Gout is an inflammatory arthritis marked by sudden, severe attacks of pain, swelling, and redness in joints, often affecting the big toe. It arises from elevated uric acid levels in the blood, leading to the formation of sharp uric acid crystals. Allopurinol is a medication prescribed to manage gout by lowering these high uric acid levels.
Understanding Allopurinol’s Purpose
Allopurinol, available under brand names like Zyloprim and Lopurin, functions as a xanthine oxidase inhibitor. It blocks the enzyme xanthine oxidase, which produces uric acid in the body. By inhibiting this enzyme, allopurinol lowers uric acid in the bloodstream.
Allopurinol’s primary purpose is to prevent gout flares over time. It dissolves existing uric acid crystals and prevents new ones from forming, reducing the frequency and intensity of future attacks. Allopurinol is a long-term treatment designed to control uric acid levels, not to alleviate the immediate pain or inflammation of an acute gout attack.
Treating an Acute Gout Attack
When a gout attack occurs, the immediate focus is on rapidly reducing pain and inflammation. Medications for this include non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or indomethacin. These drugs reduce inflammation and pain in the affected joint.
Colchicine can lessen inflammation and pain when taken early in an attack. Corticosteroids, administered orally or via injection, are effective anti-inflammatory agents for rapid relief during severe flares.
Starting or Continuing Allopurinol During an Attack
Initiating allopurinol during an acute gout attack requires caution. Rapid changes in uric acid levels, which occur when starting the medication, might paradoxically worsen or prolong the current flare. This happens because dissolving existing uric acid crystals can dislodge them, triggering further inflammation.
Traditionally, healthcare providers advised waiting until an acute attack fully resolved, typically 2 to 4 weeks after the last flare, before starting allopurinol. This aimed to avoid exacerbating symptoms. However, newer guidelines suggest allopurinol can be started during an acute flare if accompanied by concurrent anti-inflammatory therapy to prevent worsening symptoms.
If an individual is already consistently taking allopurinol prior to a gout attack, they should continue their medication throughout the flare. Stopping and restarting allopurinol can cause significant uric acid fluctuations, which might destabilize the condition and trigger or worsen subsequent attacks.
Consult a healthcare provider for personalized advice on medication management during a gout attack. They can assess individual circumstances and determine the most appropriate course of action, considering immediate symptom relief and long-term uric acid control.
Long-Term Management with Allopurinol
Once allopurinol therapy is established, consistent daily dosing is crucial for effective uric acid control and gout prevention. Regular monitoring of uric acid levels by a healthcare provider is essential to ensure the medication works effectively.
Dosage adjustments may be necessary to achieve target uric acid levels, usually below 6 mg/dL (or 360 µmol/L), which helps prevent future attacks. Some individuals may experience initial side effects, such as a temporary increase in gout flares, rash, or gastrointestinal upset.
Allopurinol prevents serious gout complications, including tophi (visible uric acid crystal deposits) and kidney stones. When taken consistently, allopurinol significantly reduces the risk of future attacks and associated health issues.