From the Research
It is recommended to wait until at least 2-4 weeks after a gout attack has completely resolved before starting allopurinol for gout prevention, as supported by the most recent study 1. Starting allopurinol during an active gout attack can potentially worsen or prolong the flare. When beginning allopurinol therapy, it should be initiated at a low dose, typically 100 mg daily, and gradually increased every 2-4 weeks until reaching the target dose or until uric acid levels fall below 6 mg/dL, as suggested by previous guidelines 2, 3, 4. Some key points to consider when initiating allopurinol therapy include:
- The importance of waiting for the acute gout attack to resolve before starting allopurinol, to avoid exacerbating the condition
- The need for gradual dose escalation to minimize the risk of adverse effects
- The use of anti-inflammatory medication, such as colchicine or NSAIDs, to prevent flares during the initial months of allopurinol therapy, as recommended by recent studies 1
- The goal of reducing serum urate levels to prevent crystal formation and future gout attacks, as emphasized by various guidelines 5, 4 Allopurinol works by inhibiting xanthine oxidase, the enzyme responsible for producing uric acid, thereby reducing serum urate levels and preventing crystal formation over time. It is essential to weigh the benefits and risks of allopurinol therapy, considering the potential for adverse events, such as diarrhea, myocardial infarction, and neuropathy, as reported in recent studies 1. Overall, the management of gout requires a comprehensive approach, including lifestyle modifications, anti-inflammatory therapy, and urate-lowering treatment, as outlined in recent reviews 5, 4.