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What Causes Acute Gout Attack In Ankle Post Intake Of Allopurinol?

Posted on Thu, 7 Apr 2016

Question: I have been taking allopurinol for a couple of weeks and stopped colchicine a week ago. I now have an acute gout attack in my ankle. Took a couple of colchicine with no improvement. Should I take diclofenac as it has eased pain in the past. is there any reason I should not combine allopurinol and diclofenac.

Answered by Dr. Swarnava Dattagupta (21 minutes later)

Brief Answer:
Avoid allopurinol; take diclofenac +/- colchicine

Detailed Answer:
Hi,
Thank you for posting your query in Healthcaremagic.com.
This is Dr. Swarnava Dattagupta answering your query.

I understand your concern.
You are having an acute attack of gout; NSAIDs like diclofenac, aceclofenac, ibuprofen etc are the mainstay of treatment and should be taken as soon as possible to reduce pain. Colchicine are sometimes used alongwith to reduce pain and swelling. Also corticosteroids can be used too. But there is no role of allopurinol in acute gout, rather it can precipitate an attack.
Hence, my suggestion will be to avoid allopurinol now and take diclofenac +/- colchicine if required. Also, apply ice locally and elevate the affected limb by placing a pillow under the ankle. Alongwith, drink plenty of water and oral fluid. An acute attack might take upto 7 days to subside.

Hope I have answered your question.
If you have any further questions I will be happy to help.
Regards.

Above answer was peer-reviewed by : Dr. Deepak

Follow up: Dr. Swarnava Dattagupta (1 minute later)

Can you advise how long it takes for a response and does it come to my email address ?

My doctor advised to continue with allopurinol should I have a further gout attack as I have long term high uric acid and allopurinol will be a long term solution to this. Resuming colchicine does not seem to be doing anything to alleviate the pain. The gout attack began a day ago and has steadily got worse. I have taken diclofenac before for gout attacks but not since I started allopurinol on 13 January this year.

Further to the above - allopurinol can cause gout attacks when it is first used while it is getting rid of uric acid and I was told that attacks might happen but not to stop taking the drug. My question really is: is it OK to take both allopurinol and diclofenac together.

Many thanks

I have been taking 200mg allopurinol daily

Dr Swarnnava - many thanks for your help :)

Answered by Dr. Swarnava Dattagupta (5 hours later)

Brief Answer:
Yes it is okay

Detailed Answer:
Hello again.

Yes it is okay to take allopurinol and diclofenac together.
There is no known serious interactions between them.
You can take them safely provided you do not exceed usual dosage.

Regards.

Above answer was peer-reviewed by : Dr. Naveen Kumar