allopurinol Tag

Specific research on allopurinol and alcohol is hard to find. Allopurinol patient information advises limiting alcohol. However, no sources are cited that support this advice:

When taking allopurinol, keep your alcohol intake to a minimum i.e. 1-2 standard drinks, once or twice a week. Drinking more than 4 standard drinks on one occasion, even if infrequently, is strongly discouraged.

Continue reading about allopurinol, alcohol, and how you should manage them both

As part of my research into this thorny issue, I was reminded of some comprehensive research into gout drug utilization. I have referred to this previously in a newsletter, so it’s high time I summarized this research as part of my forthcoming review of gout treatment compliance.

Gout Drug Utilization Research

This research was reported at the 2006 Annual Scientific Meeting of the American College of Rheumatology (ACR). I have paraphrased some of the language to avoid some jargon, though it is inevitable that some scientific terminology is required in this type of report.

Gout Drug Utilization Research Title

Retrospective Claims Analysis of Gout Drug Utilization, Compliance and Associated Serum Urate Levels [1]

Gout Drug Utilization Research Authors

R. Halpern; K.G. Saag; R.R. Mody; T.R. Mikuls; P.A. Patel

Gout Drug Utilization Research Abstract

PURPOSE:

Gout affected an estimated 8.4/1,000 people in 2002. Our objectives were to:

• Estimate the prevalence of gout in one of the largest US health plans;
• Examine drug therapy utilization;
• Determine the association of allopurinol compliance with serum uric acid (sUA) level.

METHODS:

We used medical, pharmacy, and laboratory claims data from a large, geographically diverse health plan (approximately 13 million lives) with commercial, Medicare, and Medicaid coverage. Gout patients were identified according to medical claims:

• 2 or more medical claims with a gout diagnosis (274.xx) on separate dates or
• 1 or more prescription claim for allopurinol, probenecid, colchicine, or sulfinpyrazone between 1/1/02 and 3/31/04;

The first relevant claim provided the “index date.” Claims were examined for 1 year before and after that index date.

Compliance was measured as medication possession ratio (MPR: days supply of drug from first fill through follow-up/days from first fill through follow-up, range 0-1). So if a claim for 30 days of allopurinol were followed by a 50 day gap before the second claim, then MPR = 30/50 = 0.6.

RESULTS:

25,226 gout patients were identified based on our selection criteria: 11,660 (46%) by prescription; 4,895 (19%) via diagnoses; 8,671 (35%) met both criteria. The mean (standard deviation (SD)) age was 54.6 (13.5) years. 82% of the study population was male.

Many gout patients suffered other health problems, known as co-morbidities. Prevalent co-morbidities were:

• Hypertension, high blood pressure, (affecting 49% of the population)
• Hyperlipidemia, high cholesterol, (41%)

4,901 (approx 19% – slightly less than 1 in 5) of gout patients had 1 or more sUA lab result during baseline or follow-up. The study reports that the average sUA level was 7.6 mg/dL (0.45 mmol/L), though this is largely meaningless, as it does not consider the effects of uric acid lowering drugs. Gout prevalence in the health plan population between 1/1/02 and 3/31/04 was 9.25/1,000. Prevalence was higher among men and increased with age.

60% of gout patients filled 1 or more allopurinol prescription during the 2-year study period, making it the most commonly prescribed gout drug therapy. Nearly 31% filled 1 or more colchicine prescription, followed by probenecid (3.1%), probenecid/colchicine (2.2%), and sulfinpyrazone (0.1%). About 16% used 2 or more gout drugs during the study period; most common were allopurinol and colchicine.

Average MPRs were: 0.64 for allopurinol; 0.23 for colchicine; 0.50 for probenecid; 0.41 for probenecid/colchicine; and 0.41 for sulfinpyrazone.

2,941 patients had an sUA result and at least 1 allopurinol prescription. These allopurinol patients 41% were “compliant” (MPR at least 0.8); however, only 35% of compliant patients had sUA below 6.0 mg/dL (0.36 mmol/L).

CONCLUSION:

The prevalence of gout in this health plan population is consistent with previous estimates. A high proportion had other chronic health conditions.

Although allopurinol was the most commonly prescribed drug for gout management, non-compliance with this agent was frequent. Moreover, a large proportion of patients compliant with allopurinol did not achieve target sUA level below 6.0 mg/dL, suggesting room for improvement in the current management of gout and gout medication compliance.

Gout Drug Utilization Summary

The accepted long term treatment of gout (a gout fix plan) is:

1. Take allopurinol (or other uric acid lowering treatment) everyday
2. Test uric acid in the blood at least once a month to establish the right dose
3. Be prepared to take pain relief in addition for a few months, as required or as a daily preventative.
4. Review treatment every 6 months to one year

If your doctor advises this, then follow this advice. If your doctor does not advise it, then either insist on this treatment, or seek another doctor. If any part of this is unclear, then discuss it in the gout forum.

Gout Drug Utilization References

1. AUTHORNAME. Retrospective Claims Analysis of Gout Drug Utilization, Compliance and Associated Serum Urate Levels . . 2011-01-20. URL:http://acr.confex.com/acr/2006/webprogram/Paper4307.html. Accessed: 2011-01-20. (Archived by WebCite® at http://www.webcitation.org/5vsWdew4k)

Gout related research from Y P Siu and colleagues, Use of allopurinol in slowing the progression of renal disease through its ability to lower serum uric acid level,[1] investigates the use of allopurinol in patients with high uric acid levels and impaired kidney function.

They recognized that high uric acid levels (hyperuricemia) is associated strongly with the development of high blood pressure and kidney disease. As allopurinol decreases serum uric acid levels, they hypothesized that administrating allopurinol to decrease serum uric acid levels to the normal range in hyperuricemic patients with chronic kidney disease may be of benefit in decreasing blood pressure and slowing the rate of kidney disease progression.

They conducted a randomized controlled trial with 54 patients with high uric acid levels and chronic kidney disease. Half were treated with allopurinol tablets (100mg to 300mg per day), and half continued with normal treatment.

See the results of the Allopurinol Tablets & Kidney Disease study

This “Buy Allopurinol” article was first published in May 2008. I republish it here as part of ongoing website maintenance. Please note that benzbromarone is restricted in many countries due to concerns about effects on the liver.

Why Buy Allopurinol?

Gout Treatment Research

Medline abstract:

2008 Apr 23 [Epub ahead of print]

Efficacy and tolerability of urate lowering drugs in gout: a randomised controlled trial of benzbromarone versus probenecid after failure of allopurinol.

Reinders MK, van Roon EN, Jansen TL, Delsing J, Griep EN, Hoekstra M, van de Laar MA, Brouwers JR.

Department of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, Netherlands.

OBJECTIVES:

To investigate the efficacy and tolerability of allopurinol as first-choice uric acid lowering (antihyperuricemic) treatment for gout, and compare the efficacy and tolerability of benzbromarone and probenecid as second-choice treatment.

METHODS:

Prospective, multi-center, open-label, randomized controlled trial (RCT) of gout patients with normal kidney function.

Patients were given 300 mg allopurinol for 2 months (stage 1).

When allopurinol was not tolerated or failed to attain target serum urate concentrations (sUr)

RESULTS:

Ninety-six patients were enrolled in stage 1.

Eighty-two patients (85%) were eligible for the analysis of stage 1: serum urate concentrations concentrations decreased 36[+/-11]% (mean[+/-SD]) from baseline; twenty patients (24%) attained target serum urate concentrations

Sixty-two patients were enrolled in stage 2: 27 patients received benzbromarone (3 lost to follow-up) and 35 received probenecid (4 lost to follow-up).

With benzbromarone 22 out of 24 patients (92%) were treated successfully.

Treatment success with probenecid was 20 out of 31 patients (65%) (p=0.03 compared with benzbromarone). Compared with baseline values, serum urate concentrations decreased 64[+/-9]% applying benzbromarone and decreased 50[+/-7]% applying probenecid (p<0.001).

CONCLUSION:

This study demonstrates a poor efficacy and tolerability profile of allopurinol 300 mg/day to attain a biochemical predefined target level of serum urate concentrations

In stage 2, benzbromarone 200 mg/day is more effective and better tolerated than probenecid 2000 mg/day.

(controlled-trials.com number ISRCTN21473387).

PMID: 18250112 [PubMed - as supplied by publisher]

I have made some slight changes to the gout research abstract from Medline to make it easier to read. The original abstract and full report are on the ARD website.

You can discuss this research, and all aspects of why to buy allopurinol (or not) on the gout treatment forum.

Allopurinol Medication: The Gout Cure That Can Hurt

1. Do you understand uric acid?
2. Do you know the crippling danger it presents?
3. Do you know why they must reduce uric acid?
4. Do you understand why reducing uric acid can temporarily cause more pain?

As a gout patient, you must understand why you need to endure the pain of allopurinol medication to get rid of gout.

Understanding Uric Acid

Uric acid is vital to humans, but, like many a good thing, too much of it is bad.

Too much, causes uric acid crystals to form in and around your joints, and under your skin.

Many people imagine these crystals to be painful, often describing them as sharp and needle-like. They are actually so small, that they don’t cause physical pain directly, but your immune system sees them as virus-like invaders, and attacks them causing inflammation and acute pain.

It is not enough simply to get rid of this pain.

The Crippling Danger Of Uric Acid

Most people need some additional medication to tolerate the pain. This is usually colchicine or other anti-inflammatory drug, but pain relief will do nothing to get rid of uric acid crystals.

The inflammation and pain will gradually disperse as your immune system stops fighting the uric acid crystals. But, unlike a virus, your immune system cannot kill uric acid crystals. Instead, it hides them in a protein coating, and they will build up to cause crippling joint damage unless you do something to get rid of them.

I’ve seen a 70 year old man in tears with this pain, and I do not want it to happen to you.

Why You Must Focus On Lowering Uric Acid

The uric acid crystals build up gradually, often over several years, and they don’t always cause the traditionally painful, swollen acute gout flare.

Often numbness or tingling are the only signs, yet under your skin the uric acid deposits increase until they burst through as tophi, or damage your joints, or both.

The only way to get rid of uric acid deposits, and avoid the critically painful tophaceous gout stage, is to lower uric acid below 6mg/dL.

Though there are several uric acid lowering drugs, and new ones being developed, allopurinol medication is most widely prescribed and currently the most effective, as long as the correct dose is taken every day.

Lowering Uric Acid Can Cause Pain

At the correct dose, all uric acid lowering treatments will cause uric acid crystals to dissolve. Remember, this is what we must do to avoid skin-bursting tophi and crippling joint deposits.

Unfortunately, as they are dissolving, uric acid crystals shed the protein coating, and the immune system starts to attack again, which may result in a painful gout flare. You must be prepared for this, and discuss with your doctor whether you take anti-inflammatory pain relief with the allopurinol medication, or take pain relief when a gout flare occurs.

Deal With The Pain Of Allopurinol Medication

All too often gout sufferers concentrate on finding pain relief and forget about the dangers of a long-term buildup of uric acid crystals.

You must understand the dangers of uric acid, how crystals can cause serious damage, often without pain, and how lowering uric acid might temporarily increase pain.

Distinguishing between pain relief and lowering uric acid is one of the key aspects of managing gout. Understand it, and you are less likely to be amongst the 90% of gout patients who fail to endure the pain of allopurinol medication to get rid of gout.

More Allopurinol Information

Read more vital allopurinol information:

Are Allopurinol Side Effects Serious?

Allopurinol side effects worry many people, so just how serious are they?

3 Vital Allopurinol Dosage Rules

Allopurinol dosage needs to be planned, measured and adjusted for different treatment phases. A standard 300mg dose might be just what you need – but make sure that it is set by diagnosis and judgment, not by dangerous guesswork.

Allopurinol For Gout Control

In-depth look at the management of gout using allopurinol.

Allopurinol Drug Not Just For Gout

Though mostly used in gouty arthritis, the allopurinol drug has found to be useful for other conditions.

Allopurinol Drug Spelling

Like many medicines, allopurinol is often misspelled. Though spelling is often overrated, it pays to take extra care with medicines, as a misunderstanding might cause treatment problems in the unlikely event of a similar sounding drug being taken mistakenly.

Allopurino

Missing final l.

Alluporinol

lupo changed to lopu.

Allupurinol

lop changed to lup.

Alopurinol

allo changed to alo.

Alopurenol

allo changed to alo, and purin changed to puren.

Alipurinol

allo changed to ali.

Alipurinal

allo changed to ali, and nol changed to nal.

Allipurinal

allo changed to alli, and nol changed to nal.

Alopurinal

allo changed to alo, and nol changed to nal.

Allopurinol

This is the correct spelling of allopurinol - the most common gout treatment for lowering uric acid.

Allopurinal

nal ending changed to nol. This is the most frequent mis-spelling of allopurinol

Alupurionol

Allo changed to Alu, and extra o added before nol.

If you are aware of other alternative spellings, please share them on the gout forum.

Allopurinol (or allopurinal)

It reduces uric acid levels, thus lowering the risk of future gout attacks.
There is no permanent effect, so as soon as you stop taking it the benefits are lost.
Forgetting the odd day might not matter too much, but it is important to continue taking it for the rest of your life once started.

There are no immediate benefits from taking allopurinol – it can take 6 weeks or longer before acute gout attacks are significantly reduced.
Importantly, during this period, which could take up to a year, the risk of acute gout attacks increases.
Doctors will usually prescribe a pain relief drug to be taken alongside allopurinol for six months or more.
What actually happens is that allopurinal reduces the uric acid levels in the blood and so the uric acid crystals in or around the joints start to redissolve causing a gout attack.
Therefore, the longer you have had gout, the longer it will take for allopurinol to prevent attacks.
This is also the reason why you should not start taking allopurinol during an acute gout attack, but if you were already taking it, then you must continue.
Don’t keep stopping and starting with this drug – you need to take it as prescribed, otherwise you lose the benefits.

There should be no diet restrictions, though you must be careful with alcohol. It causes allopurinol to be excreted from the body quickly, which might stop your uric acid levels being lowered enough. Frequent blood tests are important if you are taking allopurinol, and these will tell you if your allopurinol dose is enough to lower uric acid properly.

If your uric acid level is not maintained below 6mg/dL, then discuss with your doctor whether you need to reduce alcohol or increase your allopurinol dose.

More Allopurinol Information

Read more vital allopurinol information:

Are Allopurinol Side Effects Serious?

Allopurinol side effects worry many people, so just how serious are they?

3 Vital Allopurinol Dosage Rules

Allopurinol dosage needs to be planned, measured and adjusted for different treatment phases. A standard 300mg dose might be just what you need – but make sure that it is set by diagnosis and judgment, not by dangerous guesswork.

Allopurinol For Gout Control

In-depth look at the management of gout using allopurinol.

Allopurinol Drug Not Just For Gout

Though mostly used in gouty arthritis, the allopurinol drug has found to be useful for other conditions.

Allopurinol Misspellings

Like many medicines, allopurinol is often misspelled. Though spelling is often overrated, it pays to take extra care with medicines, as a misunderstanding might cause treatment problems in the unlikely event of a similar sounding drug being taken mistakenly.

Allopurino

Missing final l.

Alluporinol

lupo changed to lopu.

Allupurinol

lop changed to lup.

Alopurinol

allo changed to alo.

Alopurenol

allo changed to alo, and purin changed to puren.

Alipurinol

allo changed to ali.

Alipurinal

allo changed to ali, and nol changed to nal.

Allipurinal

allo changed to alli, and nol changed to nal.

Alopurinal

allo changed to alo, and nol changed to nal.

Allopurinol

This is the correct spelling of allopurinol - the most common gout treatment for lowering uric acid.

Allopurinal

nal ending changed to nol. This is the most frequent mis-spelling of allopurinol

Alupurionol

Allo changed to Alu, and extra o added before nol.

If you are aware of other alternative spellings, please share them on the gout forum.