Allopurinol (Zyloprim) versus Uloric (Febuxostat)
When you are first diagnosed with gout, your rheumatologist is going to consider the two major drugs on the market. Allopurinol is usually the first choice when it comes to preventing a gout attack and excreting uric acid from your body. The one big pro about Allopurinol is that it has been around the longest and the cost of the drug is fairly inexpensive, even without insurance. Uloric on the other hand is fairly newer and the cost is going to be a little bit more on the higher end. There are more research studies surrounding Allopurinol than there is Uloric, but both are moderately safe to use.
Both medicines can be taken with or without food. Both drugs are not an NSAID (Non-Steroidal Anti-Inflammatory drug). According to drug.com Uloric Dosage Guide – Drugs.com the recommended dosage for Uloric is going to be between 40 to 80 MG. The Mayo Clinic Allopurinol (Oral Route) Proper Use – Mayo Clinic recommended dosage when starting out is between 100-300 MG. This can increase to 800 MG in rare circumstances.
Uloric usually has one pill to take care of the dosage from 40 to 80 MG, but Allopurinol is different. Allopurinol usually can come in a 100, 200 or 300 pill and anything higher needs to just add in combination. If your doctor suggests 700 MG, you will get something like 300 MG pill bottle and a 100 MG, but the amount of pills in the 300 MG might be double. The highest MG for Allopurinol in a pill bottle is 300 MG. I take 300 MG and never had to go higher.
Why Take Allopurinol Versus Uloric?
There is a breakdown of the two medications pros and cons listed on GoodRX Health. Uloric vs. Allopurinol for Gout: Important Differences and Potential Risks. (goodrx.com) Allopurinol can raise the risk of kidney stones and can “Possible risk for low blood cell levels and liver damage.” Now these risks are fairly small, but they are still risks.
In the same website, Uloric does show some cons that are significant as well. Uloric is “Not a good option for people with heart conditions.” If your body doesn’t respond to Allopurinol the doctor will respond with a Uloric option. In the rare case of your body showing side effects of Allopurinol then the doctor will put you on Uloric.
Both pills will not stop a gout attack. That’s where you would take medicine like Indomethacin or Colchicine. The Mayo Clinic advises us to never stop your Allopurinol even during a gout attack. Allopurinol (Oral Route) Proper Use – Mayo Clinic. Stopping Allopurinol suddenly could cause some side effects to sprout up, so only stop if your doctor tells you to. The FDA advises the same issue about Uloric and stopping your medication during a gout attack. FDA adds Boxed Warning for increased risk of death with gout medicine Uloric (febuxostat) | FDA
What do I take between Allopurinol versus Uloric and my history?
I have found in the last 25 years of having this disease is that my body responds better to Allopurinol. Not only is it cheaper for me, but I find that Allopurinol has a better effectiveness. I only tried Uloric for a year, because of how expensive it was in the early 2010s.
What I found is that my anxiety and heart rate went up when I had gout attacks while taking Uloric. I was in need of more steroid shots to reduce the severity of attacks. Now this is my body, and all bodies are different. Now a days, I find new doctors that I see want to get me back on Uloric, but as the last link to the FDA website up above listed, there is an increased risk for cardiac arrest. My family has a high rate of heart attacks. So, the option to go back is not one for me, especially as I approach 40.
So, what is going to be your deciding factor?
When it comes down to it, with a new diagnosis your doctor will prescribe a low dose Allopurinol and take notes from your bloodwork and your response to the drug. If your family has a history of heart issues, doctors may take that into effect and still try Allopurinol. I do not believe one is better than the other. Uloric is expensive still but can be incredibly effective.
One thing to note, please check out the links I added on this article as some of the websites show more detail than what I can provide in here. The Mayo Clinic link shows what medicine you shouldn’t mix Allopurinol with. Back in 2019 I was on a national trial for Krystexxa (Pegloticase) with Methotrexate under the incredible care of Dr. Kenney. Here’s his link if you are in the Spokane Washington area and need a nationally rated rheumatologist Arthritis Northwest PLLC: Rheumatology: Spokane, WA & Spokane Valley, WA (arthritisnw.com). Tell him that Jacob sent you!
I was advised by Dr. Kenney to not take Allopurinol during my Krystexxa trial. The medicines clash with Allopurinol. Be prepared to stop using Allopurinol if you are about to Krystexxa.
My last two cents on the matter
Don’t let the fear of side effects hold you back from taking Allopurinol or Uloric. I have heard hundreds of adults say, “I don’t want to take a pill for the rest of my life.” These pills are super small and take up maybe 10-30 seconds of my day. I find that when I am on either pill, my gout attacks are less. You might even see your uric acid reduce down to below 5 MG/DL and your dosage of either drug drop significantly! Fear is the biggest enemy to combating your gout health. Let your doctors guide you. Get a great rheumatologist and you should be fine.
Comment below if you have any questions or want to share your history with either or both of the medicines. I would love to see them.
Check out my other article where I talked about being diagnosed at the age of 13. Warning About Pediatric Gout – Do Better Medical Field – thefamousjacob.com
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