Reply To: My gout diary (?)


Some people get extra strong attacks after starting allopurinol.
I expect you are now taking 200mg. You might benefit from taking more than that after your next blood test which I wouldn’t delay in light of your situation.

It could be that you need larger doses of colchicine and indo.
I can’t speak about indo dosage because I’ve only taken acemetacin (which I understand turns into indo within the body) and I don’t know how to convert doses from one to the other. But obviously some people have taken pretty large doses for gout compared to what is often recommended for other uses.
Colchicine is most effective when taken before you start hurting. Once you are really hurting, you need to take higher doses and still it’s not effective right away. The maximum dose is very high and the default instructions for colchicine here are to take 3mg the first day (waiting at least 3 hours between 1mg pills) and 2mg the second day if you’re trying to fight an attack as opposed to prevent it. I’m not sure most people would benefit from taking that much but certainly there can be a benefit in taking more than the daily 1mg (or 1.2mg) people are often told to take.
It seems you’re healthy and would be able to tolerate heavy doses but, especially with indo, better talk to you doctor first before taking heavier doses than you’re used to. If you were to take a lot of indo, your doctor might want give you yet another drug in order to prevent some of the side effects.

And if colchicine and indo really have become inadequate, there are other drugs which fight inflammation.
There are of course also painkillers you can take on top of that, though the most effective ones tend to be debilitating which wouldn’t help you if you want to perform at work.

I hope you can find an effective way to stop your attacks dead in their tracks before you get back to work.
This will likely not be your last and in my opinion dealing with the symptoms aggressively when they start would likely reduce your total drug intake.