Allopurinol and ACE inhibitors

[sputnik]

After being diagnosed last year and having had three attacks of gout I bought the wonderful UA monitor from Arctic Medical and presented three months of tests to the Doctor today. (Average reading 8.9mg/dl). I said that I would like to be treated with medication that reduced the amount of uric acid rather than with anti inflammatories that I consider only mask the real problem. My father was not treated properly for years and now has kidney disease that prevents him taking allopurinol etc.  The doc agreed to treat me but prescribed sulfinpyrazone rather than allopurinol as I am also taking 10mg Ramipril daily for high BP. Apparently there is a (low) risk of allopurinol causing reactions with ACE inhibitor medication. This seems to work differently to allopurinol by increasing excretion of UA rather than reducing its production. I have a blood test booked next week to correlate my readings with a lab result and then start the sulfinpyrazone in gradually increasing doses until reading is within normal range.  All these drugs carry the risk of side effects so does anyone have more information on what is the best treatment?

Thanks

[zip2play]

sputnik,

Sulfinpyrazone and probenecid are infrequently used because they generally cause MORE undesirable  side effects than allopurinol. Is sulfinpyrazone available in the U.S.? I saw some conflicting info.

You are right, the chance of allopurinol side efffects are enhanced with an ACE inhibitor but only slightly and the causal evidence is scant. Your dosage of rampril is on the high side so maybe best to err on the side of caution.

I tried my hand at two of the ACE inhibitors, enalapril and captopril and both made me cough my head off…usually at the most incredibly inappropriate times: last straw was at the MET (Metropolitan Opera)…those around me were SO happy to listen to me hack before I got the good sense to go home and waste my $100 seat.)

So serendipity had me switch to losartan (Cozaar) an ARB which coincidentally is the only antihypertensive that is uricosuric…a good combo for gouty hypertensives.

If the sulfinpyrazone gives you a hard time consider allopurinol and losartan. Alas, it's the weakest of the ARB's and some of us must take it twice a day for much of an effect.

Let us know how the sulfinpyrazone treats you. Nobody else here has been on it…if my memory serves me.

[sputnik]

Thanks zip2play

I also had the ACE cough but nowhere near as bad as you and it gradually went after about a month. I will update the thread after I have started the sulfinpyrazone and established the dose I need to reduce to 6mg/dl UA or below, assuming no serious side effects of course. This is now the third “lifetime drug” I will be taking, along with ramipril and simvastatin for high triglycerides. I hope this cocktail is not antagonistic. At least we are doing our bit for research!!

[sputnik]

Well the Sulfinpyrazole (Anturane) worked very well on two 100 mg tablets per day and got me to 4.8 – 6 mg/dl UA readings most days without side effects.  Unfortunately on attempting to get my second prescription I was told the manufacturers has stopped making it! I was then prescribed Alllopurinol (by a different Doctor). Not so good, harder to control UA level on 200mg per day so far and side effects of bad stomach cramps and general aches. I returned to the Doctor and asked about Febuxostat but she wasn't aware of this alternative and said it couldn't be prescribed. I understand from my own internet research that it was recently licensed for use in UK for patients not able to tolerate allopurinol. She would not search the internet which is annoying as this is the first thing my local practice Doctors usually look at. Does anyone know the availability of this drug in the UK and has anyone experiencing allopurinol side effects tried Febuxostat without problems?

Thanks

[Keith Taylor (GoutPal Admin)]

According to an organisation called NHS, the UK launch of Adenuric (febuxostat brand outside USA) was March 10th (it has been approved for months, but supplies were almost non-existent). I wonder if your doctor has heard of this organisation??

[sarcasm explanation to non-UK residents: The NHS – National Health Service – pays for our drugs and pays our doctors (out of our exhorbitant taxes)]

[zip2play]

sputnik,

There's no reason to assume that becasue you were on 200 mg. sulfinpyrazone (a uricosuric) that the same dosage should apply to allopurinol (a xanthine-oxidase inhibitor.) The commonest dosage of allopurinol  is 300 mg. but there's no reason one cannot take more, up to 800 mg., to control SUA to desirable levels…like <5.0 (for a safety margin.)

I recommend you upgrade from 200 to 300 mg. and see what readings you get.

Remember, that Uloric costs 30 times what allopurinol costs, so if one CAN take allopurionol, one certainly SHOULD.

[Author]

Posts