Keith (the site’s owner) advocates the maximum dose which would be 800mg or 900mg but I think that would be pointlessly risky in most cases.
I certainly advocate 900mg allopurinol per day (UK maximum) for me. But, I hope I have stressed that every gout patient must work with their doctor to maintain the correct dose for that person. Importantly, they must consider how to manage dose changes safely. So, the safe way to use allopurinol is:
1. Start with 100mg and assess effects on uric acid, kidney function, and liver function.
2. Increase allopurinol dose over a period of time to achieve target uric acid for debulking.
3. Monitor uric acid crystal debulking to assess when to move to the maintenance phase.
4. Decrease allopurinol dose over a period of time to maintain the agreed long-term safe uric acid levels.
5. Check annually and adjust dose as necessary.
I should emphasize that monitoring your blood with the 3 tests at step 1 is vital throughout. Also, you have to discuss any perceptions you have about side-effects with your doctor. Most importantly, the time periods, doses, and targets are different for every gout patient.
Prior to starting allopurinol, I spent lots of time researching risks. Then, I reached the personal conclusion that the risks of untreated gout compared to allopurinol are an ocean compared to a teaspoon.
The only downsides I found were situations where dinosaur doctors insisted on prescribing allopurinol negligently. The upsides indicated many positive advantages from long-term allopurinol use.
So, I really don’t understand “pointlessly risky in most cases”
To me, risks are only pointless when you take them without consideration. Therefore, taking ANY dose of allopurinol is a pointless risk without the detailed personal allopurinol treatment plan that I summarized in 5 core steps.