Allopurinol: What it does and how to use it safely
Allopurinol is a common medicine that lowers uric acid. Doctors prescribe it mainly for gout and to prevent uric acid kidney stones. If you get repeated gout attacks or your blood shows high uric acid, allopurinol is often the next step after short-term treatments.
It works by slowing the enzyme that makes uric acid. Lower uric acid means fewer crystals in joints and fewer painful attacks. Allopurinol won’t stop a flare that already started—acute attacks need separate short-term treatment—but it reduces how often those attacks happen over months.
Dosage, starting tips, and what to expect
Doctors usually start low and increase the dose slowly. Common starting doses are 100 mg daily, then rising to 200–300 mg, with some people needing up to 600–800 mg daily under supervision. Your kidney function affects the dose—people with reduced kidney function often use lower amounts and are monitored more closely.
Starting allopurinol can trigger gout flares. That sounds odd, but it happens because uric acid levels shift when treatment begins. Doctors often give a short course of colchicine or an NSAID for the first 3 months to lower flare risk. Don’t stop the drug mid-flare unless advised by your doctor.
Common side effects are mild: skin rash, stomach upset, or changes in taste. A rash can be a warning sign—if it appears, call your doctor right away. Rare but serious reactions include severe skin reactions and allopurinol hypersensitivity syndrome (AHS). People with certain genetic markers (HLA-B*5801), more common in some Asian and African groups, have higher risk; your doctor may test if you’re in a high-risk group.
Interactions, monitoring, and buying advice
Allopurinol interacts with some drugs. It can dangerously increase effects of azathioprine and mercaptopurine, so those combinations require dose changes or avoidance. It can also affect theophylline and needs care with certain chemotherapy drugs. Always tell your prescriber every medicine you take, including supplements.
Before and during treatment your doctor will check blood tests: uric acid levels, kidney function, and sometimes liver tests. Aim for a target uric acid under about 6 mg/dL (your doctor may set a different target). Testing every few weeks when changing dose, then every few months once stable, is common practice.
Don’t buy prescription allopurinol from suspicious websites. Use a registered pharmacy and keep a valid prescription. If cost is an issue, talk to your provider about generics or patient assistance options.
Practical tips: drink water to help flush uric acid, cut back on beer and high-purine foods (organ meats, shellfish), and work on steady weight loss if needed. If you notice a new rash, fever, sore throat, or unexplained tiredness after starting allopurinol, contact your doctor immediately.
Allopurinol can change life for people with frequent gout attacks. With the right dose, monitoring, and a few lifestyle changes, many people see fewer attacks and better long-term joint health.
