New Dose Schedules Aim to Reduce Gout Flares - #4 of '10 Things You May Not Know About Gout'

PHARMACIST Fi shares how, in recent years, new dose schedules for the urate-lowering medicine allopurinol are in prescribing guidelines for doctors in places like Australia. These modern dose schedules (in Australia's Therapeutic Guidelines 2023, and in the Australian Medicines Handbook 2023) start with a lower allopurinol dose, and then increase the allopurinol dose
more gradually (by smaller amounts and with more time between the dose increases) compared to the older allopurinol dose schedules (please note that older dose schedules may still be in some allopurinol prescribing information documents).
The eventual allopurinol dose for a particular person to achieve their target [lower] uric acid level may be the same if either an older or new dose schedule is used, but with the new dose schedule the process of increasing allopurinol dose takes longer - so the change in uric acid level is slower - and the new dose schedule has been designed this way because sudden changes in uric acid level may trigger gout flares, but the aim of these new allopurinol dose schedules is to decrease risk of gout attacks during the early months of urate-lowering treatment with allopurinol, while gout urate crystals are still being melted.
However, even with gout flare risk reduction by this new allopurinol dose schedule, please note that also taking a different medicine to prevent gout attacks (an anti-inflammatory medicine - if it is suitable for the person's medical conditons, medicines, and kidney and liver function) is still recommended (if suitable for the person) during this early allopurinol treatment phase while urate crystals are being melted (you may remember this role for an anti-inflammatory medicine was mentioned in the 2nd video of this '10 Things You May Not Know About Gout' video series:
https://youtube.com/shorts/HHmBCMZ9ZBY?feature=share ).

Please note that the next paragraph (below this paragraph) is for doctors, so if you are a person with gout who is taking allopurinol: DON'T make any changes to your allopurinol dose unless you have been advised to do so by your doctor, because sudden increases OR decreases in allopurinol dose may trigger gout attacks (also called gout flares) in some people during the early months of allopurinol treatment when urate crystals are still being melted (but you are welcome to give the information below to your doctor, so they can discuss it with you and consider whether or not it might be relevant to your allopurinol dose schedule).

If you are a doctor, you might find the following info interesting: When this description section was written on 18 March 2023, one of the dose schedule options in Australia's Therapeutic Guidelines is (if allopurinol is considered suitable for a particular person with gout) to start the person with gout on allopurinol 50mg once daily for 4 weeks, then
increase that daily dose by 50mg each month or fortnight until the person's uric acid level reaches target treatment level for their particular gout presentation (e.g. less than 0.36mmol/L (less than 6mg/dL) if the person has no tophi, or less than 0.3mmol/L (less than 5mg/dL) if the person has any tophi). Please note: this schedule is for people without kidney impairment; lower start dose and slower dose increases with close kidney monitoring are used for people with significant kidney impairment (please see Australian Medicines Handbook 2023 for details). As you can see, this modern dose schedule is quite different to older allopurinol dose schedules (which may still be in some allopurinol prescribing information documents). It is hoped that by starting with a lower allopurinol dose, then increasing the allopurinol dose less often and by smaller amounts (until serum uric acid target is reached), this modern allopurinol dose schedule may reduce risk of gout flares early in urate-lowering therapy with allopurinol (before all the urate crystals have been dissolved). However, even with this modern allopurinol dose schedule, it is still currently recommended that the person with gout also take an anti-inflammatory medicine to prevent gout flares (if suitable for their medical conditions, kidney & liver function, & medicines; e.g. colchicine or NSAID, if suitable) during the early phase of allopurinol treatment when their uric acid level is changing.

If you found this video interesting, here is the link to the playlist of PHARMACIST Fi videos about gout, and gout treatment medicines which may or may not be prescribed (depending on a person's other medical conditions, other medicines, and kidney and liver function levels): https://www.youtube.com/playlist?list=PLwyYRbsDY3ju2-aCCW8SBu6fcOxitCfCJ

We hope you found this video helpful.
Please also see disclaimer at the end of this video.
If you would like to support PHARMACIST Fi to make more videos, please consider buying merchandise: https://pharmacist-fi.myshopify.com/collections/all , or giving a donation at: https://www.pharmacistfi.com/donate

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