Allopurinol for Gout – Administration, Dosage, Side Effects

allopurinol for gout

Gout is a form of inflammatory arthritis that causes severe pain. It mainly manifests itself on the big toe(s), but it can also be evident on other joints. The affected joint inflames, swells, may appear reddish and may feel hot or warm. Gout is treatable and manageable, and one way to manage it or prevent an attack is by using allopurinol for gout. Allopurinol works for most gout patients, and in this article, we offer you details about how it functions and its administration.

How gout develops

Gout develops as a result of a build-up of uric acid crystals around a joint. Uric acid is what is formed after the body breaks down protein substances known as purines. Purines are naturally found in the body, and they are also found in certain foods.

Typically, uric acid is meant to dissolve into the blood, be filtered out by the kidneys, and passed as urine. However, there are cases when the body produces too much of it, or the kidneys are not fully capable of filtering it out. This may be due to kidney disease. As a result, the uric acid accumulates and forms sharp or needle-like crystals around a joint. This is what is referred to as gout.

How does allopurinol work?

Allopurinol is an oral tablet whose brand names are Zyloprim and lopurin. It belongs to a drug category referred to as xanthine oxidase inhibitors. These are drugs that work similarly during treatment. It lowers serum uric acid levels in the bloodstream and the urine.  It reduces the quantity of uric acid produced by the body cells. This drug decreases the uric acid levels through the blockage of xanthine oxidase, the enzyme which is responsible for the production of uric acid.

Administration and dosage

Allopurinol for gout is strictly available on prescription, and administration is individualized for every patient. It comes as 100 and 300mg tablets. To attain complete gout control and reduce the serum uric acid to normal or close to normal depends on how severe a patient’s case is.  For those with mild gout, the average intake is 200-300 mg daily. Those whose condition is relatively severe may require to take 400-600 mg in a day.

The doctor advises on how many tablets to take and the times of administration. As you take allopurinol, you will have regular blood tests. These are meant to confirm and monitor the levels of uric acid. If the levels do not go down enough, the dosage can be increased to 800mg, especially for very severe cases.

Allopurinol is also available in an intravenous form, and a health professional must only administer this.

How to take allopurinol

Swallow the tablet(s) with water after eating. For most cases, allopurinol is taken once a day, but for those on high doses, the physician may advise that they split the amount. Dosage above 300 mg needs to be divided.  The minimal effective allopurinol dosage for gout in a day is 100-300 mg, and the maximum dosage is 800mg.

Sometimes, the doctor may prescribe that a patient takes the drug with lots of fluid. Try to take 2-3 liters of fluids daily. Such a sufficient fluid intake will yield slightly alkaline or neutral urine or the desired output. It is recommended that you take the doses at the exact times every day. However, it can be taken at any time.

For those on a once-a-day dosage, if by any chance you forget to take your medication, take it the moment you remember.  Those meant to take it twice or more a day; if you forget a dose, skip it until the next one. Don’t double dose as compensation for a missed dose.

Do the doses go lower or higher?

A patient will typically begin treatment on a low dose. Based on the uric acid levels results, it may be increased or reduced. To reduce the chances of developing a flare-up, the recommendation is that a patient starts with a low dose of 100mg per day. This is increased in weekly intervals until the desired levels of uric acid are attained. Normal serum urate levels will mainly be achieved in one to three weeks. The uppermost limit for men and postmenopausal women is 7 mg/dl and 6 mg/dl for those that have not hit menopause.

The kidney mainly expels allopurinol and its metabolites. Due to this, an accumulation of the drug can result in renal failure. It is therefore always crucial that administration is consequently reduced.

Side Effects

The very prevalent among the drug’s side effects are:

  • A very severe skin rash. Symptoms may include scaly skin, itchy hives, red spots on your skin. Once you develop a skin rash, you need to alert your doctor but do not discontinue the administration.
  • Troubled breathing, fever, and chills.
  • Drowsiness.
  • Diarrhea.
  • Nausea.
  • Flare-ups.
  • Alterations in the liver function test results. With a liver injury, you may suffer a lack of appetite, tiredness, jaundice, pain or discomfort in the right upper abdominal area, and weight loss.

Some mild side effects may disappear within a few days. More severe ones or those that do not go away must be brought to a professional’s attention.

Caution with other drugs

Within the first few months of the administration, you may suffer gout attacks or flare-ups as the drug starts to function. However, the doctor can prescribe NSAIDs or colchicine to help. It is always better to continue with anti-inflammatory agents until your uric acid levels stabilize and when there are no frequent attacks for several months. Mainly, you will start allopurinol administration once an attack settles.

You may take allopurinol as part of combined therapy. This means that it can be taken alongside other medications. It can interact with other drugs and substances such as herbs and vitamins to alter how they function. This may prevent a medicine from working efficiently and can potentially be harmful. Therefore, to avoid interactions, let the doctor manage your medications and substance intake. Let them know about anything you are taking beforehand.

Some of the interactions that may trigger the risk of side effects are:

  • Thiazide diuretics like hydrochlorothiazide can increase diarrhea, gout flare-ups, nausea, and altered liver function test results.
  • Amoxicillin may increase the risk of a skin rash.
  • Allopurinol taken with mercaptopurine, cyclosporine, and azathioprine may cause their level increase in the blood. It blocks the enzymes that break down the drugs to cause adverse side effects.
  • Those on drugs to reduce immune response must inform the doctor before administration- for example, those who have had an organ transplant.

Who can take allopurinol?

It is safe for adults and sometimes children to take allopurinol. However, it is not suitable for;

  • Those that have developed an allergic reaction to the drug.
  • Those with kidney and liver problems.
  • Those that have had a current gout attack.
  • Those with thyroid problems.
  • For women, it is not usually recommended for the expectant. For those that are breastfeeding, only the doctor should confirm administration. It may pass into the breast milk to cause side effects for the baby. Anyone trying to get pregnant must also inform the doctor.

Final Thoughts

Anyone who has suffered from gout knows how painful the condition can be. However, since the condition lacks an absolute cure, the best thing to do is find a way to live with it and manage it. Taking medication meant to lower the uric acid levels is ideal. Gout patients can therefore seek medical attention from a professional who can guide them on taking allopurinol for gout. It reduces uric acid levels to prevent further damage by gout. Since allopurinol can bring about severe side effects and other health conditions, patients must always take precautions to take the medication as prescribed and directed by a doctor.

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