June 17, 2017 at 9:14 pm #4198
How you doing guys.
I was just wondering what dose of colchine you guys take during preventative and during acute attacks of gout..?
I’ve been given the all clear to use it should I need to but I wanted a general idea of what dose you guys take or use to take during treatment?
June 17, 2017 at 9:46 pm #4199
MauriParticipantŦallars: Ŧ 5.30Rank: Detective
I don’t use it for treatment ; only for prophylaxis. Took it for 6 months to prevent attacks after starting allopurinol 600 and my dose was 0.5 real day. Did not have any issues. Good luck
June 17, 2017 at 10:17 pm #4200
Right now I’m not doing too well. No biggie but I’m wasting more time online than usual.
Is your hemoglobin situation improving?
Cochicine is kind of a puzzling drug to begin with. And the dosing recommendations are all over the place. You’ll have to experiment and weigh the risks for each situation.
As with any unfamiliar drug, go easy at first and watch for interactions with other drugs you’re using or unusual conditions you’re suffering from.
Maybe because I’m large, I haven’t had a good experience taking 0.5mg/day. I’d rather go 1mg or alternate between 0.5mg and 1mg.
To attempt to speed up the resolution of a serious situation without NSAIDs, the MINIMUM dose I’d use is 2mg. No more than 1mg every three hours though, as per the doctor’s instructions. I would then progressively lower the dose over the following days (unless perhaps the symptoms actually got worse but that’s a situation I have yet to encounter).
June 18, 2017 at 1:27 pm #4203
@Mauri – thanks for your contribution mate.
Why mate, what’s bothering you? We are all heading or already are spending too much time online, being out with people is like being out with smartphones and tablets! I was out enjoying the few summer days we get yesterday and believe it or not it was like being out with smartphones. Every beep or ring everyone would look at their devices. But whats on your mind pal..?
With regards to the Colchicine, well since stopping the Allopurinol on May the 31st I did another blood test on June the 16th and it turned out the haemoglobin actually went up slightly to 5.7 g/dl. Now although not significant I am extremely thankful as the trend seems upward and haemoglobin generally takes longer then white cells or platelets to recover. My next blood test is due at the end of this month but I might postpone it slightly until first week of July as I’ve had 4 blood tests each with two tubes alone this month for all the required tests (kidney, liver, iron, fbc, urate) which can also impact haemoglobin so levels might actually be higher and recovering quicker but being hindered by the amount of blood tests I’m having.
In any case the rheumatologist prescribed two 500microgram Colchicine tablets so 1mg total a day to take for foot my which is still slightly inflamed from my 12 week attack and as preventative treatment so that I can start febuxostat immediately. I personally will not be taking any drugs including Colchicine or febuxostat or naproxen until we get to the bottom of the current haemoglobin issues (if they were allopurinol).
However I kept the tablets in the unfortunate case of an ad-hoc acute attack over the next 3-4 weeks. I am approximately 58kilos and was wondering if 500micrograms twice a day was sufficient or even too much for dealing with it?
p.s. Baring in mind this is the same rheumatologist who wanted me to go straight to 80mgs of febuxostat.
Thanks as always.
June 18, 2017 at 2:52 pm #4205
Having been blindsided by a flareup in the big toe, I was simply in pain. Like I said, no biggie.
Not much of a smartphpone user myself. I use mine like a dumbphone with a better keyboard and I rarely allow the thing to disturb me. I guess that makes me a weirdo.
Good to know your hemoglobin stopped falling. Looks like it really was allopurinol.
For what it’s worth, my hemoglobin dropped a bit after a while on febuxostat (about 1 g/dl, more than the usual variations but a good bit less than the drop I got from minor abdominal surgery for instance) but it might have been an odd coincidence. I don’t get that tested often. But in the data I’ve got, I didn’t notice any effect from colchicine on my hemoglobin.
When using it after a serious attack has started, 0.5mg cochicine doesn’t do much (if anything) for me. I guess two such pills a day would be helpful to prevent the attack from coming back or lasting weeks though.
Whether small doses would work better for you, I can’t say. Small doses might also work well in combination with naproxen. You’ll have to try.
And I don’t know the impact colchicine would have on someone with your blood problem. But as far as the general population is concerned, 1mg/day colchicine is very far from the maximum dose. It’s nothing like 80mg/day febuxostat.
June 19, 2017 at 12:20 pm #4209
believe me mate, I totally understand. Insidious disease, horrible pain.
Frankly speaking I admire people like you who are able to part from their smartphone. It makes me sick watching all these people using them with no regard to how quickly life goes by. All I hear is Facebook post, or twitter feed or whatever. I personally don’t use any of it.. So call me a weirdo too 🙂
Yep, that is certainly good news with the haemoglobin mate. I can’t tell you how much weight has been removed from my shoulders. We still aren’t sure it was the allopurinol but lets hope it was.
So do you still use febuxostat? Is it a good drug? Just out of curiosity how come you got hit by an attack whilst being on it? Was it the usual after starting ULT attack?
Well at least its good news to see my rheumatologist went a little more conservative with colchicine dosing to start with. Initially he prescribed it as preventative when starting febuxostat and to reduce this long standing inflammation I have. I think he wanted me to hit 3 tablets should I get an acute attack. I am just reluctant to taking absolutely anything right now. Believe me the risk of not taking any ULT is killing me. I’m banking on the 4 months of hardcore low uric acid levels to have dissolved as much as possible and to give me some breathing space until at least I see my new rheumatologist in mid July (and if the haemoglobin shows recovery after allopurinol).
June 19, 2017 at 1:48 pm #4210
This was more of an overconfident-after-a-while-on-ULT attack… assuming it was gout (got no tests done seeing it struck during the week-end). Haven’t been through something this nasty in years.
I did more “hardcore” ULT than you. But you know how the time it takes for the old crystals to clear seems proportional to the time you’ve had high UA or gout? Well, in light of that I should have been more careful.
Correction: with your hemoglobin so low that it’s got one less digit than mine, I messed up my unit conversion above. Febuxostat (which I’m still taking) might have caused my hemoglobin to fall by about 1 (something like 6%), not 0.1 (which is nothing).
June 20, 2017 at 8:00 pm #4317
I’m so sorry to hear that mate. The attack I got in March really really punished me too. Even till this day I still feel some of the aftermath pain and have some inflammation and I tend to just ignore it and get on with it despite the rheumatologist seeing it and telling me to take 2 * 500micrograms of colchicine a day till it resides. No thanks. I’m on a pill detox for now.
Yep, believe me after starting allopurinol and the attack I got I certainly am aquatinted with how it all works. How do you mean more hardcore? Did you take a really high dose of febuxostat for a short period of time? Or was it that you just got really overconfident with diet? I’d like to know since I might be on the same drug as you in 3 weeks! 🙂
I figured 0.1 was a typo 🙂 Ah, that’s very interesting, So you got a little dip in haemoglobin too after starting febuxostat, by any chance did it recover?
oh and I forgot to mention with the slight increase in haemoglobin after what we think was because of stopping allopurinol my uric acid has spiked to 760ummol. It was never that high and always sat at 550-600 at most. I’m hoping it could just be that residuals from what was dissolving whilst on allopurinol?
A few questions there for you 🙂
June 20, 2017 at 9:49 pm #4319
I’m not surprised you were recommended colchicine in your condition. It’s not good at relieving acute inflammation but it’s good at putting it to rest, slowly but surely.
I was talking about SUA, as you did when you used that word. Starting from a lower level than yours (thanks in part to my diet), I ended up with lower SUA test results than yours even though I’m only taking a small dose.
I never took a very strong dose of febuxostat. I wouldn’t dare as my liver is touchy.
I was overconfident in terms of how I neglected both to baby my joints and to take a prudent (meaning pretty large) amount of colchicine at the first sign of trouble.
re: my hemoglobin
The dip showed up in my last test. I would usually not get tested for this stuff as I have no blood problems (well, I routinely have abnormal white cell fractions but I suppose that’s to be expected when someone’s got chronic inflammation) so I’m probably not going to be able to tell you if it was a temporary dip anytime soon. If it turned out to be permanent or even if it got a bit worse over time, that wouldn’t be an issue for me.
re: your SUA test result
I warned you about this. I also got a surprisingly high result shortly after quitting ULT (that was before my current ULT). But I’ve got to say 760 is even higher than I would have guessed!
I don’t know why SUA rebounds that way. The crystals must be part of it but it’s possible your metabolism tried to compensate for your lowish SUA by overproducing and hasn’t adjusted back yet.
For what it’s worth, going by the tests my SUA seemed to have dropped back to normal fairly quickly after that ULT-discontinuation spike.
June 21, 2017 at 5:23 pm #4330
the rheumatologist was also pretty shocked to see such a long standing attack. By the way, assuming one doesn’t take colchicine will the inflammation eventually go on its own..?
Ah right. So what dose are you taking now then?
So how long have you been on febuxostat prior to this attack. I know crystals can linger around for possibly years but when did you actually start taking febuxostat after learning you have gout?
re: my hemoglobin
Chronic inflammation is exactly my worry. Its been ages with this minor inflammation I have and I have no idea when it will go. Is your chronic inflammation a result of not treating it with colchicine or is it something that may never go away?
re: your SUA test result
Yep, you sure did and to be honest I never thought it would go up by 160ummol. I was thinking more 50 or so. Let’s hope it is just a “drug stop shock” and the body just re-adjusts. When you say fairly quickly, how long roughly after stopping? So you are no longer taking ULT?
June 19, 2017 at 2:14 pm #4211
Returning to colchicine dosing, I still struggle to accept that it has any anti-inflammatory effect. So, I never took more than 2 a day (2 times 0.5 g = 1g/day). But, I did rely on ibuprofen – probably because I was used to it, and never had problems (I remember a nurse saying I had a cast iron stomach. She made no comment about any other part of my anatomy). On a few occasions, I supported ibuprofen with intermediate paracetamol (acetaminophen).
That’s when I came up with my 3-pronged strategy of:
– Stop/slow inflammation spreading (colchicine).
– Reduce inflammation (NSAIDs).
– Block residual pain (paracetamol).
Of course, the principles can be applied to different treatment combinations. But, I’m always wary of too much colchicine, based on how it works.
June 19, 2017 at 2:51 pm #4241
The issue isn’t whether colchicine technically has any anti-inflammatory effect (as opposed to a pro-anti-inflammatory effect?) but whether 1mg/day does indeed “stop/slow inflammation spreading”. In my experience, it does not do so in a timely fashion.
In any event, it’s obvisouly not going to have the same effect as ibuprofen-type drugs.
June 20, 2017 at 5:40 am #4310
Nobody, just to be clear, are you saying that if you take 1mg colchicine during a gout flare it gets worse after an hour, yet taking a higher dose makes gout pain the same or slightly less in an hour? My choice of an hour is just random. It might make more sense to say half an hour.
June 20, 2017 at 4:48 pm #4316
Of course that’s not what I’m saying. I wouldn’t know because I never tried taking more than 1mg colchicine at a time, as I was told not to do so. But really, do you think it’s possible colchicine could work that fast?
The timeframe I was talking about was the one you originally were talking about: a day. My flareups have previously gotten worse by the next day when I took less than 2mg. But every time I took 2mg or more, whether it got worse over the next few hours or not, by the next day the flareup had started abating. It could of course be a coincidence.
What really makes no sense to me is to take the same amount the first day as during the following days. The stuff is going to build up in your system so if you’re not afraid of what that’s going to do to your body on day 3, why not take more colchicine the first day and get the full effect quicker?
July 31, 2017 at 11:55 pm #4892
@nobody – I was just reading through this thread again. Just to clarify you take 2mg a day during an accute attack but no more then 1mg at a time?
1. Are you saying you take two tablets then a further 2 tablets a few hours later? If so how, how many hours later?
2. Do you use any NSAIDs with your treatment package “in combination”?
August 1, 2017 at 1:32 am #4895
My tablets are 1mg. I usually take halves as I prefer spreading the intake over time but have many times taken a whole tablet without issues (mostly as an emergency measure).
I’ve taken different amounts. It depends on the situation. I have no fixed rule other than: no more than 1 mg every three hours.
Now I’ve never kept taking that much past the second full tablet and I might split that second tablet depending on how the symptoms evolve. Part of the reason I start cutting my intake at that point that is significant side effects supposedly suggest the dose was excessive and I know I’ll get side effects later if I push it further. But over the course of a whole day, I’ve taken more than 2 mg.
There might be other reasons to take less: if I had already been taking lower amounts as a prophylactic (the stuff can build up in the body), if I was already struggling with the side effects of a different drug, if I didn’t have easy access to a toilet and so forth.
I generally avoid NSAIDs as I tolerate colchicine way better but I would take a moderate NSAID dose on top of colchicine if I had a really bad attack. If I took that NSAID however, I wouldn’t take so much colchicine.
My doctors are concerned about drug interactions. Perhaps that’s only because they know I’m prone to serious side-effects. For instance when I started my current ULT I took neither colchicine nor NSAIDs for a while out of concerns about interactions and that is not what most patients do.
While I’ve used low-dose NSAID along with prophylactic-dose colchicine, my serious attacks have been few and far between since I’ve been taking colchicine and I never tried to use an NSAID along with a large colchicine dose. The one time I was tempted to do that was the first (and only) time I took a large colchicine dose while on febuxostat and I was reluctant to mess with that experiment by adding in another source of side effects.
I also never tried throwing alcohol into the mix. I don’t drink anyway but I’m just mentioning that as a warning since lots of people do and interactions aren’t only between pharmaceuticals.
Has your hemoglobin been improving by the way?
August 3, 2017 at 11:01 am #4910
@nobody – good to hear from you mate. The information on Colchicine really does vary across the board. My rhumatologist advised me to take two 500micrograms tablets a day in attempt to finally rid me of the slight swelling and pain I still suffer from today. As you know I refused to take any medication until we isolate and try and resolve my haemoglobin issue.
Which brings me to some very interesting findings over the last 6 weeks. As you know I stopped allopurinol on the 31st of May. A week later the haemoglobin climbed slightly to 5.7 which was encouraging but still worrying, if you remember my uric acid also shot through the roof to 700ummol which is what you expected.
Fast forward slightly under a month and a blood test taken first week of July showed uric acid down to 650ummol and a haemoglobin of 7.3. Fast forward a further week to around mid July and uric acid had dropped further to 600ummol and a haemoglobin of 7.5.
So, it “seems” allopurinol was the culprit however my haematologist says it could have been an internal viral infection and not to just rule out allopurinol. He also went on to say that we can follow the rheumatologists opinion to try febuxostat if he feels it may be better suited because the rhumatologist suggested that allopurinol may cause anemia.
Now prior to starting fexbostat I have one more baseline blood test to do next week. I’ve asked them to include liver function, kidney function, full blood counts and finally uric acid. Once we get the results were going to start fexbostat.
I know you are taking it and from what I understand it’s best to start with a lower dose then 80mgs so I’ll be splitting that tablet to 40mgs but are there any other hints, tips, pointers that I should be aware of before jumping onto your febuxostat boat? 🙂
August 3, 2017 at 6:36 pm #4912
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.
June 19, 2017 at 4:35 pm #4289
Could we return this to the general discussion thread as its a little more then just a question and more a discussion and even a friendly thread going on between me and @nobody about a few things. I’d really much prefer to “discuss and assess” the subject as I’m not really going through a help my gout attack.
Anyway, your call. Thanks 🙂
June 20, 2017 at 5:59 am #4311
d-q it’s important to me that the forum works best for you. So I could move this topic elsewhere. But, surely not General Discussion. Because that is strictly non-gout. It’s supposed to be for General Interest outside the world of gout. So colchicine is definitely a gout subject.
My feeling is this forum is for any aspect of gout. So you will often see me starting random gout discussions here. Where the only question is when I ask for other gout sufferers opinions and experiences. My logic is : new members usually need help. Then experience tells us that help often has wider context. So this discussion of colchicine helps gout sufferers.
I don’t want to be bombastic about this. It’s just a matter of us all agreeing what is best to help people learn about colchicine.
On a related matter, I need to rearrange structured help forums. I prefer a better name. But my hope is that current personal forums evolve to be customised to whatever you want. Then, that would also mean you could start your own General Colchicine Forum, if you want. Maybe first, I should start a moderator forum for actual and potential moderators?
June 20, 2017 at 8:20 pm #4318
No worries buddy, it was just a little friendly messaging was going on shortly after discussing the colchince dosing about our attacks and haemoglobin and smartphones etc. which doesn’t really fit with the requirements of this forum heading. Feel free to move that part if you like. Anyway totally cool either way 🙂
p.s. The moderator thing does seem like a good idea. If you need any help just let me know mate.
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