Allopurinol - FAQs

Starting a new medicine can be worrying, but knowing what to expect and being prepared can be helpful. Here are some common questions people ask about allopurinol.

On this page, you can find the following information:

  1. What are the benefits of taking allopurinol?
  2. What is the best dose of allopurinol for me?
  3. What can I expect in the first few days or weeks of starting allopurinol?
  4. How long will I need to take allopurinol for?
  5. If I am having a gout attack, will an extra dose help?
  6. What if allopurinol does not help?
  7. What happens if I stop taking allopurinol suddenly?

What are the benefits of taking allopurinol?

Allopurinol is a long-term treatment that prevents gout attacks. It helps to prevent permanent damage to your joints.

What is the best dose of allopurinol for me?

The dose of allopurinol will be different for different people. Your doctor will usually start you on a low dose (50 to 100 milligrams) and increase it very slowly over a few months, until a target serum urate is reached. 

Serum urate is measured by a blood test and most people need to aim for a level below 0.36 mmol/L. The usual dose of allopurinol is 300 milligrams or more daily. Doses up to 900 milligrams daily may be needed in some people. Know what dose you should be taking.

What can I expect in the first few days or weeks of starting allopurinol?

When you first start taking allopurinol, you may get stomach upset and nausea (feeling sick). Taking your dose with food may reduce these symptoms.  

When you first start taking allopurinol, you may have gout attacks in the first few weeks or months as you are increasing your dose. Your doctor will prescribe additional medication such as a low-dose non-steroidal anti-inflammatory (NSAID) or colchicine to reduces the chances of an attack during this time. Keep taking allopurinol every day, even during a gout attack.

You may get a skin rash or itching (about 2 in every 100 people who take allopurinol will have a skin rash). This can happen anytime while taking allopurinol, but especially in the first few months while increasing the dose. If this happens, stop taking allopurinol and contact your doctor immediately – even if the rash is mild. This can develop into a severe allergic reaction. 

How long will I need to take allopurinol for?

Allopurinol is a long-term treatment. You will probably need to take allopurinol for the rest of your life, even during acute flares. Taken everyday, allopurinol will prevent flares of gout from returning. The effects of allopurinol are not immediate. It takes a few weeks or months for allopurinol to lower serum urate to the target level in your blood. Research shows that if allopurinol is stopped, even after years of being symptom-free, most people will experience a return of flares within four years.1 

If I am having a gout attack, will an extra dose help?

No. Allopurinol is not a pain reliever and does not take effect immediately. If you have an attack of gout while taking allopurinol, keep taking it at the same dose. Do not stop taking it. Your doctor will advise you to take a pain reliever medicine such as NSAIDs (ibuprofen, diclofenac, naproxen), or steroids such as prednisone or colchicine. You can also apply ice-packs and rest the affected joint, to reduce pain. See your doctor if the pain and inflammation does not improve in 24 hours.   

What if allopurinol does not help?

After starting allopurinol, your doctor will monitor your symptoms and your serum urate levels. If after a few months of being on an optimal dose of allopurinol, your symptoms do not improve and your serum urate levels remain high, your doctor may try you on other medicines instead to lower your serum urate such as febuxostat, probenicid or benzbromarone.

What happens if I stop taking allopurinol suddenly?

Do not stop taking allopurinol suddenly unless you have a skin rash or allergic reaction. Speak to your doctor or nurse before stopping. Stopping allopurinol quickly can cause a flare up and make your gout worse.

Learn more

The following links have more information on allopurinol.

Allopurinol (Māori) New Zealand Formulary Patient Information
Medicines for gout Ministry of Health, NZ
A conversation about gout (includes dispelling common myths including gout is a bad drug)
 BPAC, NZ
Out with gout Pharmac, NZ

References

  1. Allopurinol New Zealand Formulary
  2. Managing gout in primary care: part 1 BPAC 2018
  3. Managing gout in primary care: part 2 BPAC 2018