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Taking Allopurinol for Gout


James

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A year ago I decided to stop drinking Pepsi Cola, to reduce my sugar and caffeine intake. A few days later I had a problem with my big toe getting swollen, red and very painful. I went to my local hospital casualty department and thought it must have been thrombosis (a natural conclusion to jump to). It turns out that my (crash) diet had triggered my first case of gout. Since then I've had blood tests which show my uric acid level to be consistently high (.7, .7, .6, etc) compared to the normal range of .1 to .4 millimols per litre. I've also had my hands and feet x-rayed for signs of joint damage (because gout is a form of arthritis). The consultant rheumatologist thinks that further instances of gout are inevitable unless my uric acid levels are lowered. Part of this involves some further diet restrictions but I have also been advised to take Allopurinol on a daily basis for the rest of my life.

I found a useful guide to gout at http://www.ukgoutsociety.org/ and have learnt that in a typical UK general practice of 2000 patients there may be 17 men and three women with gout. There are several things sufferers can do to help prevent a recurrence of gout. As uric acid is a by-product of purine metabolism a low-purine diet can be helpful. An excess of foods that are high in purine should be avoided. These include: meat ? particularly red meat and offal, such as liver and kidneys; game; seafood ? especially mussels, herrings, sardines; alcoholic beverages ? including beer, lager, port and some red wines. In addition, yeast products, oatmeal, mushrooms, asparagus, spinach and some pulses - especially lentils - can all increase the level of uric acid in the body and should be eaten in moderate quantities. "Quick fix" slimming regimes, particularly crash and 'yo-yo' dieting and fasting, should be avoided. They can lead to uric acid retention by the kidney. This is due to lactic acid production and ketosis as a consequence of fasting. The solubility of uric acid decreases in acid urine, and therefore treatment with alkalis may be useful for the minority of gout patients who produce more than average amounts of uric acid. In order to decrease the tendency for stone formation a high intake of fluid (8-10 glasses of water each day) will also decrease the likelihood of crystals being deposited in the kidneys as calculi. There are other aspects of the diet which may require more detailed discussion with a health professional.

Following a kidney stone (oxalate based) a couple of years ago I have already increased my fluid intake and cut down on red meat. Spinach is already on my hit list because of the warfarin. I asked to be referred to a dietitican and apart from a few nips and tucks there isn't much room for manoeuvre in my diet to reduce uric acid levels except by medication. If I don't reduce it I can expect a second attack sometime within the next year.

So, I'll soon be starting a course of Allopurinol, which in itself can trigger a case of gout, so it will be backed up with some NSAIDs. It will mess up my INR levels (increasing them) so my warfarin dosage will have to be readjusted. I also have a number of dental appointments coming up so my INR is going to be very tricky to keep under control but regular blood tests will see me through.

I wonder how many other people on our forum are taking Allopurinol as well as anticoagulants and what they think of the drug? Do you remember starting your course of Allopurinol and do you have any comments that might help me know what to expect?

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Hello James, I am sorry to hear about your gout, you look too young to have this problem! My dad had very bad arthritis, resulting in the digits of his fingers bending out of shape. My dad was a vegetarian and a qualified doctor, but over the years, seeing how I had managed my health using alternative medicine, he began respecting alternative medicine.

He took an ayurvedic herbal supplement called"arthrid". Within six months of that treatment his fingers had their normal functions. Arthrid is available in several different categories. The preparation is in potency according to age and sex. I don't know if it is available in the UK, here in Malaysia, it is eadily available, over the shelf, at any pharmacy.

All cola drinks have a high acidity level.

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  • 2 months later...

I started my course of Allopurinol today. I'm going to be taking one 100mg tablet each day (the pharmicist recommends after food with plenty of water). I will get my INR checked in a couple of days time, as advised by my haematologist, and we will be on the lookout for an elevated INR. I also have to be cautious about the onset of a new attack of gout during the first month or so. Possible side effects are just as scary as any other drug (everything from pins and needles and hair loss to breast enlargement in men) but in particular skin rashes.

Of course I could have started the Allopurinol back in March but I have been having dental work and so rather than having my INR go up and down and all over the place I decided (in association with the rheumatologist) to hold back on starting the new medication. Yesterday my dentist confirmed that the tooth being worked on is now fractured and is no longer viable so it will have to be extracted. It is three weeks until my next appointment so I'm hoping to get my INR stabilised before then.

If there are any useful observations about how warfarin and allopurinol get on with one another I will keep you informed with further replies to this topic.

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I've been taking Allopurinol for a week and so far so good - no adverse reactions. However my appointment for a dental extraction came through much earlier than expected and was carried out yesterday. Therefore I took my usual dose of warfarin (5mg) and 100mg of Allopurinol for five days, then stopped warfarin for two days and kept taking the Allopurinol, had dental work and went back to 5mg warfarin and 100mg of Allopurinol, and now additionally Co-Dydromol (di-hydrocodeine and paracetomol) for pain management. If I had known the dentist was going to do the work so soon I would have postponed starting the Allopurinol because it is known to raise the INR. Prior to treatment my INR was tested and was 1.65 although the dentist(s) said they would have been okay to accept a higher INR. I'll readily admit my nerves got the better of me on the day because this was the first 'surgery' I have had whilst on anticoagulants and the nausea was worse than the pain.

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As far as I'm aware Protein S Deficiency can only cause thrombophilia. If you can deal with that you don't have to be looking out for anything else. However, in a broader sense you can look beyond the immediate issue of thrombosis and consider the secondary issues such as side effects of medication, post thrombosis complications (varicose veins, fitness levels, depression, disability) and pregnancy issues. It is possible to look for information and support on all of these (secondary) issues on other related web sites and the comments would be perfectly valid... for example support stockings can alleviate the problems of varicose veins, but they might not mention how relevant the information might be to someone taking anticoagulants.

To illustrate: I have Protein S Deficiency which has caused DVT and PE and thrombophlebitis. As a consequence of the thrombosis I have a swollen right leg and varicose veins. I take warfarin and this causes me to bruise easily so I have to avoid certain activities. I have to watch my diet and alcohol intake because of the peculiarities of the anticoagulant (though this may change). I wear a medic alert bracelet to assist in first aid if I suffer an injury. I also have (in no specific order)... asthma, atopic eczema, hayfever, gout, allergies to some animals and some foods and have had kidney stones although none of these are related to PSD. Treatment of my other health issues is sometimes modified due to the presence of PSD but there is no cause and effect linking them.

Information about thrombosis is more readily available than information about PSD and thrombosis. Treatment of thrombosis is pretty much the same regardless of the underlying condition but as someone with PSD my motivation for creating this site is to ensure it gets the airtime and recognition as the other causes so that when advances are made I'm in a position to hear about them.

If you have PSD and Illness XYZ there is no link between them but the circumstances may be similar... e.g. if you also have Protein C Deficiency as well as PSD then the underlying reason is probably that you inherited defective genes for each condition in the same way. Having PSD doesn't make you more prone to PCD even though both conditions may be found together.

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James, thanks for the information. I was just wondering because a doctor at a Oregon Health Science University told me that since I have PSD I could have another; like lupus or another clotting deficency. They did some testing of others but nothing came up positive. But she said they are developing new tests for others all the time.

Thanks again,

Tamy

P.S. this site is a great........ I'm so happy I found it. :rolleyes:

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There's no reason why PSD would cause lupus or another clotting condition but if you step back one step you can see that whatever genetic damage/mutation that might have caused the PSD might also have caused other conditions.

Erm, here's another way of looking at it... a bus is travelling down the road. It crashes into a house which is damaged. The next week you walk down the street and notice the damage. The neighbour's house is also damaged. Was it damaged by the bus at the same time as the first house (1)? Is it damaged for some other reason, like a storm the following day (2)? Or did the first house fall over and do the damage (3)? Just because you see two houses both damaged next to one another doesn't mean that there is a connection between the way they got that way. If you imagine that PSD is the first house then 1 and 2 are possible but 3 isn't. PSD doesn't cause any other conditions except thrombosis.

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I see what you are doing here James and respect that. Thank you for this forum. I think you have reached and touched the lives of so many people, I sincerely hope they know what you have done. My book, Life is a Leaky Bucket, will be out shortly. It deals with taking care of our problems . I have been in "remmission" for 3 years and during that time I have had blood clots that have had to be treated with LMWHeparin. In my book I give acknowledgement to your website. If you give me a forwarding address I would really like to send you a copy of my book.

Talking of gout. Have you ever thought of eleminating nightshade vegetables from your diet? Tomatoes, Potatoes and egg plant are the cause of aggrevation that result in esclated pain. and thus turining to allopathic medicine to alleviate the pain.

I do not know if this is acceptable, but my goal is to educate people with blood clotting disorders and letting them know that it can be controlled without taking Wafarin Sodium. Vit E can replace Wafarin Sodium, however, I am not willing to jeopardise the wonderful work you are doing. I think you are wonderful in your pursuit and salute you for that.

Please feel free to delete this comment from your BB. I understand where you are coming from, all I am trying to say is, I have been there and done that.

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Hi Zarin. What with anticoagulants, kidney stones, food allergies, food poisoning and then gout it seemed as though my diet was getting more and more prescriptive so I asked my rheumatologist to refer me to a dietician. It really helped me personally but a newly focussed diet had no impact on my uric acid levels, so it became clear that it wasn't going to bring the reductions in uric acid levels that were needed and so I opted to start the medication. I didn't take the decision lightly but based it on all the evidence (x-rays and a series of blood tests) and the opinion of my rheumatologist who explained that with levels as high as mine it would be inevitable to get gout within the next year or two.

I'd be interested to read your book. My contact details are low profile on this site (to encourage people to use the forum in the first instance) but are by no means secret. Please follow the link on this page... http://www.protein.org.uk/james.htm - maybe you could add a note in your forum signature to help raise awareness when it is published?

Incidentally, its day five since the tooth extraction and I'm off the painkillers but my jaw still hurts and gums are tender. Most people are told recovery is three days so it will be a useful benchmark for me to indicate when the pain for someone on anticoagulants actually subsides. Oh, and no sign of gout just yet (fingers crossed).

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  • 1 month later...

Just by way of an update, it took two weeks before my tooth extraction settled down. However, getting back to discussing my new daily drug of Allopurinol it appears as though it has caused a side effect during its introduction. They say that the first month is the risky period where you may get a triggering of gout but at week five/six I was admitted to hospital with lower back pain. It looks like I had another kidney stone. Previously I had an oxalate stone which took two weeks to pass, but this time it was mercifully just one day - it didn't show on the x-rays directly which may suggest this one was a urate stone, which leads me to think it was a product of starting the Allopurinol medication.

On the upside, it was just one night in hospital (Tuesday), and I'm very fortunate that they declared me fit to fly on the weekend. I've just returned from my holiday (2.5 hour flights) after taking all the usual precautions such as full leg compression stockings and I am now in good health. I see a urologist in a couple of weeks time and hope to find out whether he thinks the stone was caused by Allopurinol.

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Oops, not again! Sunday night I had a ghastly spasm and then back pain so I went to the Accident & Emergency department at my local hospital and they kept me in overnight and discharged me the next day. X-rays show my left kidney is operational again but they think I had renal colic and another kidney stone. It's not as painful as the one I had a couple of weeks ago (only morphine kept the pain at bay for that one). I've been discharged this time with paracetomol, diclofenac and tramadol. I see the urologist tomorrow.

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  • 4 months later...

James,

Out of curiousity, how many instances of Gout did you have before you were treated for it ? Also, how are things going now, and how would you rate the prescribed medicine ?

Thanks in advance :)

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I had just the one 'classic' attack of Gout in my right big toe. The diagnosis by the rheumatologist required blood tests, x-rays of my hands and feet and urine analysis. I think that my recent kidney problems are also related although I've been given an almost clear by the urologist (they lost the radiographer's report for my CT scan but I have a review in February).

The medicine prescribed for my Gout is Allopurinol. I've been taking 100mg daily since I started in June and did not have any side effects. My INR appears to be unaffected and I still take the same dose of warfarin each day (5mg). Recent tests of my uric acid levels show that they have lowered but I'm still above average. I haven't spoken to the rheumatologist since I was diagnosed but I would anticipate my dosage of Allopurinol to be increased at some point. The most important aspect is that I haven't had any Gout attacks since starting the medication, no side effects and INR unaffected. So far so good.

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James, Thank You for taking time to reply :) .

I have just got over my fourth case of Gout. I haven't had any medication, nor have I in the past.

The most recent episode was not as painful as my prior bouts, but it lasted alot longer. Five days of not being able to put any pressure on my foot, carrying a 6 month old, and running around after a 5 yr old, and a 2 yr old... Suffice to say it wasn't much fun :angry: .

It has made me seriously consider starting treatment !!!

Many Thanks once again :)

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Before starting Allopurinol I asked the rheumatologist what my options where. She showed me my uric acid level results and said that with them as high as they were it was almost a certainty I would develop more gout attacks - she did a sketch showing where most of her patient's levels where and I was on the upper end of expectations. But you can't start the medication when you have just had an attack. Before you commit to taking any medication for life I think it is right to pause and consider your options but if you don't have any information to base your decision on it can be tricky. The x-rays were also used to look for 'notches' in the bones of my joints which are tell-tale of gout. I also think that the arthritic-ache in my hands has eased somewhat. If you are considering starting treatment ask to be referred to a rheumatologist and get your uric acid levels properly tested - several times preferably - once you know what they are you can decide what to do. Meanwhile I'd recommend reading http://www.nutramed.com/Gout/allopurinol.htm and http://www.chemsoc.org/exemplarchem/entrie...innott/gout.htm and http://www.ukgoutsociety.org/

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  • 3 years later...
Guest davidr

James,

Although I do not suffer from PSD I have recently suffered a DVT due to long haul flight. Unfortuneately I have also had two attacks of gout (I have had them in the past). As my diet is well balanced with no high purine foods and I have not touched a drop since the DVT it was a bit of an unwanted suprise.

My doctor is waiting on confirmation of my urate levels before recomending treatment but one option is Allopurinol. As you said this would be a balancing act between warfarin and the dose of allopunirol.

I was trying to find out if there was a link between warfarin and uric acid levels. The doctor says no but I did find an article postulating the possiblity. Did you consider this? The following website is the pdf of the paper. http://www.clinchem.org/cgi/reprint/32/8/1557

David

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I am very grateful to you for letting me know about this research paper. I had no idea that warfarin could be involved in elevating my levels of uric acid.

I was referred to the consultant rheumatologist for x-rays and blood tests following my admission to hospital for suspected DVT (which turned out to be my first gout attack) so you would have thought they could put 2+2 together and say something about this.

I am quite relieved... because if this research can be confirmed it would mean that if there is a new drug instead of warfarin it may actually mean I can come off the Allopurinol too.

I am also quite annoyed... because it also means that my higher uric acid levels are yet another side effect of warfarin but with rather more serious consequences. Gout is a type of arthritis and the crystals formed in my joints are wearing them away. In the long term this could be a big problem.

We'll have to look around for more information on this one... it could affect quite a few of us.

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  • 2 years later...

Hi All

I also have Protein S Deficiency have been taking warfarin for 20years in the last 1yr I have had recurrent paintful joints, my fingers, knees, feet and toes, I have recently been to have an MRI Scan to determine what this is, the last time i saw my dr. he said that my blood was saying I had some form of arthritis but my xrays were clear hence the reason for the MRI scan to try and solve the problem, I was wondering if I may have gout it sounds quite similar to the symptoms I have been having, havent got an appointment to see my consultant until 18th September so its just a waiting game to see whats going on, I was told from my heamatoligist that you can be prone to painful joint whilst on warfarin so am not sure what to think, will have to wait until 18th to find out.

Tina

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  • 1 month later...

Sorry for a late reply to this thread.

I just checked the site when Admin posted a new research article and decided to take a look at recent posts.

I have recurrent gout and take allopurinol. The gout usually starts in between my foot bones, then moves to

the big toe joints and increases in severity after a couple of days. It also will start in my achilles tendon and move

to the ankle then the front half of one foot.

I know my father and his father both took colchicine for gout, and their onset was about the same age as mine: 46 years old.

I also noted that my first two attacks were after a round of vancomycin IV for a recurrent MSRA infection. I feel that the

kidney function reduction of these antibiotics can cause Uric Acid levels to rise. I had the first of about 3 attacks more

recently without the antibiotics as a contributing factor. I run a Uric Acid level around 7 without allopurinol at 100 mg daily.

I wonder if my chronic very high blood pressure that is resistant to treatment, caused by venous resistance to blood flow through

old clotted areas and the old clotting in the area of my vena cava filter (placed just above my renal veins)

could be a factor in long term kidney damage.

My father has done quite a bit of research into gout, I'll have to review the posted materials here and see if i can add anything.

One thing i do when pushing fluids during an attack is cherry-cranberry juice. I water down the bottled juices, just for personal taste.

It breaks the monotony of quarts of water. Cherries are one of the foods that have a natural colchicine like compound in them.

It is mostly in the skins, so raw fruit is better than juices. It could alter ph levels as a negative factor, but i push a lot of water with the juices.

Allopurinol prevents the buildup of uric acid by altering kidney and liver functions. Colchicine removes uric acid crystals from the acute

episodes.

One thing to note is that uric acid levels are not a very good indicator of gout. Normal levels are not very well established.

People can have symptoms of acute gout attacks with low or normal uric acid levels, and not show symptoms with high levels.

So other diet influenced factors like blood ph and electrolyte balance are strong contributing factors.

My INR remains unchanged with about 3 months of allopurinol and unchanged dose of coumadin (15 mg. daily).

I have stopped the allopurinol for 30 days, feeling that the gout was gone due to diet changes.

It came back with a very intense toe inflammation and i decided to remain on the allopurinol for good.

One thing doctors will overlook is that gout does not have to attack the toe joints. It is known to settle into any joint that has had

past injuries, so the great toe is a common spot (most people stub a toe good and hard once or twice in their lives).

But inflammation and acute pain with telltale red and hot tissue should be suspect in other areas. My fathers onset occured in the

space between some old rib fractures he had in a fall around 10 years before the onset. His doctor insisted it could not be gout,

as his uric acid levels at that time were only high/normal, not really excessive. He changed doctors and found that colchicine for acute

attacks and allopurinol maintenance reduced the acute episodes. He can cause an acute episode by eating peanut butter, pork, or

drinking caffeinated drinks.

well, i'm off. I'll review the posted references in this thread and see if i have any non-duplicate information to add.

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One thing i do when pushing fluids during an attack is cherry-cranberry juice.
My INR remains unchanged with about 3 months of allopurinol and unchanged dose of coumadin (15 mg. daily).

There is a warning about drug interaction between Cranberry Juice and Warfarin (Coumadin). See this topic...

http://www.protein.org.uk/forum/index.php?showtopic=557

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