Allopurinol Side Effects & Liver IntroductionIn Allopurinol Side Effects & Liver, I summarize concerns expressed in GoutPal forums. Then I describe relevant facts from gout studies that help you discuss those concerns with your doctors.
Allopurinol Side Effects & Liver PurposeThe purpose of this article is to help allopurinol patients discuss concerns about liver side effects with their doctors. So we consider side effects at Step 5 of GoutPal's Gout Patient Plan. However, if you are new to GoutPal Plans, you will see that some baseline tests covered here should be considered before Step 5.
Allopurinol Side Effects & Liver ConcernsGoutPal contributors have discussed allopurinol side effects & liver on several occasions. So here I summarize relevant discussions. Then in the next section, I describe appropriate uric acid research.
Does allopurinol taken for gout contribute to liver damage?In 2007, an American GoutPal reader asked,
“Does allopurinol taken for gout contribute to liver damage?” Unfortunately, I've lost the origin of that discussion. But it led to Graeme adding related allopurinol concerns:
"Do you think I should go back to Allopurinol to try to bring down the LFT score?"
Interestingly, we see opposing views of allopurinol side effects on the liver:
- Fear of allopurinol causing liver damage.
- Hope that allopurinol might relieve liver damage symptoms.
Later, you'll see these hopes and fears reflected in a range of results from the lab. But Graeme's reference to Liver Function Test results takes us to a related allopurinol concern...
Can allopurinol be causing my Liver Function Test elevations?Brendan started the discussion fearing that allopurinol had elevated his Liver Function Test. Then that fear led to more worries about how he might manage his gout going forward. Yet, it turned out his result was a temporary, unexplained blip.
Interestingly, that scare prompted Brendan to change his approach to gout management...
I do think it is important to keep aware of your liver function tests and UA levels going forward. If I didn't have the elevated LFT's, I would not have been aware of the importance of my liver's health. Going forward, I will closely monitor my UA and LFT's as part of managing my gout.
Subsequently, we discussed various liver enzymes and allopurinol. But I feel that detailed discussion of liver enzyme test results have to be discussed with your doctor. Because liver enzyme levels have to be interpreted with respect to personal medical history.
Having said that, one contributor revealed:
I have found that my liver enzymes (AST and ALT) are significantly elevated during an acute gout attack. The 300mg daily Allopurinol I take has not raised my liver enzymes, which is very important to me as I have NASH (non-alcoholic steatohepatitis) and I MUST keep the enzymes down.
This discussion emphasizes the importance of Liver Function Tests. But how common are they in gout management? You can find out from the second study below.
Allopurinol Side Effects & Liver StudiesIn the previous section, I summarized concerns about allopurinol side effects & liver. Now, I describe two gout research studies that might help you discuss your concerns with your doctor.
Allopurinol Side Effects & LiverA 2021 study includes investigation of allopurinol side effects and liver damage. Most significantly, this study shows that any damage is usually mild. Also, though controversial, some studies[*] show side effects of allopurinol that are beneficial to the liver. In fact, this is supported by the data from this study that I have used for my article illustration. Because it shows that for some patients, allopurinol gives better LFT results than placebo.
However, even if some people might get liver benefits from allopurinol, we don't know what the factors are. So the authors recommend:
monitoring of liver function upon the initiation of ULT [Urate Lowering Therapy] and if symptoms of liver injury occur is recommended. As I believe this is important, I've emphasized monitoring upon initiation. So be sure to get liver function tests before and during allopurinol treatment.
Allopurinol & Liver Function TestsA 2016 investigation reveals that only half of gout patients will get adequate blood tests. Including Liver Function Tests and Kidney Function Tests.
The current analyses on gout management by PCPs [Primary Care Physicians] in the United States and Europe identified regular testing of sUA [serum uric acid], liver function and kidney function in conformity with the guidelines by approximately 50% of physicians,
Allopurinol Side Effects & Liver SummaryIt's essential to discuss liver function tests with your doctor before you start uric acid treatment. Also, discuss results during your treatment period. So for GoutPal's Gout Patient Plan, you will take your baseline uric acid and organ function tests some time before Step 5 of the plan. Exactly when depends on your doctor. But it should be before you start allopurinol.
Subsequently, you should arrange Liver Function Tests at Step 5 whenever you monitor changes to your uric acid. Also, if you are keeping my recommended "Gout Symptoms Log", remember to include your doctor's opinions about your test results.
Your Allopurinol & Liver ConcernsYou have learned... - Most allopurinol patients do not suffer liver damage from allopurinol. - Any liver damage caused by allopurinol is usually mild. - Some allopurinol patients see benefits for liver health. - You should insist on a Liver Function Test prior to starting allopurinol. Then repeat whenever you have a uric acid test.
If you still have concerns about allopurinol and your liver, you should discuss those concerns with your professional health advisers. However, if you want help to prepare for that discussion, please see the contact me.
Allopurinol Side Effects & Liver References
- GoutPal Forum Users. "Liver And Allopurinol Side Effects." Original GoutPal Forum (Mar 2007): Archive accessed 26 Oct 2020.
- GoutPal Forum Users. "Allopurinol and Liver Function Test." Original GoutPal Forum (Nov 2010): Archive accessed 7 Aug 2020.
- Doghramji, Paul P., Steve Fermer, Robert Wood, Robert Morlock, and Scott Baumgartner. "Management of gout in the real world: current practice versus guideline recommendations." Postgraduate medicine 128, no. 1 (2016): 106-114.
- Zhang, Siliang, Qiming Xie, Shuqing Xie, Jianwei Chen, Qingyue Deng, Ling Zhong, Jing Guo, and Yuan Yu. "The association between urate‐lowering therapies and treatment‐related adverse events, liver damage, and major adverse cardiovascular events (MACE): A network meta‐analysis of randomized trials." Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy 41, no. 9 (2021): 781-791.
Allopurinol Side Effects & Liver Footnote
- There are more details about these studies in the GoutPal Progress Notes for this page. Along with other details. Including some full studies. So if you are unfamiliar with GoutPal Progress Notes, ask in the Gout Forum.