From the Guidelines
No, patients should not discontinue allopurinol during a gout attack. Allopurinol should be continued at the same dose throughout the acute gout flare. Stopping allopurinol during an attack can actually prolong the flare or potentially trigger additional attacks due to fluctuations in serum urate levels.
Key Considerations
- While treating the acute gout attack with anti-inflammatory medications such as colchicine, NSAIDs (like naproxen or indomethacin), or corticosteroids, the allopurinol should be maintained without interruption.
- This approach helps maintain steady urate levels and supports the long-term goal of reducing urate crystal deposition.
- If a patient is just starting allopurinol therapy, it's generally recommended to delay initiation until 1-2 weeks after the acute attack has resolved, and to start at a low dose (typically 100 mg daily) with gradual upward titration to minimize the risk of triggering flares.
- Prophylactic anti-inflammatory medication (like colchicine 0.6 mg once or twice daily) is often prescribed for the first 3-6 months when initiating allopurinol to prevent flares that can occur during the early phase of urate-lowering therapy, as suggested by the 2016 updated EULAR evidence-based recommendations for the management of gout 1.
Management of Gout
- The 2020 American College of Rheumatology guideline for the management of gout also provides recommendations for the management of gout, including the use of allopurinol and other urate-lowering therapies 1.
- However, neither of these guidelines explicitly address the question of whether to discontinue allopurinol during a gout attack, but the general principle of maintaining urate-lowering therapy during acute flares is supported by the goal of reducing urate crystal deposition and preventing future flares.
Patient Education
- Patients should be educated on the importance of continuing their urate-lowering therapy, including allopurinol, during acute gout attacks, and on the potential risks of stopping therapy, such as prolonging the flare or triggering additional attacks.
- Patients should also be advised to seek medical attention if they experience any increase in symptoms or worsening of their condition while taking allopurinol.
From the FDA Drug Label
They should be reminded to continue drug therapy prescribed for gouty attacks since optimal benefit of allopurinol tablets may be delayed for 2 to 6 weeks.
The patient should not discontinue allopurinol during a gout attack. Instead, they should continue taking the medication as prescribed and follow the treatment plan for gouty attacks. 2
From the Research
Gout Attack and Allopurinol Treatment
- During a gout attack, the management of the condition involves the use of non-steroidal anti-inflammatory drugs, colchicine, and corticosteroids to alleviate the symptoms 3, 4, 5.
- Allopurinol is a xanthine oxidase inhibitor used to reduce concentrations of uric acid, and it is an effective treatment for gout 3, 4, 6, 5, 7.
- The general recommendation is to continue urate-lowering therapy, such as allopurinol, during a gout attack, as discontinuing it may lead to a rebound effect and worsen the condition 4, 6.
- However, it is essential to note that the treatment should be individualized, and the decision to continue or discontinue allopurinol during a gout attack should be made under the guidance of a healthcare professional, taking into account the patient's specific condition and medical history 4, 5, 7.
Key Considerations
- Allopurinol is typically used for long-term management of gout, and its discontinuation during an acute attack is not generally recommended 4, 6, 5.
- The primary goal of treatment during a gout attack is to manage the symptoms and reduce inflammation, while continuing urate-lowering therapy to prevent future attacks 3, 4, 5.
- Regular laboratory follow-up and comprehensive patient education are crucial components of gout management 4, 5.