Allopurinol lowers uric acid to prevent gout attacks. The thing that catches people out is that it can trigger attacks when you first start it — and that this is expected, not a sign it is failing.
Allopurinol does nothing for an attack that is already happening. During an attack you need an anti-inflammatory, colchicine or a steroid — allopurinol is the long-term medicine that stops attacks recurring.
It is usually started a few weeks after an attack settles, at a low dose, and increased gradually based on blood tests until uric acid is below target.
If you have an attack while taking allopurinol, do not stop it. Treat the attack alongside it. Stopping and restarting causes more attacks.
Attacks can become more frequent for the first few months as uric acid crystals dissolve and shift. Many people are given colchicine or an anti-inflammatory to take alongside during this period, precisely for that reason.
It is a long-term medicine, usually taken for life. Stopping once attacks settle simply lets uric acid rise again.
Rash, nausea and diarrhoea are the more common ones. Take it after food with plenty of fluid.
Tell your prescriber if you take azathioprine or mercaptopurine — those combinations need specific dose adjustment — and if you take warfarin or a diuretic.
Kidney function affects the dose, so blood tests are done periodically.
Alongside the tablet, staying hydrated, limiting alcohol (especially beer), and reducing high-purine foods such as red meat, offal and shellfish all help.
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