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Should I start allopurinol now, or wait until all pain is gone?

Stopping Gout Together Forums Help My Gout! The Gout Forum Should I start allopurinol now, or wait until all pain is gone?

This topic contains 7 replies, has 5 voices, and was last updated by  Keith Taylor 1 year, 4 months ago.

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  • #3593

    Gout Patient
    Ŧallars: Ŧ 1.46
    GoutPal Carer Badge Rank: Carer

    I have a bottle of allopurinol pills ready to go but my Dr. and pharmacist says not to take them until I was symptom-free. I have a slight aches that move from foot to foot affecting my ankle and achilles on my left foot and an occasional ache on my right toe. Every day it’s somewhere different. It seems to change locations all the time. It’s not what I would call a flare up but just a lingering ache. I take Indomethacin when needed but I want to get to the root of the problem and try allopurinol. Should I start or should I wait until all pain is gone. What will happen if I don’t?

  • #1241

    Gout Patient
    Ŧallars: Ŧ 1.46
    GoutPal Carer Badge Rank: Carer

    My toe has been flared up for 3 weeks. Pain level up and down. Went back to doc and received script for allipurinol. Had appt scheduled for today with Ruematologist and it was cancelled until August. I don’t know what to do. Do I continue the indomethacin and start the allipurinol? I have the 300mg but could split them if necessary. I feel like I am trying to treat this without any direction. Please help!

    • #1243

      Ŧallars: Ŧ 0.00
      Rank: Should I start allopurinol now, or wait until all pain is gone?

      Hi Fellow Sufferers..

      I finally felt I understood what was happening with my gout and got it under control after reading the book “Beating Gout” A Sufferers Guide to Living Pain Free – Victor Konshin

      In essence the recommendations were along the lines of the following:

      1. After elevated uric acid is confirmed with uric acid test ( >6 mg/dL) commence taking a life time course of Allpurionol which assists your body excrete the excess uric acid from your joints, soft tissues and your blood.
      2. Start with a low dose of 100 mg built to 300 mg over the course of a month but importantly never stop taking the Allpurionol (even during a gout attack) as this is what is excreting the additional uric acid in your blood, something your body is no longer able to do.
      3. Commence a preventative course of anti inflamatories (Indomethacin and Cochiline) to counter potential and likely gout attacks as your uric acid levels stablise over the next 6 months. I think it was 1 x 25 mg capsule in the morning and the evening. Cochiline is 0.5 mg 3 or 4 times per day check the book.
      4. At the first sign of a gout attack hit it hard with 2 x 25mg capsules of Indomethacin 3 times a day until the pain subsides. I don’t recall the doseage of the Cocholine but read the book.
      5. The Allpurionol treatment should commence 4 weeks or so after an attack and when started it should never be stopped. It’s objective is to stabilise your uric acid blood levels to prevent future gout attacks.


    • #1244

      Gout Foodie
      Ŧallars: Ŧ 0.68
      GoutPal Carer Badge Rank: Carer

      First off I am not a doctor…..

      Indomethacin is a pain and inflammation relief drug. It does addresses the symptoms of gout, not the cause. If it hurts take them!

      The immediate cause of gout is elevated urate levels, the Allopurinol will address that, though the correct dosage is important. If your doctor put you on 300mg per day then follow his orders! It does seem high. I was put own 100. Self decided to go up to 200, (confirmed by doctor) the rheumatologist put me up to 300. That is only just keeping it in check.

      You can Indo and Allo separately, together, whatever. Don’t take to much and follow doctors orders!

      The question then arises: why are your urate levels high? You can try and reduce them by altering your diet. This may help, but in my experience not much.It may be you are ageing and your body isn’t working as well as when you were young. It could be genetic – you are prone genetically to this problem.

      Meat and shellfish are known to be high in purines. I am vegan so I don’t eat that and I still get gout. I am currently experimenting with Soy. I think Soy may be bad for gout (for me anyway), but I am not yet convinced.

      One important thing is weight. Are your overweight? I need to lose 10kg. The rheumatologist also said gout in and of itself is a symptom – an indicator that all is not well. He told me I must lose the weight.

      Hope that helps a little.


    • #1258

      Keith Taylor
      Ŧallars: Ŧ 1123.04
      GoutPal Scholar Badge Rank: Scholar

      Hi again, Marilyn,

      You got some great responses from Craig and Rod. I hope they help.

      When I reviewed Beating Gout by Victor Konshin, I was very impressed. I remember thinking that if it had been around when I first got gout, I’d never have started GoutPal. Of course, you can’t compare a book to a website, but it is a helpful publication. I don’t know if it covers the latest professional rheumatologists recommendations for gout treatment. Certainly, be careful about using the book to get gout medication doses. They should come from a knowledgeable doctor. If you can find one!

      300mg is too high to start allopurinol. It’s a serious health risk to do that. Best to change them for 100mg, so you can do what Rod advises. If not, splitting them gives you 150mg. 50 to 100mg is the clear recommended starting dose for allopurinol from the American College of Rheumatologists. So, best to split twice and start on 75mg per day.

      What are your thoughts Marilyn?

    • #1263

      Gout Patient
      Ŧallars: Ŧ 1.46
      GoutPal Carer Badge Rank: Carer

      Yes I have received wonderful information. I can’t get in to see a rheumatologist until August so when I found this website of folks that have gone through this, I was I would get some information to assist me. And I did.. Since starting the allipurinol the pain has subsided and the redness has decreased. The GP doc gave me the script for 300 mg, but I decided to cut in half after reading information. I am going to cut in half again based on your recomendations. Once I see the rheumatologist he can suggest my ongoing treatment.

      Thanks again for providing great information..

    • #1265

      Keith Taylor
      Ŧallars: Ŧ 1123.04
      GoutPal Scholar Badge Rank: Scholar

      That’s great, Marilyn. If you’ve been taking 150mg OK without any problems, then I would continue. My suggestion for splitting again, was just to be cautious, if you hadn’t started the allopurinol first.

      I wish you continued success with your treatment. And I hope to read you’ve made a full recovery soon. 🙂

  • #3598

    Keith Taylor
    Ŧallars: Ŧ 1123.04
    GoutPal Scholar Badge Rank: Scholar

    Thanks for this great question, Alan. It’s very interesting to me for a few reasons.

    Most importantly, your question highlights the problem of getting new gout research known to frontline medical professionals. Because, we now know that, for most gout patients, there is no need to wait for gout flares to resolve before starting allopurinol. So, that’s the quick answer to your question – start now.

    Then, you ask, what will happen if you don’t start allopurinol now. So, again, the quick answer is, you will needlessly delay your admirable goal of wanting “to get to the root of the problem”

    Now, I’ll indulge myself with a bit more explanation. Please feel free to ignore this if you wish. Because, most of it relates to the importance of your question to how I manage GoutPal.

    Firstly, I searched for “should i start allopurinol now or wait until all pain is gone“. But, as you can see, there are no results that are relevant to your question. Because, it’s a fine example of the paradox of asking good gout questions. That is: you don’t know the best way to ask the question until you know the answer.

    Incidentally, I get round that paradox in 2 ways:
    – Either, you do exactly what you did, and post your question here. That’s the best way for most gout patients.
    – Or, you start a structured help project. Which, requires time each week, but results in a more personal answer.

    Next, I changed my search to “when should i start allopurinol“. So, I was delighted to see my complete explanation at the top of those results: Start Allopurinol Quickly, But Carefully. But, in reality, it’s not the complete explanation about when to start allopurinol. Because, I need to improve that page to reflect:
    1. More recent science confirms the findings of the report I reviewed.
    2. The message needs to be clear: this only works where the gout patient is confident of gout pain control during uric acid lowering. So, I believe this to be true in your case, Alan, as you refer to indomethacin with confidence. However, I’m slightly concerned that you don’t make any reference to uric acid blood test results.
    3. I need to widen the scope of this key information to ensure it gets picked up by searches similar to “should i start allopurinol now or wait until all pain is gone”.

    I hope that answers your question adequately, Alan. If not, please ask for clarification. Also, please feel free to ask more questions about managing your gout recovery. Because, I want to be sure that 2017 is the year you finally kill the root of your gout problem.

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