Reply To: Allopurinol dosage and gout pain relief

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#3682
nobody
Participant


I’m not aware of hard evidence (as opposed to conventional wisdom which is subject to biases) but it’s not so much a matter of getting this “wrong” as a matter of over-simplifying it.
If xanthine inhibitors were all there is to SUA and if all deposits were equally exposed to blood flow throughout the dissolution phase, your reasoning would be sound. But the actual system is a lot more complicated. Generally, you’re most likely right but there’s room for doubt when it comes to particulars such as how quickly people ought to increase their dose and when they ought to stop increasing it. Clearly, the optimal approach isn’t going to be the same for everyone.
It’s not necessarily that easy to prevent symptoms by the way. Your forum is replete with people who can not this drug or who are already taking the maximum dose of that drug.

My non-expert opinion is that there’s little point in wasting the time of someone who has an SUA above 10 with small doses.
You still need to make sure the body tolerates the drug of course but there are doctors who slavishly follow protocols devised by profiteers and who would therefore (in Europe and North America) make their patients ramp up allopurinol slowly but prescribe a much stronger initial febuxostat dose whatever the patient’s status and history ought to tell them about the balance of risks involved.
It seems to me the main issue in cases where SUA is very high should be whether patients would benefit from a drug or at least dietary intervention that helps with UA excretion in addition to the xanthine inhibitor. If there are enough deposits to overwhelm the body’s UA excretion abilities, no xanthine inhibitor dose is going to be sufficient to prevent temporary hardship.

My anecdotal experience has been that a moderate dose is sufficient to make my SUA fall like a stone and that there are no worthwhile benefits from getting very low (as opposed to merely satisfactory) SUA test results. But I’m of course not claiming that what I gleaned from my experience is generally applicable. I’ve never had obvious tophi for one thing.