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Well after being on 200mg for a few weeks, virtually no pain (general soreness) and UA levels below 6 consistently, I woke up last night at 4:45am (to use the bathroom) and my big toe joint was very sore to the touch and shiney again! I immediately took my home test and found that my UA was 6.5! Is this twinge still from crystals dissolving? Due to the pain, I'm quite sure this would be bad without Colchicine so I took 2 immediately, followed by 1 an hour later. I'm now at work and it hurts only when I walk but I plan on taking another dose every hour (hopefully it wont take many). Should I increase my AP dosage? Nothing really has changed with my lifestyle. Yesterday I ate some high fiber cereal and banana for breakfast. Lunch I had a ham sub from Subway and an apple. For dinner I ate 2 slices of pizza. I basically had no foot pain when I went to bed and drank over 100 oz of water yesterday. The last time I tested UA was the day before yesterday at 12pm and it was 5.6. What should I do now?
cjeezy,
It sounds like you might turn out very AVERAGE and thus need 300 mg. allopurinol like so many of us. Although I wouldn't up the dosage until this attack subsides.
As we know, while 6.5 urate might be fine for non-gouties, it is too high for us because we have permanent re-crystallization sites and thus cannot maintain uric acid in supersaturation. If you recall, I tried 200 mg. allo for several months and got a 6.7 at the doctor and felt it wise to retun to 300 mg. We need what we need.
Also the theory goes that when crystallization starts the serum UA falls so probably during the night you were even higher than 6.5.
Sorry you are revisiting the pain and I hope just a very few colchicine are needed becausue you acted so quickly.
Hi Zip,
Yes I'm hoping it will only take a few colchicines too as I'm working today and would hate to do a 12 dose cycle during my shift! I'm slightly confused why this happened though. Would one night at 6.5 (or slightly above) cause an attack? Oh well, back to square one :(. I'm going to order some more test strips today. I'll posts some results in a week or so once I'm on 300mg. I can walk today, but there is definitely pain and soreness when I touch it or my shoe rubs it. Do you think it would be safe to start 300 mg now? or perhaps 250mg since its not a full blown attack?
You probably CAN take the 300 mg now because of that long half life of oxypurinol you won't have the full effects of the change for a week or more.
I guess if the obscene FDA ban on generic colchicine comes to bear on us, we (in the U.S. at least) will be counting on allopurinol more because we cannot risk an acute attack and dosing with $5.00 Colcrys tablets. I for one have has only ONE 9 day attack of EXCRUCIATING, CRIPPLING podagra and it was so AWFUL that I don't think I could bear another, especially if a gun was handy. If colchicine becomes unavailable to me I will go to 400 mg. allopurinol to keep my numbers below 5.0 to do all I can to insure no attack..
I HAVE been walking around with my numbers in the mid 6's probably for some time (what with my lowering to 200 mg.) and I haven't been hit with anything but the occasional morning twinges. Maybe I got away with it and you didn't becasue I have been on 2 decades of allopurinol and maybe I have fewer active exposed deposits? Does that sound reasonable?
In any case, I think a small amount of colchicine will resolve your newbie!
Going to 300mg allopurinol should increase your safety margin and also dissolve existing crystals faster, so generally a good thing. You can always drop back to 200 later.
The danger with a dose that is not quite enough is that your uric acid drops to the kind of figures you reported earlier (4.1 – 5.9). 5.9 is certainly enough to dissolve crystals, but that dissolved uric acid goes into your blood stream before it gets excreted. The effect will vary from person to person depending on how well you excrete uric acid, but the immediate effect has to be an increase in uric acid.
Allopurinol has slowed your production of uric acid, but it can do nothing for uric acid that comes from dissolved crystals. If it rises high enough then it is possible that new crystals could reform. It is certainly enough to slow down the dissolving process, so the crystals start to dissolve, the protein coating that was hiding them from the immune system drops off, then they stop dissolving and the immune system attacks again.
The only other thing I can think of is to do the 24 hour urine test and check your uric acid excretion rates. If they are low, then a combination of allopurinol with a uricosuric such as probenecid should help.
Finally, just in case anyone is wondering what zip2play is referring to – click this for more about “obscene FDA ban on generic colchicine“
Hi cjeezy,
I hope you are feeling better now. I think ZIP and GP are correct. We seem to be in a denial mode that lower dosage will work. I think, it makes sense to go to 300 mg dose and get the extra cushion for “incase” elevations of UA due to food or exercise or whatever. More cushion we have, betterof we will be.
I got my results of the blood test yesterday and the UA numbers are 5.0. Tested at 2:30 pm. It was 5.1 a week back and 5.5 two weeks back.
As suggested by GP, I am planning to move to 300 mg. I am however having some dizziness issues and difficulty in focussing for last couple of days( similar to vertigo) and am not sure if it is due to Allopurinol. I showed it to doctor and he says these are not related to Allopurinol. But I will wait few days to let them resolve before I increase my dose.
I also had some extra pain in the toe today( at a particular point where the toe bends upward) and uneasy feeling. I am not taking extra Colchcine and wait to see if it improves. It seems better than what it was in the morning.
Let us know what your status is at this time.
I used my last test strip after being on 300mg for 5 days and the result of my Home Test was “Lo.” I hope it's not too low! I have more strips coming hopefully this week so I'll retest then. Should I be concerned that mt SUA is too low right now?
How LO can you GOUGH?
(Does your paperwork describe what LO means? Can one have minus urate? Antigout perhaps?
)Just got new strips in the mail today. This morning afternoon ate banana, apple, rice crispy treat with choc drizzle and a fruit bar. Measured UA at lunch and got 4.0. Guess its not too low 🙂
zip2play said:
Sounds like it's 300 mg./day forever and never another attack for you.
That would be excellent but the part of this experience that I hate is not knowing how my body will react to things since I haven’t been dealing with this condition very long. While 4.0 is good, I’m still wondering if I’ll need to watch my lifestyle at all though?how many points do people see their UA typically fluctuate in a day? Not that I lead an unhealthy life or anything, but hypothetically what if (I know the dreaded “what if” questions :))I wanted to go to the gym, then go out and drink say 8+ beers and eat some seafood 2-3 nights in a row on my vacation. Would this be detrimental and take my 4.0 reading well above 6? I guess I’ll have to test it one of these weekends if I'm not too scared:)
Also, roughly how long do you think it takes for crystals to dissolve at this UA level? is it weeks? months? years? my big toe joint is not hurting as bad, but is still very swollen and redish purple now! Again these past couple months have really been my first ever gout attack?but I'm thinking there could be quite a few crystals since the attack has been on and off for over 2 months.
Good question to ask. I am in almost similar situation like yours. I am on 300 mg for 4 days now. Had a banana, rice crispy treat, potato bread and a petite vanila scone from Starbucks at lunch. Tested UA at home after 90 minutes of lunch and the reading says 4.2.
All other times, I have tested after 4-5 hrs of fasting but this time it was after food. My reading was 4.3 two days back.
Mine question is also same like yours – how much time for crystals to dissolve and do I have that many crystals? Mine attack started 4 months back due to big toe injury by direct blow to the bedpost. The Allopurinol treatment started exactly 2 months back.
I'm still wondering if the antibiotic I took somehow caused my flare up last week. I didnt have any issues for 2-3 weeks and then right as rain, the night I started my antibiotic I woke up to “the pain.” Anybody ever have a RX cause a flare up?
Well, from the old timer here, I feel that I can do or eat ANYTHING as long as I am taking 300mg. allopurinol. I have had “vacations” involving 600 ml's of booze daily for 14 days. I eat seafood whenever I can, I love shellfish, gravies, calves liver smothered in sauteed onlions.
I have no trouble at all. Sum total of pain is one annoying little tophus on my little finger that one cannot see unless attention is called to it. Sometimes it looks like it is trying to break through the skin. Rarely does it cause any discomfort.
Feet are fine.
So that's what one can expect from 20 years of allopurinol.
Thats definitely reassuring. Quick question, isn't 600 milliliters equal to 20 oz though?…or only about a beer and a half?
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