken the first day of an attack (how this would be possible I don't know as it takes 2-3 weeks to see a doc). I suppose they would see you as an urgent case which would mean waiting till all patients who have appointments have been seen. Hope none of us have any more bouts.

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  • Posted

    After a number of years of severely crippling gout I went back on Allopurinol. You do have to let it kick in . In my case a couple of weeks. First time round my gp didn't warn me about this but a friend did. Four years on, and not a single attack

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    • Posted

      change your GP, if they are so negligent in the basics - then what else are they asleep at the wheel with? Have thry been testing you annually? Did thry warn you if the life threatening dangers of allopurinol during the first few weeks? Did they warn you of the consequences of not controlling high blood urate etc etc.

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    • Posted

      Hi,

      I had a very very painful period of Gout hence being put on allopurinol my GP did not say any side effects were possible. I had an xray taken of my hands as they have arthritis in them however Gout was found in my fingers which at times are so painful. It would seem from your last post I should be having a strong word with my GP> Thank you for your comments. M

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