Allopurinol Alternatives: Practical Options for Managing High Uric Acid
Allopurinol is a common drug that lowers uric acid by blocking xanthine oxidase. It works well for many people, but some can't tolerate it, develop side effects, or don't reach their uric acid targets. If that sounds like you, there are several real alternatives and treatment strategies to discuss with your doctor.
Main options include febuxostat, uricosuric drugs like probenecid or benzbromarone, the enzyme therapy pegloticase, and some off-label choices that may help lower uric acid. Lifestyle changes also make a measurable difference and should be part of any plan.
Febuxostat (Uloric) is another xanthine oxidase inhibitor. It often works when allopurinol doesn't or causes reactions. Studies show it lowers uric acid effectively, but some data raised concerns about cardiovascular risk in people with existing heart disease. That means your doctor will weigh heart history, kidney function, and overall risk before choosing it.
Probenecid helps the kidneys remove uric acid. It can work well for people with normal kidney function and is sometimes used alongside xanthine oxidase inhibitors. It isn't right for everyone, it can raise the risk of kidney stones, and it interacts with several drugs, so medication review is essential.
Pegloticase is an IV therapy for hard-to-treat, chronic gout. It quickly breaks down uric acid and can help people who failed other treatments. Because it can trigger allergic reactions and is given in a clinic, it's usually reserved for severe cases and requires close monitoring.
Other uricosuric agents include benzbromarone and sulfinpyrazone. Benzbromarone is not available in some countries but is effective where prescribed. Losartan, a blood pressure drug, has mild uricosuric effects and may be a useful addition for people who also need blood pressure control.
Lifestyle steps lower uric acid without drugs. Lose weight if needed, limit alcohol, especially beer, cut high-fructose drinks, and reduce portions of red meat and shellfish. Drink water, aim for steady weight loss, and include low-fat dairy and vegetables. These moves don't replace medication when you need it, but they improve results.
Monitoring matters. Your doctor will check serum urate and kidney and liver tests after changing therapy. Don't stop urate-lowering drugs during an acute gout attack without medical advice; flare prevention often needs short-term colchicine or NSAID when starting or switching therapy.
Questions to ask your clinician: which alternative fits my kidney and heart health, what side effects to watch for, how often will I need blood tests, and will I need specialist referral. If you have sudden rash, breathing trouble, new chest pain, or worsening kidney symptoms after a medication change, seek care right away.
Bring this page to your appointment to help guide conversation and get a plan that matches your health and goals.
Switching meds can take weeks to show effect. Expect follow-up blood tests and possibly prophylaxis against gout flares. Always tell your provider about all medicines and supplements you take, including over-the-counter painkillers and herbal remedies, so they can avoid interactions and choose the safest option.
