Muscle pain/weakness with allopurinol?

[T K]

I’m 52, lean, and very athletic, with a good diet (mostly veggies) and no drinking. Have been dealing with gout for 6-7 years, and on allopurinol 150mg/day for ~3 years. I recently started having some mild pain that arises in the head of either metatarsal and lasts for days before fading. Recent UA was 350 (~5.9). I bumped my allopurinol up to 200mg/day and immediately found that I started having strange muscle pain and weakness, particularly in my quads. I cycle daily, 40-80km, and didn’t have an unusual bump in distance or intensity. The only new thing was the higher dose of allopurinol. I have a concern about this, particularly because daily training on the bike is my main means of keeping fit.

Anyone else experience this, and if so, was it transient or permanent?

[nobody]

Hi,
I certainly experienced strange pain and weakness, but hasn’t everybody else (or at least everybody who isn’t young anymore)? Maybe a more specific description might be useful but this is probably something you should talk about with a doctor who would perhaps run a few tests to see if anything unusual is happening with your muscles. There could be many causes even if you didn’t change anything other than your allopurinol dosage (which didn’t change much).
Without looking at older UA numbers, it’s impossible to guess if you might still be experiencing gout symptoms (though unexplained metatarsal pain that lasts a few days is suspicious indeed!). If you still have solid uric acid in your body doing damage, this might end up interfering with your training. Uric acid has been known to move around the body and cause symptoms at the strangest of places soon after people drop their SUA low enough but I would be surprised if this happened to someone after three years of allopurinol (even if the dose wasn’t quite high enough). Damage caused by gout in the past might also end up causing problems (mainly bone issues) but so far as I know, there’s nothing that can be done to prevent it once the damage is done. So I would want my UA lower than 350 in your situation. In case allopurinol turns out to be an issue (which seems unlikely at this point), there are alternatives.

[Author]

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