So, my blood Uric Acid was 13.1 not long ago and I had a severe gout attack. Now (yesterday) it is down to 8.8 and the doctor suggested meds to get down to the normal range. Previously, he has said that taking meds whilst having a gout attack could worsen the symptoms. He told me to take Feburic. As my impression had been that he had pushed meds on me for poor reason previously, I asked for how long and he seemed not to know, suggesting indefinitely. I asked about cost and he said he didn't know, so I asked if it was available over the counter and then went to a pharmacy instead of buying it at the hospital (before I left he recommended I buy 10 pills there, seemingly affirming that he wanted to help the hospital financially by selling meds). At the cheapest pharmacy in Bangkok, Feburic cost THB 2500 (more than USD 700) for 30 pills, so I said 'HELL NO' as my uric acid levels have been decreasing and I have learned about diet to limit the production of it etc. Then I looked online and found Allopurin. It seems Feburic and Allopurin do pretty much the same thing and have similar frightening potential side-effects. The pharmacy had two kinds of Allopurin, made in the US and made in Thailand. I opted for the latter and 10 pills cost THB 15 (USD 0.50), so I bought 30 pills (USD 1.50) and will check my Uric Acid again in one month. I am also taking Tart Cherry capsules and, of course, being careful not to overtrain or eat a lot of animal protein.
What do the rest of you know about Feburic, Allopurin, and other meds to lower Uric Acid? Information about dealing with gout is also appreciated.
PS. I have 3 small kidney stones at the moment and am taking Xitrin to help get rid of those, though I am not sure the doctors know the composition of the stones I have but have deduced they are Uric due do my high levels of Uric Acid. My eGFR is just above 50.
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NilsB
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Having uric acid and kidney stones is no joke so if there is something to do to stop and get rid of the stones, then you should. I went through several years of producing many, many stones before my doctor prescribed allopurinol. I have been on it for years. Stopped the stones, but after damage was done to my kidneys. I still take it. I also take sodium citrate because I have psoriatic arthritis and it lowers my uric acid levels. This helps to keep it more normal. Big difference in how I feel.
So you take one med that lowers uric acid and one that increases it? Can you explain how that works? In 2017 I had stones that needed lithotripsy bilaterally. It took a long time after for the stones to pass and I think scar tissue may have contributed to the lowering og my kid ey capacity. Right now, I am taking 100g of allopurinol daily (2nd day today).
Haha. Lucky I was curious. I will look into Sodium Citrate. Is there a specific reason why you combine it with Allopurinol and could you give any recommendations based on your experience? Sadly, I do not really trust the doctor as Thailand's private hospitals operate on a US-style model, sadly.
The allopurinol is the gold standard here for gout and uric acid. Baking soda is another common remedy but I couldn't tolerate it. If you do not trust your doctor, get one you do.
Yup. Plan to do that this coming Wednesday, at a government hospital. They are not as good and can have waiting times but the incentives are not screwed up.
I take 200 mg of Allopurinol daily and have been on this medication for about 5 years. My uric acid level was around 8 when I started and below and it is at 6 now. It did take almost a year to get this level down to the normal range. I only had one gout attack that caused me to start the medication. Since taking the medication, I have not had any attacks. Its not a good idea to leave this condition untreated as the crystals that are formed around the joint can injure the bone.
Yes, I heard that taking this medication during an attack can intensify the attack. That always seemed odd to me, but I think its true.
Thank you very much. One year... Can I ask how much you took daily and if you are expected to take the meds indefinitely? I heard one should start at 100mg and max dose is at 800.
I take 200 mg daily.and have taken this dose for a few years. I did start out with 100 mg daily, but the uric acid levels was not decreasing as fast so the dosage was changed to 200 mg a day. Now, my uric acid level is just at the upper limit of normal range. However, there are times when I feel an attack starting and then it goes away and never develops. I'm hoping that I do not.have to increase my dosage, but i know that I'll be taking this medication indefinitely. My one and only attack was very painful and I dont ever want another one
Yes, it is sad, but it is also a great relief to have something to help with the pain. I had an X-ray for a possible ankle fracture last year and by chance saw all the uric acid crystals around the toe joint that was the site of my only gout attack. It's scary to think what collects when untreated.
I also am not a big medicine fan myself and was distressed when the dose had to be increased. Nonetheless it worked and hope I can stay on the edge of this normal uric acid range. I've accepted it and believe my doctor made the right choice. Good luck.
consult your nephrologist on the actual med you should take, but for people w/ gout which I am one, allopurinol is the first and go-to med. Personally, I have had gout for around 18-19 years - way before being diagnosed with CKD (currently on stage 3a). I started at 100mg maybe 15 years ago, and had to increase it to 300mg a year or two later b/c I was still having gout attacks (on my big toes). I also eventually changed my diet as well after identifying shellfish being a BIG trigger. Think the last time I had an attack was at least 5 years ago.
With that said, 300mg is the max my nephrologist said someone with my CKD stage should take. She had even lowered my dosage back to 100mg since my uric acid levels are ok. You will need to watch it. She mentioned that people with CKD should aim for uric acid levels around 6, and not the range listed in our blood reports (around 8.8).
My mother finally got Allopurinol for her severe gout. She got an attack in mid foot, then ankle so not just big toe. She tolerates one half a pill, so 50mg a day. She gets headaches easily. She got an attack in the first two weeks of taking medicine, but thankfully has been gout free for the last few months. She has to take a Methylprednisolone pak because the attacks are so bad. Before, they gave her colchicine which gave her a migraine. So, steroids to treat an attack, allopurinol to prevent attacks.
Medicines used to treat gout attacks relieve pain and inflammation and include:
Nonsteroidal anti-inflammatory drugs (NSAIDs) (which we can’t take with CKD)
colchicine
Corticosteroids.
Medicines to prevent recurrences of gout either block the production of uric acid or improve its removal. Examples include:
allopurinol
febuxostat
pegloticase
probenecid.
If you already have kidney stones, you certainly should be on medication as tolerated, but also keep an eye on those uric levels. Hope the allopurinol works for you.
Thank you. I have Colchicine and Prednisolone and pain-killers on hold. A study I read said that the dosage for Colchicine should be an initial 2 pills and then another pill one hour later and then nothing. Supposedly, this was just as effective as taking pills for a longer period (I don't remember the exact details). As NSAIDs are a no go (too bad since Arcoxia worked miracles), I also have prednisolone. The pain-killers are for if/when the stones start to move. I will re-check the uric acid at the end of this or next month. Fingers crossed...
I am very sorry to hear you cannot get rid of them completely. I had several before O realized it was gout and they were so painful that I was completely immobilized until I took Arcoxia. Now I have hopped they will cease and I hope for the best for you as well
I have taken allopurinol for years. I had my severe gout issues in 2004-2006. I had so many attacks I had tophi in most all joints. I was referred to a rheumatologist in 2006 and she was a life saver. I was always prescribed allopurinol after a gout attack but I suffered from an additional gout attack hen I started the allopurinol. The rheumatologist started me on 150mg of allopurinol with .6mg colchicine on Monday and Fridays and 7.5mg prednisone daily as prophylactics. She kept the prophylactics and increased me to 300mg of allopurinol over a six month period. No additional gout attacks and did not hav any until August of this year after I had COVID. I had been off the allopurinol for 2 years with no issues until the COVID. Now starting back with the same plan as in 2006. It is a huge benefit to get uric acid below 5 if possible. Not just for gout but for kidney issues in general.
Some. They went from about 6 back to 8. However, after COVID 9.5 plus. So back in the allopurinol. For me I can’t just start taking it as any fluctuation in my uric acid cause a flare. Since I have had gout well over 20 years, there are no mild flares and I develop tophi quickly. Neither are good. The flares because they f*#%ing hurt and the tophi because they represent hyper-hyperuricemia which is destructive to the kidney nephrons. Meaning like leaking protein they destroy kidney function. So when I begin allopurinol after a break it is only with the prophylactics mentioned above.
You have to avoid certain food that high risk of uric acid.
Recommendations for specific foods or supplements include:
-Organ and glandular meats. Avoid meats such as liver, kidney and sweetbreads, which have high purine levels and contribute to high blood levels of uric acid.
-Red meat. Limit serving sizes of beef, lamb and pork.
-Seafood. Some types of seafood — such as anchovies, shellfish, sardines and tuna — are higher in purines than are other types. But the overall health benefits of eating fish may outweigh the risks for people with gout. Moderate portions of fish can be part of a gout diet.
-High-purine vegetables. Studies have shown that vegetables high in purines, such as asparagus and spinach, don't increase the risk of gout or recurring gout attacks.
-Alcohol. Beer and distilled liquors are associated with an increased risk of gout and recurring attacks. Moderate consumption of wine doesn't appear to increase the risk of gout attacks. Avoid alcohol during gout attacks, and limit alcohol, especially beer, between attacks.
-Sugary foods and beverages. Limit or avoid sugar-sweetened foods such as sweetened cereals, bakery goods and candies. Limit consumption of naturally sweet fruit juices.
-Vitamin C. Vitamin C may help lower uric acid levels. Talk to your doctor about whether a 500-milligram vitamin C supplement fits into your diet and medication plan.
-Coffee. Some research suggests that drinking coffee in moderation, especially regular caffeinated coffee, may be associated with a reduced risk of gout. Drinking coffee may not be appropriate if you have other medical conditions. Talk to your doctor about how much coffee is right for you.
-Cherries. There is some evidence that eating cherries is associated with a reduced risk of gout attacks.
Great response. I was surprised that high purine veggies do not lead to gout. Also, I will admit that staying away from animal proteins has made me eat more baked goods and sugar... Ugh. Tricky stuff, but salads without animal products simple leave me craving more food. The doctors said no dairy, bit I have actually started to eat dairy again and, frankly, it makes me feel much better though exactly how it affects my system may reveal that I am mistaken. I have never been a coffee drinker but have started now after reading information posted here. Thanks once again for a great summary.
Caffeine has had mixed reviews, but since it is basically addictive, so I prefer to avoid it and stick with organic herbal teas without it. However, the antioxidants in green (including matcha), black and white teas are very helpful. So, choosing what is right for you depends on your overall health needs, not just gout.
So sorry to hear that. Colchicine has side effects as well. Kidney disease is no fun and greatly affects, at least for the liver of food, quality of life. It has been found that kidneys can regenerate to some extent and recently some success was achieved towards using pigs' kidneys for transplants, which may reduce the future need for dialysis. However, I don't foresee any great advances in the near future. I hope, but I don't expect. Astra Zeneca is also working on helping people with kidney problems.... Let's all hope the scientists see great success and soon. Hang in there. Also, I hope you have found great food options without animal protein.
Porcine transplants could save many lives and it's exciting, but US regulations prohibit rapid development of this. There are major innovations in the works to help with home dialysis including forward osmosis for pure water, zero water processing backpacks, etc. All these things are about 3 years away at earliest.
Interesting. One more added to the list, this one administered by injection. According to what I found in a quick search on Google, it is a last resort medication (side effects and cost), very highly priced, and in the US not covered by insurance (such an ugly system). The working mechanism sounds absolutely genius. drugs.com/krystexxa.html
What have you made of the low/very low protein plant based diet recommendations? At eGFR 50 it would have risen in your consciousness. You seem clued in generally
Just wondering whether diet would achieve both gout and kidney goals whilst avoiding meds with "frightening" side effects.
Kidney damage is either very difficult to reverse or impossible. However, I have read about plant diets and brown rice in particular helping people to improve their kidney function somewhat. I don't know if the kidneys actually improve. I suspect strict diets just decrease the load on them and prevent degeneration but maybe... I do believe that the goal of preventing further degeneration can be achieved with diet only with possible exceptions for cases when the kidneys are too badly damaged to deal with even a strict diet. Where the line goes for that, I do not know.
Agrees. There is no unscarring scar tissue. That said, inflammation, for example, will reduce efficiency so eliminating inflammation will improve function and make the kidneys better than they are.
Had you heard of the 2020 KDOQI guidelines advocating specifically on low/very low protein diets (which automatically necessitates plant based to achieve protein targets). The science for very low preferable over low appears pretty sound.
I was just wondering whether, by, as you say, removing workload on kidneys by reducing protein /acid food, your kidneys would handle uric acid better?
Hello NilsB! I’m sorry to hear about the rough time you’re having with gout flares. Believe me, as a person who suffers now with chronic gout, I’ve been there, done that, and got the T-shirt, as they say!
What many don’t know about gout, and what I found out the very hard way, is it’s not just red meat and shellfish that we need to avoid. I once went on an oatmeal kick because I thought I was doing a good thing fiver-wise, until my gout began exploding (going from my thumb, to two of my fingers, and then my elbow). I finally went online and discovered that there are so many other food items that can cause a gout flare-up. Among the more shocking items were:
- Oatmeal and any other whole grains including whole grain rice, barley, wheat, etc.
- Mushrooms, peas, beans, asparagus, spinach, alcoholic beverages (especially wine and beer), turkey, grapes, raisins, caramel, butterscotch, and any other highly condensed sugary products, and some foods high in Vitamin C, as the Vitamin C allows the purine in these foods to be more easily absorbed by our bodies.
I would suggest to you to also go online and do a little research. I think you’ll be a little shocked, as I was, by what you find out. It’s surprising the amount of different foods that can affect gout.
In my case, because of my kidney issues, I can’t take Allopurinol. When I was on it initially, it really made me sick to such a degree that my doctor was forced to discontinue it.
I hope you find this helpful. Glad to hear that your uric acid levels are decreasing. I wish you all my best! Please keep us posted on how you come along! God bless. 😊👍🙏
Dang... That really is sad news. I knew the protein in oats might stress the kidneys a little and that whole grains contain purine but I thought as you did that oatmeal would be good on the whole. Just the other day I had a big helping of it actually. Ugh. I will follow your advice and read more online. At the same time, I really don't know if I would want to live if I can't eat good food or exercise... We shall see. One step at a time as always.
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