August 11, 2009 at 3:24 pm #2942cjeezyParticipant
So the consensus from nearly everyone is that this drug has been around forever and is very safe “long-term.” Is there any statistical information that shows it can cause damage? Or what are the cons of long-term usage? I’m also curious as to why, if this drug is so safe, people still refuse to take it.
In addition, do those with Gout typically live the same length of time as others without gout (if UA levels are controlled of course), or do other symptoms still eventually creep up? My thinking is that UA probably causes a lot of problems for those who never actually get gout so UA lowering therapy for gout sufferers could “possibly” extend life. Just some thoughtsAugust 11, 2009 at 10:20 pm #5295zip2playParticipant
THe claimed possible long term consequences of allopurinol is a particular rash, and some evidence of damage to the immune system, probably anecdotal.
I think gout on average will deduct some time from a lifetime, but it;s also possible that by focusing attention on health, it might INCREASE lifespans.
UNtreated gout however will severely truncate the average lifespan.
I think people resist it for the same reason that people wil resist ANY lifetime drug, even insulin, statins, antipsychotics etc. A pill a day FOREVER just sounds so unsavory.August 12, 2009 at 4:25 am #5298Keith Taylor (GoutPal Admin)Participant
From everything I have read so far, there is a tiny proportion of the population who can have a severe reaction to allopurinol. It is so rare that documentation is scarce, but the consequences are severe enough that medical consensus is to start with a 100mg dose and increase week-by-week until the uric acid level is lowered to target.
Just like reported news in the media, good stories are rare, and so it is with reports on allopurinol. You mainly hear about people who have problems, but rarely from people who have taken it year after year without problems.
I have made a start on trying to collect data on long term health issues with allopurinol, and have found that there is very little evidence. There are some oblique references to kidney problems from the metabolytes of allopurinol if insufficient fluid is taken, or if the urine becomes too acid. I am struggling to find any meaningful risk assessments, so if anyone sees anything relevant, I'd love to see it.
The “pill a day forever” fear seems to be strongly linked to the middle-aged revelations that life is not going to last forever and this is the first step of the “daily pill ritual” that our elderly friends and relatives seem to delight in making the highlight of their life. Next step the nursing home? “Surely there is a solution that doesn't put me on life long medication,” the gouties exclaim.
There is some evidence that uric acid lowering extends the life of kidney patients. The key issue, for most of us though, is quality of life.
Quality of life definitely decreases at an accelerating rate with untreated gout. Left untreated, the consequences of skin-bursting tophi and joint-crumbling urate deposits are much harder to deal with as we get older. Seeing a retired butcher friend in tears, wishing for the tools of his trade to remove his gouty arm, is a real wake up call.
Personally, I have been avoiding the medication for life scenario and fooling myself that weight loss and healthy lifestyle alternatives will provide a better solution. Who am I kidding?
The reality is that anything you do for gout that is not lowering uric acid below 6mg/dL is simply prolonging the agony and ensuring that gout attacks will get worse. My last attack was serious enough to make me see that popping allopurinol everyday is far healthier than popping painkillers so as I said last week, I'm definitely taking the plunge on allopurinol.
TomorrowAugust 12, 2009 at 6:22 am #5301zip2playParticipant
I have always made the assumption that you have been on allopurinol for a long time. Your last paragraph confuses me. Is it just what an allopurinol avoider WOULD say but you put it in the first person?
If you haven’t been a long time allopuurinol user what has been the mainstay of your uric acid control ?
August 12, 2009 at 8:58 am #5306trevParticipant
GP has already admitted to being a provoker, not a toker on the AlloP trail 🙂
However, I have a scrip filled and after the next attack will start on that track , if unable to see another way forward and having to take diuretics for best BP therapy.
I won't miss the pain of Gout , once settled on it for sure -and it's a lot easier to gauge than BP meds.August 12, 2009 at 9:00 am #5307Keith Taylor (GoutPal Admin)Participant
I have a very high, but fast eroding pain threshold. (and, probably fast eroding knees )
More soonAugust 12, 2009 at 10:20 am #5308cjeezyParticipant
How have your UA levels been without meds?March 16, 2015 at 2:24 am #20301Shirley HersoonGuest
Is Allipurinol safe for a woman, 79 years of age, with severe arthritis and bouts of gout.? Afraid to take it.March 16, 2015 at 8:38 am #20307Keith TaylorKeymaster
Allopurinol safety is not related to age or gender. It’s related to genetics.
The most at risk groups are Han Chinese, Thai, and Korean. Any doctor worth his salt should arrange a genetic screening test to test for the specific gene responsible for most bad side effects. If the test does not apply, or if it is negative, it is still important to approach dosing properly. That means:
1. Test the patient’s blood to get starting values for uric acid, kidney function, and liver function.
2. Start 100mg allopurinol per day.
3. Re-test within 2 to 4 weeks of starting allopurinol, and again every dose change.
4. Increase dose by 100 to 200mg until uric acid is low enough to dissolve uric acid crystals. Best to go as low as possible for about a year.
The best thing to do, Shirley, is to post gout questions, opinions, and experiences as often as you can. That way, we can stop your bouts of gout in the fastest, safest way.
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