February 24, 2015 at 10:10 pm #20025Stuart GreenwellParticipant
I just started treating Gout, and I am using Uloric 40 mg. The shock at the pharmacy window was amazing, when I got the $250 bill (at least lowered to $175 with the savings program). However, I would like to get 80 mg and just cut the pills in half to save money, since they are the same price. My doctor is on board. The Pharmacy says they have no warnings against this. But, I can’t find any info on if these pills have an Enteric coating or not.
Anyone in this same boat?
February 24, 2015 at 11:01 pm #20028
Hi Stuart, thanks for a good question.
I have a vague memory that this has been discussed before, and a pill-cutter was discussed.
So try searching for Uloric pill-splitter. But if you cannot find one, please start a new gout resources topic.
There’s also a link there for the discount scheme that you mention. Other financial help is available from needymeds.org.
Pill-splitting is generally considered acceptable for all common uric acid-lowering pills. These are not something that are normally enteric-coated. However, some patents have been applied for, so specialist versions of febuxostat might become available. It will be obvious from the labeling if these are coated or not. Uloric is not enteric-coated, despite what you might read elsewhere.
My first reaction is: go ahead! Then I thought a bit more.
Uloric, just like any other uric acid lowering treatment, must be dosed to meet your target uric acid level. As you have 40mg now, you really must get uric acid tests after 2 to 4 weeks. If 40mg does not bring your uric acid down to 5mg/dL, or lower, you might actually need the 80mg. Also, I believe that there is a very strong argument for aiming much lower than 5mg/dL for your first year of treatment. That gives you the fastest way to reduce your risk of continuing gout flares.
Also, you might have the option of alternating an 80mg dose over two days. This is easier with allopurinol, which stays in your body about twice as long as Uloric. This is something you need to discuss with your doctor, as the effects of missing a day on Uloric might be more serious than missing a day on allopurinol. If you have that discussion, please come back and share your doctor’s advice.
My main concern is that you get the right dose of Uloric to get your uric acid safely down to 5mg/dL or lower. If you don’t achieve that, it is a complete waste of money.
My secondary concern is that 80mg Uloric tablets are tear-drop shaped. I believe this is a deliberate ploy by the manufacturers to discourage pill-splitting. With a good quality splitter, you should be able to split the pill horizontally along it’s long axis. See Is 80 mg Uloric always enough?
I don’t think you need worry too much about the accuracy of the split. An important part of uric acid control is that we must account for natural variations in uric acid level. The 5mg/dL target gives a safety margin.
Stuart, I realize that what I’ve said complicates a fairly simple question. I feel I must point out all the important aspects. If I have not made it clear, then please tell me, and I’ll try again. I don’t want to complicate matters unnecessarily, but I do want you to be aware of all the salient facts. Similarly, I want you to be aware of the need for proper follow-up blood tests, but we can leave that for another time.
For Uloric patients who want to know about long term maintainance of uric acid levels, browse Gout Progression Phase 7 Maintain Uric Acid Cure.February 25, 2015 at 6:41 am #20048Stuart GreenwellParticipant
Keith, thanks for the follow-up. I think it is very clear and It is good to know I have this option. I did get a nice pill splitter that has a plastic holder/guide inside. I have tried cutting one, and it worked pretty well. So, I think I am ok there.
My UA levels have been around 9 mg/DL and with Uloric 40mg, they dropped (on my first 2 week blood work) follow-up to 5.6. As, my doctor was shooting for 5.5, he thought that was good enough for now and will have another blood test at 4 more weeks out.
If I were to take the 80mg in full, are their concerns for UA being too low? If 40mg dropped me from 9 to 5.6, I would guess that 80mg would drop it much much lower than 5.
Thanks again.February 25, 2015 at 7:16 am #20052
Ah, doctors! Wonder where he gets 5.5 from? I can guess, but I’ll refrain.
You can’t go too low with uric acid. In extreme cases of intolerance, the intravenous Krystexxa is used, which knocks out uric acid to almost zero. It only lasts a few months, but that’s all you need. Horrendous tophi gone in weeks! http://www.goutpal.com/3408/best-tophi-picture/
Also, there is a disease that renders people unable to produce uric acid. I can’t remember what it is caused, but people with it seem to suffer no ill-effects through lack of uric acid.August 13, 2020 at 7:24 am #24351
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