Reply To: Febuxostat and Colchicine dosing


1mg daily is a pretty consensual colchicine dose actually.
The controversy is about what dose to take when dealing with an acute attack. I think it’s obvious that it should be a good bit more than 1mg if you hadn’t been taking colchicine previously considering that the stuff is going to build up in the body if you take the same amount daily.

I recommend you try colchicine before taking febuxostat if you’re going to use it because you don’t want to be testing two unfamiliar drugs at the same time.
Ideally, you’d have a blood test on colchicine alone (or colchicine + NSAID if that’s what you’re planning to take) prior to starting febuxostat so as to avoid blaming the wrong drug for abnormal test results.

About febuxostat, I’m going to go into paranoid mode since you seem to have had trouble with pharma before…

The most important thing to understand in my opinion is that even in the UK, doctors are often subject to local profiteering biases. In the case of febuxostat, this can lead to improper dosing. Yes, I did recommend against starting with more than 40mg. But I did also recommend starting with less, didn’t I? In case you didn’t get it, I’ll lay it extra thick for you…
I don’t think you should consider 40mg as a mere starting dose. I doubt you’ll have a use for 80mg except possibly as a way to make you sick. And if it turns out you get nasty side effects at 40mg, it wouldn’t mean febuxostat is not for you because it’s not a given you couldn’t acheive an adequate SUA with a lower dose, especially with dietary support. The way your system reacts to the stuff will of course trump all prior guesses…
Here’s a quote you might find interesting: “The usual adult dose is once daily orally starting from 10mg. Thereafter, increase the dose gradually as needed while monitoring blood uric acid level. Usual maintenance dose is 40mg once daily. Dosage should be adjusted as needed according to the patient’s condition. The maximum dosage of febuxostat is 60mg once daily.” This was as you may have surmised not issued by the profiteers who saw fit to make ridiculously strong (and therefore expensive) pills and to make a show of marketing them at patients who got insufficient SUA reduction from inadequate allopurinol dosing (or for want of an uricosuric) rather than at the patients feubuxostat was designed for and who actually need to buy these pills.
If you decide to cut the pills smaller than they were designed to be cut, precision is not critical.

Other than that…
Don’t be panicked by initial side effects, especially if you go straight to 40mg from zero. Your body will need to adjust and there are ways to mitigate this type of side effect. The one type of side effect I’m aware of which might warrant stopping the drug immediately is an allergic-type reaction such as a rash. I would also consider stopping the drug pending testing in the event of cardiac side effects.
Don’t be disappointed if your SUA doesn’t drop immediately. You should get a large drop fairly quickly but it would probably keep dropping for several weeks without a dose increase.
I would recommend you initially avoid alcohol as well as other non-essential drugs or anything else which might upset your liver such as fatty meals until you know for sure it’s coping well. That would mean no paracetamol/acetaminophen… if you have no alternative on hand, consider asking your doctor about painkillers which do not hurt the liver before an acute attack gets you, stressing the temporary nature of the situation. For what it’s worth, colchicine is easier than NSAIDs on my liver.

If you’re going to have a baseline blood test, you could add bilirubin, TSH, CPK and blood urea (some of these may already be planned but unlike ALT and so forth, they are not routinely done here) which are known to be affected by febuxostat in some cases. Urine tests may also be affected but unless you have kidney concerns, it’s probably not worth the bother to baseline that.
You might also want to initially monitor your blood pressure, cardiac rythm, frequency of bowel movements, appetite and weight. Febuxostat can (if indirectly) affect them all and simple changes might provide useful clues. Occasionally monitor your skin and eyes color as well. Possibly there’s something else you are equipped to monitor on your own.