This question was answered on Thu 09, Sep 2010 12:42pm by Dr Anku Sharma

Allopurinol & Indomethacin for Gout

    
Asked by askmydoc (Male; 40; I have been suffering from Gout for last about 10 years.; Relevant drugs:Allopurinol, Indomethacin, Prednisone ) on Wed 08, Sep 2010 03:01am

Ifve been suffering from Gout for the last about 2 months. My doc prescribed me to have half of Allopurinol (150mg) and also Indomethacin (25mg each) (1 or 2 depends on the pain) to take at the same time after dinner. My question is, do these two medicines go together? I asked my Doc & he replied that there is no problem to take both of the medicines at the same time as soon as Ifve pain on my feet. Ifve been suffering from Gout pain on my left foot. At the moment my Uric acid level is about 0.32 mmol/L. It used to be 0.61 mmol/L few months ago. But still Ifm having pain on the right side of my biggest toe of the left foot with light red colour & the pain usually increases during the middle of the night! Itfs also swollen. I also took Prednisone by the docfs advice for 5 days which helped me to reduce the pain & also swollenness of my left foot. But as soon as I stopped taking Prednisone, the foot again started swollen and also pain came back. I canft take Prednisone anymore because I experienced bad side effect while I was taking this medicine. I get strong headache and also feel vomiting strongly after taking Prednisone. This is why doc recommended me to take Indomethacin instead of Prednisone side by side of half of Allopurinol (150mg). Please advise me regarding the above matter. Is there other option available that I can try? I appreciate it. Thanks.

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Answer by Dr Anku Sharma  on Thu 09, Sep 2010 12:42pm:

Hi. It is common for the starting dose of allopurinol to be low and gradually increased. Noticeable benefit from taking allopurinol may take months. In fact, during the first few months of use, the medication may actually increase the number of gout attacks. Eventually, allopurinol will prevent gout attacks. In the interim, colchicine may be prescribed as well. Do not stop taking allopurinol even if you're feeling well. avoid allopurinol in allergic patients. A dose change is required if patient is on Amoxicillin, and Other gout medications Allopurinol can cause upset stomach, diarrhea, and drowsiness. Rash is one of the more common side effects and can occur even after months or years of therapy. Uncommon side effects that are more severe if they occur include hypersensitivy reactions. Patients are advised to drink 8 glasses of water daily (unless a doctor instructs otherwise). Alcoholic drinks may decrease the effectiveness of allopurinol. Excessive vitamin C and allopurinol can combine to make urine acidic and cause kidney stones. Avoid injury to the joint, fever, excessive eating and recent surgery. The small joint at the base of the big toe is the most common site of an acute gout attack of arthritis. An acute attack of gouty arthritis at the base of the big toe is medically referred to as podagra. Other joints that are commonly affected include the ankles, knees, wrists, fingers, and elbows. Acute gout attacks are characterized by a rapid onset of pain in the affected joint followed by warmth, swelling, reddish discoloration, and marked tenderness. Tenderness can be intense so that even a blanket touching the skin over the affected joint can be unbearable. Finally, indomethacin (Indocin) and naproxen (Naprosyn) are effective anti-inflammatory medications for acute gout. These medications are tapered after the arthritis resolves. Common side effects of NSAIDS include irritation of the gastrointestinal system, ulceration of the stomach and intestines, and even intestinal bleeding. People who have a history of allergy to aspirin or nasal polyps should avoid NSAIDS because of the risk of an intense allergic (anaphylactic) reaction.Corticosteroids can be prescribed to patients who have accompanying kidney, liver, or gastrointestinal problems. Long-term chronic use of corticosteroids is discouraged because of serious long-term side effects. uric acid-lowering medications such as allopurinol and febuxostat are generally not started in patients who are having acute attacks of gout. These medications, when started during an acute attack, actually can worsen the acute inflammation.

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