For the latest information about stopping allopurinol, see Is Allopurinol A Lifetime Drug? in the allopurinol pages. Also view Allopurinol for Gout video for the wrong way to stop uric acid treatment. You will find related information in the gout medications pages within the Gout Treatment Help Section.
Note: This discussion is about allopurinol withdrawal. There is a related discussion about coming off allopurinol.
Somebody asked me the other day, “Can I stop taking allopurinol?”
The short answer is, “Maybe.”
Not very useful, so read on for the long answer.
First of all understand how allopurinol works.
Withdrawing from Allopurinol
It is all to do with uric acid. Uric acid is a good thing, but, when you have too much, it can form uric acid crystals (commonly called urate). These crystals build up in and around your joints causing gout. The only way to get rid of them is to maintain your uric acid level at 5 mg/dL or below.
Allopurinol slows down an enzyme that causes uric acid production in your body. It does this immediately, but each dose does not last very long. Once you stop, your body will start producing uric acid again. That is all it does. It has no pain killing properties at all, and it does not do anything to change whatever causes you to produce too much uric acid.
It sounds as if it is not doing much. But in fact it is saving you from long-term joint damage and tophi – as long as you are getting the right dose. It is vital that you have frequent uric acid tests to ensure that it rises above 5 mg/dL. Your doctor will advise you how frequently these tests should be. If you want more frequent tests, easily carried out at home, see yesterday’s gout newsletter (if you missed it, subscribe now, and you will get a link to the back issues)
So, the general rule is that, once you start taking allopurinol, you must keep taking it every day. If you stop, you will soon be back where you started, and you will put yourself at risk of overloading your system with uric acid.
There is an unfortunate side effect of all urate lowering therapy, not just allopurinol. Anything that is effective at lowering uric acid will cause uric acid crystals to dissolve. As they are dissolving, they are exposed to the immune system and you can get a gout attack. Often this is more widespread than the familiar one or two joints that are affected by normal gout attacks. There is not much you can do about this – just make sure you have painkillers handy, and if these don’t work, go and see a doctor for something stronger. The gout attack won’t last for long, and as you continue to take your allopurinol they will become less frequent and less intense.
If you get a gout attack (often called gout flare) while you are taking allopurinol, you must continue. Missing a dose will do nothing to make the pain go away – it will just prolong the length of time that you have uric acid crystals in your body.
But that does not completely answer the question, “Can I stop taking allopurinol?”
If you are a good gout patient and keep taking your allopurinol daily, and keep checking that your uric acid level is never above 5 mg/dL, a wonderful thing happens.
All uric acid crystals dissolve.
Your gout is gone.
You dance with joy, but still you ask, “Can I stop taking allopurinol?”
And still I answer, “Maybe.”
You really need to consult a rheumatologist on this. I have seen a report somewhere that indicates that you can take a rest from allopurinol once all urate has been dissolved. Sorry, but despite searching, I can’t find where I read this – please let me know if you spot it. Anyway, I’m sure your rheumatologist will know best. Of course, it is vital that you keep checking uric acid levels if you stop taking allopurinol.