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* how come no ALLOPURINOL in ACUTE GOUT?
 #572354  
  drgirl - 03/07/11 13:17
 
  can someone explain this concept to me? I am not understanding it? Thanks in advance.  
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* Re:how come no ALLOPURINOL in ACUTE GOUT?
#2346960
  puo - 03/07/11 13:24
 
  nice q
I KNOW BUT DONT KNOW TO EXPLAIN
 
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* Re:how come no ALLOPURINOL in ACUTE GOUT?
#2346964
  sucessmle - 03/07/11 13:27
 
  May ppt acute attacks of gouty arthritis, so withheld for 1-2 wks after an acute episode.  
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* Re:how come no ALLOPURINOL in ACUTE GOUT?
#2346967
  step1an - 03/07/11 13:31
 
  @PUO Nice answer ........ same here.

I think its because it can precipitate acute Gout & prolong the symptoms if started during an acute attack of Gout.
 
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* Re:how come no ALLOPURINOL in ACUTE GOUT?
#2346976
  puo - 03/07/11 13:43
 
  :)

IN CHRONIC GOUT , PROBENACID IS USED FOR UNDEREXCRETORS AND ALLOPURINOL FOR OVER PRODUCERS
 
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* Re:how come no ALLOPURINOL in ACUTE GOUT?
#2346978
  puo - 03/07/11 13:45
 
  AND allopurinol is used for tumour lysis syndrome where thr is excesswive production of uric acid from tumors , ITS A MEDICAL EMERGENCY .  
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* Re:how come no ALLOPURINOL in ACUTE GOUT?
#2346981
  simran88 - 03/07/11 13:47
 
  You wouldn't use it because it has no anti-inflammatory affects so it wouldn't do much good in an acute attack anyway. It is used in chronic management to prevent these attacks and keep your uric acid levels low at a constant rate. If you give Allopurinol while an attack is occuring, then you will have rapid shifts in uric acid levels - and that can further worsen the attack.  
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* Re:how come no ALLOPURINOL in ACUTE GOUT?
#2347078
  drgirl - 03/07/11 15:19
 
  Thanks!
Simran88 - Thank you. What do you mean when you say used in chronic managemnt to prevent "these attacks". What does "these attacks" refer to?
So if you give Allopurinol in an acute case of gout you can have a rapid increase in uric acid and that can further worsen the attack? Please coorect me if I'm wrong?
 
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* Re:how come no ALLOPURINOL in ACUTE GOUT?
#2347084
  sarim - 03/07/11 15:30
 
  sudden Increase or decrease in serum levels of uric acid can trigger acute gout attack.

Allopurinol and uricosuric (e.g probenacid) cause Sudden drop in serum uric acid levels and can "paradoxically" trigger an acute attack or if used during an attack can prolong the attack and make it worse.

i don't know how a sudden drop in serum levels trigger that but this is what it is and that is why they are contraindicated during an attack.
 
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* Re:how come no ALLOPURINOL in ACUTE GOUT?
#2347099
  psychmledr - 03/07/11 15:51
 
  "Individual gout flares are often triggered by acute increases or decreases in urate levels that may lead to the production, exposure, or shedding of crystals that are not coated with apo B or apo E. This can result from acute alcohol ingestion, acute overindulgence in foods high in purines, rapid weight loss, starvation, trauma, or hemorrhage. Medications that increase uric acid levels via effects on renal tubular transport include diuretics and low-dose aspirin. Gout flares can also result from agents that lower levels of uric acid, including the use of radiocontrast dyes and medications such as allopurinol or uricosurics."

Excerpt from
http://emedicine.medscape.com/article/329958-overview
 
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* Re:how come no ALLOPURINOL in ACUTE GOUT?
#2347105
  dna12 - 03/07/11 16:04
 
  How come decrease level of UA trigger gouty attack?
Anyways, allopurinol initially mobilize uric acid stored in the tissues and increase serum uric acid level, which can make the situation worse in an acute gouty attack or can trigger a gout attack in chronic hyperurecemic patients. Thats why its not indicated in an acute gout attack . When we start allopurinol as prophylactic in chronic hyperurecemic patients, we shd warn the patient about this and also give colhicine or NSAIDs with allopurinol for the first few weeks to avoid a flare of it. One of the reson we start allopurinol at lower dose-100 OD and increase it slowly.
Allopurinol doesn't decrease UA level quickly..it takes weeks or even months to control the UA level.Hope this helps.GL
 
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