From the Guidelines
The goal uric acid level when taking allopurinol should be below 6.0 mg/dL (357 μmol/L), with some patients requiring a target below 5.0 mg/dL for severe gout or tophi, as recommended by the 2016 updated EULAR evidence-based recommendations for the management of gout 1. Allopurinol dosing usually starts at 100 mg daily and is gradually increased every 2-4 weeks based on uric acid levels, with most patients requiring 300-600 mg daily for effective control. Foods that increase uric acid levels include:
- High-purine animal proteins (organ meats like liver and kidney, seafood like anchovies, sardines, mussels, scallops, and trout)
- Alcoholic beverages (especially beer)
- High-fructose corn syrup products While on allopurinol, it's essential to:
- Stay well-hydrated
- Limit alcohol consumption
- Maintain a healthy weight
- Follow a balanced diet rich in vegetables, low-fat dairy, and whole grains Regular monitoring of uric acid levels is crucial to ensure the medication is working effectively. Allopurinol works by inhibiting xanthine oxidase, the enzyme responsible for converting purines into uric acid, thereby reducing uric acid production in the body and preventing gout attacks over time. The American College of Rheumatology guidelines for management of gout also support the use of allopurinol as first-line therapy, with a recommended target serum urate level below 6 mg/dL, and below 5 mg/dL for patients with severe gout or tophi 1.
From the FDA Drug Label
The upper limit of normal is about 7 mg/dL for men and postmenopausal women and 6 mg/dL for premenopausal women. To reduce the possibility of flare-up of acute gouty attacks, it is recommended that the patient start with a low dose of allopurinol tablets (100 mg daily) and increase at weekly intervals by 100 mg until a serum uric acid level of 6 mg/dL or less is attained Clinical experience suggests that patients with recurrent calcium oxalate stones may also benefit from dietary changes such as the reduction of animal protein, sodium, refined sugars, oxalate-rich foods, and excessive calcium intake, as well as an increase in oral fluids and dietary fiber
The goal for serum uric acid level once on allopurinol is 6 mg/dL or less. Foods that may increase uric acid levels include:
- Animal protein
- Sodium
- Refined sugars
- Oxalate-rich foods
- Excessive calcium intake It is recommended to reduce the intake of these foods and increase oral fluids and dietary fiber to help control uric acid levels 2
From the Research
Utica Acid Level for Goal Once on Allopurinol
- The target serum uric acid (SUc) concentration is <6 mg/dl (360 micromol/L) 3, 4, 5, 6
- Allopurinol is still the drug of choice for the long-term control of hyperuricemia in patients with gout, with a dose of 300 mg/day achieving the target SUc in 70.4% of patients 3
- Further dose escalation up to 600 mg/day may be needed in some patients, but this dose is generally well tolerated and achieves the therapeutic goal in 92.5% of patients 3
Foods that Increase Uric Acid
- There is no direct information provided in the studies about specific foods that increase uric acid levels
- However, it is known that diet plays a role in managing uric acid levels, and patients with gout are often advised to follow a diet that is low in purines and high in fruits, vegetables, and whole grains 4, 5
Achieving Serum Urate Goal
- Febuxostat is more effective than allopurinol in achieving serum urate goal, with an adjusted odds ratio of 1.73 (95% CI, 1.48-2.01) 4
- Factors associated with achieving and maintaining target serum urate include older age, normal body mass index, and rheumatologist as the main provider 5
- Oxypurinol monitoring can guide allopurinol therapy and help achieve serum uric acid <6 mg/dl 6