Thank you for your patience on your first post here. First post gets moderated, but all your subsequent posts go straight through.
The process you describe for allopurinol treatment is almost perfect. The graduated program is so that your doctor can check your reaction to allopurinol during the first few weeks. Your uric acid tests should be accompanied by liver function and kidney function tests. This is not to alarm you – it’s a safety check, and is almost always OK.
You are lucky to have a doctor that cares, and understands the correct protocol. At least, she seems to. I have a complaint, and a minor observation.
The minor observation is that, the 100mg start and increment should be reduced to 50mg in some patients with chronic kidney disease. I’m hoping this doesn’t apply here, hence ‘minor.’ Clearly, it’s not minor if you fall in that category.
My complaint concerns ‘topping out at 300mg’ 300mg has no significance whatsoever for allopurinol dosing. If your allopurinol label mentions maximum dose, it is generally 800 or 900 mg per day, depending on the country you live in. For some people, 100 mg is enough, 300mg might be enough, but that is not important. What matters is that you get an allopurinol dose that makes your uric acid level safe. There is no point in taking allopurinol unless it reduces uric acid below 5mg/dL.
There are personal considerations relating to this. For example, I aimed ‘as low as possible’ in order to address visible tophi. We can discuss this further, if you want.
In any case, Ross, I hope you’ll return to update us on your progress. Few things in life make me happier than seeing someone permanently control their gout.