July 2, 2018 at 4:41 am #7229
Sunny greetings from the Caribbean of Mexico!
Thank you gout-pal founders and members for this wonderful resource. My heart goes out to everyone that has had to suffer because of gout.
I’ve suffered for about 14 years now. My first attack came on when I was in the Navy at 25 yrs old. Like a lot of people, I opted out of the pill-a-day program in exchange for alternative methods. Unfortunately I have not been very successful. I do not eat red meat, shellfish, or consume any type of alcohol. I’m not overweight (6’6″ 240 lbs), exercise regularly and I still get gout regularly (once a month). The gout moves around the many joints but the for the most part has been isolated to the knees and feet.
I’m done fighting it. I’m throwing in the towel and I’ve decided to start taking ALLO. In Mexico, I have access to ALLO and Colchicine without a prescription for very cheap. And since there is more combined experience here on this forum than any doctor I will encounter in my area I’m asking for help in coaching me through the ALLO process/doses and timetable to get my uric acid levels down to where I can flush out the old crystals.
I recently a had blood work done in preparation for this post and the results are:
URIC ACID – 9.3 mg/dl
Kidney GFR – 166
Creatinine – 103 U/L
AST – 22 U/L
Albumin – 4.9 g/dl
Bilirubin – 0.6 mg/dl
Thanks very much for taking the time to help out. I look forward to hearing from you.
All the best,
July 2, 2018 at 8:28 pm #7235
We may know things that the average doctor doesn’t know but doctors really do know things we don’t. If you have an unusual reaction to these drugs for instance, having secured the support of a doctor may prove invaluable.
If you want to be your own doctor to some extent, I recommend you start by reading the medical guidelines for yourself. Some parts may be debatable but on the whole modern guidelines are quite sensible.
Certainly allo makes sense in your situation. But something which guidelines may not warn you about is that allo will probably not be a quick fix after 14 years of untreated gout. This is going to require patience.
As to your timetable, how it’s going to look like depend on how prudent you want to be (prudence would cost you both time and money).
For instance you could start by testing the effect of colchicine alone on your system. It’s most likely not worth the bother but if you start both drugs at the same time, you may not be able to guess which one caused an adverse reaction (should you get one).
July 4, 2018 at 5:56 am #7269
I appreciate the response.
I would like to be my own doctor in this situation.
I’ve been taking Colchicine for years without any adverse effects (except the occasional runs when I overdose). 😉 I’ve also read everything I can possible read about gout over the past 14 years. I’m really making an informed decision and I’m ready to dive in.
I would appreciate guidance in regards to the following –
How much Allo (mg) to start off with?
How long until my next blood test?
When to increase ALLO dosage (presuming I start at 100 mg)?
How much colchicine (mg) daily in combination with the ALLO?
Thanks very much!
July 4, 2018 at 7:56 am #7336
The more specific the questions, the easier they are to answer. So thanks for making this easy.
Guidelines recommend starting with 100mg or possibly 50mg allopurinol per day.
You may have read this a hundred times already but signs pointing to an allergic reaction as well as skin rashes including redness should be interpreted as serious warning signs. Should that happen, I recommend discontinuing allo and seeking professional help. But it is quite rare (assuming you don’t have East Asian ancestry).
I think the most prudent course of action would be to get a blood test after two to three weeks and to increase your dose once you have made sure the results are not indicative or any adverse reaction (as you probably know, kindey and liver function are of particular concern).
Keep in mind colchicine does have an effect on liver function in particular. If you never got that tested while taking colchicine, you may not be able to estimate what if any effect allo might be having on your liver function.
There is evidence that increase one’s allo dose gradually lowers the risk of attacks during the initial phase of the treatment. You could take baby steps by taking the higher dose every other day for 6 to 10 days before taking the higher dose every day. But you could also decide increasing your dose faster is worth the risk.
Ideally, you should get a blood test before every dose increase but that would be costly. You want to get frequent blood tests while you are increasing your dose but as long as every test looks good, you might choose to test a bit less often than is recommended.
The most controversial part of the recommendations is when to stop increasing the dose. But that’s not something you need to be thinking about right now.
Your experience with colchicine should guide you when it comes to dosing it. You don’t want to be taking anywhere near the dose which gives you the run every day. You may however increase the dose for a day or two whenever you feel attacks might be starting.
The instructions which come with the pills here tell you not to take more than 1mg per day for longer than a few days. But 1mg is already a pretty strong dose considering the stuff is going to be builing up in your system a bit (you won’t get the maximum effect on the first day and there are people who recommend starting colchicine before starting allo). For me, 0.5mg or 0.6mg per day is not a sufficient dose. But if that is enough for you in your experience, don’t take more. You could try to fine-tune the daily dose by cutting pills. Colchicine is pretty dangerous when used every day for a long time so you want to be careful with your daily dose. And the sooner you feel you can stop taking it every day, the better.
July 4, 2018 at 5:43 pm #7349
Thanks, Nobody! I think you hit all my questions.
I have one more for now – when could I safely increase from 100 mg to 200 mg? After my first blood test at 2-3 weeks?
I can get full blood tests done here for about $40 US. So, if I have to do one or two a month that is no big deal to be on the safe side.
The other day I bought two boxes of colchicine (1 mg x 30 tablets) and one box of Allo (300 mg x 20 tablets) for the whopping price of 58 pesos or approx $2.40 US. I wonder if we could start a business shipping these to the US for the rest of the group.
Wish me luck, I’m going to take my first ALLO pill today.
All the best,
July 5, 2018 at 7:20 am #7365
Yes, I’d recommend looking at blood test results before upping the dose beyond 100mg. Just in case.
You could also justify increasing the dose a bit slower than that, especially where the first dose increases are concerned. But waiting 2-3 weeks is probably slow enough.
I understand exporting drugs is a big business in Mexico. Maybe allo and colchicine could be sold anonymously on the Internet without attracting the wrong kind of attention. But allo should be cheap everywhere. And in case you weren’t aware, even up North in crazy country, colchicine is available at reasonable prices (people just need the right paperwork).
July 5, 2018 at 7:38 pm #7367
I appreciate the response.
I started yesterday with 75 mg of ALLO. The 300 mg tabs are easier to cut into quarters than thirds.
I will get blood test done in two weeks and then if all looks good would you suggest going up to 150 mg from there?
July 5, 2018 at 8:54 pm #7368
Like I said earlier, you can achieve an effect similar to pill cutting by taking a different dose on different days. The stuff takes a while to be dumped from your system so you won’t get a huge difference in effectiveness from day to day if you vary a bit the amount you take.
So if you have the patience for it, you could alternate between 75mg and 150mg for a week or so to make the dose increase more gradual. Switching to 225mg from 150mg will not make such a large difference but going from 75mg straight to 150mg would be a doubling.
July 7, 2018 at 1:40 pm #7373
Makes sense on the pill cutting. Sounds like wise advice. Thanks.
I’ll post back up in a couple weeks after I get my next blood test. Would you be able to help me interpret the kidney and liver function results or am I just looking to be sure they fall within the “normal range”?
July 8, 2018 at 8:37 am #7374
I can’t replace a doctor. Not only do I lack the medical knowledge, I don’t know enough about you. For instance, your creatinine seems a bit high but the amount of physical exercise you’re getting may explain it.
The normal range is irrelevant in my opinion. For instance liver values above the normal range do not necessarily bother doctors as such (some guidelines have the danger zone way above the normal range).
What you want to look for in my opinion is significant change, irrespective of the normal level. Significant change is not necessarily the end of the world but it would warrant further monitoring (in case the value keeps getting worse) and possibly a visit to a doctor.
If there is no real change on the other hand, you don’t need a doctor to tell you that there’s no problem and you might want to make the blood tests a bit less frequent.
July 9, 2018 at 5:49 pm #7377
Ok thanks. I’ll post back up in a couple weeks and can go from there.
Thanks again for your time and all your help. It’s really kind of you and I appreciate it.
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