Stopping pain need not take 3 hours. Just take enough proper painkillers. But of course pain isn’t the issue…
In my opinion, you should have tested colchicine earlier. Besides the issue of febuxostat and colchicine independently stressing the liver, possibly colchicine would interfere with your haemoglobin production. So I would have thought your blood specialist would be the one you’d talk to about colchicine rather than your rheuma.
One option would be to do without colchicine until the effect of febuxostat alone on both your liver and haemoglobin is establised.
If you’ve tolerated NSAIDs in the past and your liver function tests haven’t shown any signs of stress, I would think NSAIDs would be safe for you to take along with febuxostat. An advantage of NSAIDs over colchicine in my opinion is that you can wait until you get an attack to take NSAIDs while colchine works best if you take it ahead of time. So you needn’t take NSAIDs every day.
I’ve already told you what my rheuma recommends w.r.t. colchicine. And you don’t want to take anywhere as much since you’ve never tried the drug, much less done a blood test while taking it. As with most drugs, small doses are best until you know for a fact your body can handle the stuff.
Colchicine vs. NSAIDs didn’t come up with my rheuma because colchicine is obviously much safer for me (as well as for the thousands NSAIDs send to an early grave every year). Iron Stomach here seems to do fine on NSAIDs though and he’s not the only one. So really, your experience and blood tests ought to be what guide you in this matter.
Now, about how long to take 20mg. I would say: until the results from your first blood test come back. If your liver and haemoglobin seem OK and no other red flag is raised, increase the dose. Obviously, that’s assuming you’re not experiencing serious side effects.
I should stress the following though: testing normal or abnormal is irrelevant. If your liver function tests are elevated compared to your other tests for instance, they would likely become worse over time even if you didn’t increase the dose. Don’t wait until your test results actually get bad enough to raise a red flag to act on any information they provide. The same goes for haemoglobin.
Also note that elevated ALT is expected. If it’s the only liver function test that’s outside your usual range and if it’s not ridiculously high, I wouldn’t worry about it. Febuxostat will affect the other tests as well if you take more than your liver can handle.
I’m not sure what you mean with “I’ll see a dramatic drop afterwards”. The full effects of febuxostat on both uric acid and liver will take more than 2 weeks to become clear. I’m guessing the same goes for haemoglobin. But you don’t need to know the full effects to see where the values are going.
If you’re going to try to cut these hard pills with a knife, the following may sound obvious but the force is going to make the fragments fly orthogonally to the blade. So use some obstacle or container to collect them or the dog will find the fragments before you do.
With some cutting tools, you can safely cup the pill with one hand while the other is applying pressure.