January 26, 2023

Dr Andrew Jordan explains how he uses Allopurinol in the treatment of gout to reduce uric acid levels. He discusses dosing of Allopurinol and what should be considered when using this medication. He also discusses how Colchicine is used in combination. Don’t miss out on what he has to say with the specifics with prescribing Allopurinol.

Hi i’m dr andrew jordan rheumatologist at bjc health in sydney australia today i want to talk to you about how i use allopurinol allopurinol is a medication used in gout which is used to drop your uric acid level this is the most important thing for your long term management of your gout i’ve talked in another video about when i would use it today i want to

Talk about how i use it allopurinol works in the body by dropping your uric acid level if we get it below a certain level you won’t get gout attacks in the long term allopurinol can be used by almost everyone although there are some situations where you might not and that’s if you have an allergy to allopurinol we typically would start at a low dose and

This varies between rheumatologists and doctors so you’d be best talked to them but you would want to start at a low dose and i typically start at 100 milligrams a day increase to 200 then 300 and then i’ll assess what the uric acid level is if the uric acid level has not reached target then i will continue increasing until we’ve reached target the maximum

Dose of allopurinol is 900 milligrams a lot of people stop at 300 but there’s absolutely no reason to stop at that allopurinol has a couple of situations that you need to be aware of firstly a number of people very small number can be allergic to it this usually occurs in the first couple of months and if you get a rash or fever you should stop your medication

Immediately and contact your doctor if you don’t get a reaction to it the long-term side effect profile is actually really good occasionally you get stomach upset but um usually there’s really not too many issues when you start the allopurinol and typically i do it for at least three months you need some other medication to stop you from getting gout flares so

When you drop your uric acid level with allopurinol you can actually bring on a gout attack which is clearly not what you want i use colchicine in this situation and depending on your kidney function it might be one tablet a day or two tablets a day but i usually will keep that there for a few months to reduce the chance of you having an attack while we get the

Allopurinol dose correct i know when you’re on the right dose of allopurinol because you’re below the target of 0.36 millimoles or six milligrams per deciliter as it is in the united states when you’re at that target that’s the dose you need to continue and that’s the dose you need to continue for the rest of your life if you stop allopurinol after that your

Uric acid will just go back up and you’ll get gout sometimes quickly sometimes it’ll take a while the other most important thing you need to know about allopurinol is that if you get a gout attack while you’re on it you do not stop it you treat the gout attack with medications we’ve talked about in other videos and you continue the allopurinol at your same dose

Stopping and starting allopurinol is especially unhelpful and it often will lead to more problems down the track i hope that gives you some idea about how i use this important medication for gout this is a topic that’s really important to discuss with your treating doctor so i encourage you to do that but feel free to drop a comment and i’ll try to answer it also you

Transcribed from video
How I use Allopurinol By BJC Health