Just joined the gout club

[soupygti]

Hi, thanks for the extremely useful website. After two years of pain on and off in my big toe, and x-rays coming back saying nothing was broken, I booked myself an appointment with a consultant rheumatologist. He diagnosed it as gout straight away and gave me a steriod injection into my toe and drained any fluid. He told me to start allopurinol 100mg per day and increase after two weeks to 200mg a day, then again increase to 300mg a day after a further two weeks. (I also have to take 1 colchicine tablet daily for 3 months).

I am currently on 200mg allopurinol daily & my urate level is at 0.31mmol/l (5.21mg/dl). He mentioned the target for me should be 0.3mmol/l. As I am so close to that target, do you think I am on the correct dose or should I increase to 300mg daily as he has suggested? Is it possible to break an allopurinol tablet in half and make my dose 250mg daily?
Although the pain in my big toe has improved significantly, I still cannot bend it much. Do you think this will improve over time as more crystals dissolve?

I am only 31 so the thought of taking too high a dose for life is scary but I understand the risk of not taking enough.

Thank you so much.

[Keith Taylor (GoutPal Admin)]

If I were in your situation, I would increase my allopurinol dose, then review in 6 months. I believe that by getting uric acid below 300 for a few months, you increase the rate at which uric acid crystals dissolve. That means less time needed for colchicine, and less time you are at risk of another gout flare. Once substantial deposits are dissolved, it is quite likely that you can reduce your dose.

[soupygti]

Thank you for the advice Keith.

Do you know if it is ok to break an allopurinol tablet in half and make the dose 250mg?

Also do people build up a resistance to allopurinol and hence have to increase their dosage after a long period?

[Keith Taylor (GoutPal Admin)]

Yes, allopurinol tablets can be split.

I am not aware of any studies that show allopurinol becoming less effective over time. After allopurinol has led to substantial reduction of uric acid crystal, many patients find that less allopurinol is needed to maintain the safe upper limit of 5mg/dL. Everyone is different, but we all change as we get older. That is why I strongly recommend getting uric acid tested at least once per year.

[Keith Taylor (GoutPal Admin)]

Further to my last reply about the long term use of allopurinol.

There is very relevant evidence about long term allopurinol use from a different perspective. Studies have shown that it is possible to take a temporary break from daily allopurinol. This relies on two factors:

• Gout patients have a good response to allopurinol
• The right dose has been administered to keep uric acid at safe levels for 5 years

For the details of this gout study, please see http://www.goutpal.com/1629/is-allopurinol-a-lifetime-drug/allopurinol-5-years-not-life/

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