Gout may not sound like much to those who have never experienced it. The most common symptom of this form of arthritis, which strikes more men than women, is pain in the big toe. Those who have suffered through a stubbed toe may scoff at this, right? However, the pain of gout is so severe that it may cripple the sufferer; even the slightest breeze on the tender spot may cause him or her to cry out in anguish. And though the big toe is the most common place for gout-related pain, the unbearable aching may spread to the ankles, wrists and elbows, among other joints.
If you've ever experienced an attack of the gout, you're in good company. Men as esteemed as Benjamin Franklin, Alexander the Great, Charlemagne, Charles Darwin and Isaac Newton all suffered from it [source: Gower]. Perhaps the most famous sufferer of gout was Henry VIII of England, who in addition to being insatiable in terms of wives was also quite the glutton. Each night, he'd enjoy a side of venison washed down by multiple glasses of wine. This diet of alcohol and meat, particularly organ meats like livers and kidneys, may contribute to gout. For this reason, gout has long been considered "the disease of kings," because historically, they were the only ones who could afford such a decadent diet. Now, however, many of us can indulge in a fatty Western diet, and gout affects many more people -- approximately 3 million Americans, in fact [source: Payne].
What these modern day gout sufferers have that the kings of old did not is the drug Zyloprim, which is the marketing name for allopurinol. Allopurinol has been the foundation of most gout treatments since it was approved by the U.S. Food and Drug Administration in 1966 [source: Pacher et al.].
Gout occurs when a person can no longer rid excess uric acid from the bloodstream. What does this mean, and how can Zyloprim help?
Zyloprim at Work in Your Body
Gout results when there's too much uric acid in the bloodstream. Everyone has some uric acid in the bloodstream already; it occurs naturally as the body breaks down purines, which are chemical compounds that also occur naturally during the process of cell death. Purines are also found in abundance in certain foods, including liver, kidney, anchovies, sardines, mussels, bacon and veal, as well as in alcohol. Those purines must also be broken down into uric acid.
Most people are able to get rid of uric acid just by going to the bathroom; kidneys filter uric acid out of the bloodstream and into urine. However, if that process breaks down, either because your body is producing too much uric acid or because your kidneys can't get rid of it fast enough, then the excess uric acid will build up in the bloodstream and crystallize. As the uric acid forms sharp crystals, resembling needles, white blood cells attack the area, which results in a world of pain, inflammation and tenderness at the spot. Doctors don't know exactly why the big toe is particularly susceptible to these attacks; it may be because the toe and the rest of the foot are already subjected to a good deal of physical stress just by walking [sources: Flieger, Los Angeles Times].
Zyloprim doesn't work to cure that pain, which may last a few days or even a few weeks. Rather, it works to cut uric acid off at the pass, so that it's never formed and there's less of it in your bloodstream. Zyloprim inhibits a chemical known as xanthine oxidase, which is the last form a purine takes before it's converted to uric acid.
When purines are broken down, chemicals known as hypoxanthine and xanthine result. Mix in a little xanthine oxidase, and you'll convert those chemicals to uric acid. By blocking xanthine oxidase, Zyloprim still allows the body to break down those purines, but instead of becoming uric acid, the xanthine and hypoxanthine remain in a form that is essentially recyclable and not harmful to the body.
According to some studies, inhibiting xanthine oxidase may have additional benefits. Xanthine oxide may also play a part in ischemia (inadequate blood flow), heart failure and inflammatory disease [source: Pacher et al.]. However, that's not the current indication for Zyloprim. Find out more about that on the next page.
Zyloprim is indicated to be used as a means of preventing gout symptoms. Allopurinol may also be prescribed to people who have certain kinds of kidney stones brought about by uric acid, as well as leukemia and lymphoma patients with high uric acid levels.
As we mentioned in the previous page, Zyloprim can't be used in the midst of an attack of the gout. For that, a medical provider will likely recommend nonsteroidal anti-inflammatory drugs (NSAIDs) including over-the-counter medications like ibuprofen and naproxen. If those don't work, then a gout sufferer may take a drug called colchicine or steroids.
However, once the immediate symptoms of gout are treated, Zyloprim is the next line of defense. By taking Zyloprim, patients reduce the risk of future outbreaks. That's important, because just one isolated outbreak of gout is rare. Once you suffer one attack, more are sure to follow. For that reason, Zyloprim is thought to be a lifetime drug; once you need it, you'll likely be on it for the rest of your life. Patients may be tempted to stop taking Zyloprim because they haven't had any gout symptoms, but that's due to Zyloprim lowering the levels of uric acid in the bloodstream.
The dosage of the Zyloprim is determined by the severity of the gout. In order to obtain the beneficial effects of the drug, 100 to 200 mg must be taken a day. The maximum recommended dosage is 800 mg a day. Generally, a mild case of the gout will yield a prescription of 200 to 300 mg a day, while 400 to 600 mg daily might be recommended for someone with more severe symptoms.
Often, Zyloprim is indicated to be used as an adjunct to a so-called "gout diet," in which purine-rich food and beverages are to be avoided. However, diet alone isn't usually not enough to bring on an attack of the gout, so regular use of Zyloprim should prevent future symptoms. That doesn't mean that people on Zyloprim should go hog wild, though. Those who suffer from gout are also likely to suffer from obesity, hypertension, high cholesterol and heart attack [source: Los Angeles Times]. For that reason, gout sufferers should address their diet and exercise regimens.
Does Zyloprim have any side effects? Find out on the next page.
Zyloprim Side Effects
Since the time of the ancient Greeks, gout sufferers have treated their attacks with a drug made from the crocus lily bulb called colchicine. That drug may still be used to treat attacks if NSAIDs don't work, but it has the unfortunate side effect of causing severe diarrhea. Therefore, each time ancient people suffered that intense blinding pain in their big toes or other joints, they knew that a round of diarrhea was soon to follow. Keeping that in mind may make the side effects of Zyloprim seem a little more manageable. After all, by taking Zyloprim, there's little to no need to worry about another gout attack.
Zyloprim is a safe drug with fairly mild side effects. Those side effects include nausea, headache, dizziness and drowsiness. There's less of a chance of stomach upset, though, if you take Zyloprim with meals.
About 2 percent of patients on Zyloprim develop a rash, which is a much more serious side effect [source: Simon]. A rash, hives or peeling skin indicate that the user may be suffering an allergic reaction to the drug; other serious side effects include loss of appetite, weight loss, yellowing eyes and skin, painful urination, changes in vision and gastrointestinal distress. Patients who have kidney problems and are taking a thiazide diuretic have a much higher risk of suffering from serious side effects. As always, before starting any medication, patients should share their other medications and conditions with medical professionals.
If Zyloprim's side effects are severe and don't abate over time, medical providers have just a few other options for gout sufferers. Instead of lowering uric acid in the bloodstream, they can try to pump up the amount of uric acid excreted by the kidneys with a drug called Benemid.
For more on gout and other popular prescriptions, see the links on the next page.
Related HowStuffWorks Articles
- "Allopurinol." Lexi-PALS Drug Guide. September 2008.
- "Allopurinol, Oral." CRS Medication Advisor, Relay Health. Jan. 1, 2009.
- Altman, Lawrence K. "3 Drug Pioneers Win Nobel in Medicine." New York Times. Oct. 18, 1988. (March 2, 2009)http://query.nytimes.com/gst/fullpage.html?res=940DEFD91F3AF93BA25753C1A96E948260
- Brody, Jane E. "Gout Hobbles Plenty of Commoners, Too." New York Times. May 25, 2004. (March 2, 2009)http://query.nytimes.com/gst/fullpage.html?res=9C02E6D9173EF936A15756C0A9629C8B63
- Flieger, Ken. "Getting to Know Gout." FDA Consumer. March 1995.
- "Gout." Mayo Clinic. Nov. 14, 2007. (March 2, 2009)http://www.mayoclinic.com/health/gout/DS00090
- Gower, Timothy. "Like Charlemagne, You've Got Gout." New York Times. June 20, 2005. (March 2, 2009)http://www.nytimes.com/2005/06/20/health/menshealth/20gower.html
- Pacher, Pal, Alex Nivorozhkin and Csaba Szabo. "Therapeutic Effects of Xanthine Oxidase Inhibitors: Renaissance Half a Century after the Discovery of Allopurinol." Pharmacological Reviews. March 2006. (March 2, 2009)http://pharmrev.aspetjournals.org/cgi/content/full/58/1/87
- Payne, January W. "Preventing Gout Attacks: Know Treatment Options Like Uloric, Follow Gout Diet." U.S. News and World Report. Feb. 27, 2009. (March 2, 2009)http://health.usnews.com/articles/health/heart/2009/02/27/preventing-gout-attacks-know-treatment-options-like-uloric-follow-gout-diet.html
- Simon, Harvey B. "Preventing gout: Alternatives to allopurinol." Harvard Men's Health Watch. June 2004.
- "The Painful Truth About Gout Attacks." Los Angeles Times. Oct. 30, 2000.
- "Zyloprim Product Information." Prometheus Laboratories, Inc. October 2003. (March 2, 2009)http://www.prometheuspatients.com/PDF/Zyloprim.pdf