How Gout Medications Work media

Why colchicine with Allopurinol and Indomethacin?

Stopping Gout Together Forums Help My Gout! The Gout Forum Why colchicine with Allopurinol and Indomethacin?

This topic contains 23 replies, has 9 voices, and was last updated by  Rebecca Nahid 1 year, 2 months ago.

  • Author
    Posts
  • #4907

    Eric Bolvin
    Participant
    Ŧallars: Ŧ 19.58


    Hi; Recently had a gout attack and treated it with Indocin, colchicine, and allopurinol. Am now taking just allopurinol and doing fine. Uric acid is controlled.
    Stopped taking colchicine because it wasn’t insured, but am getting some from Canada.
    So when should I take colchicine? I know to take Indocin for acute attacks, but what about colchicine?


  • #4908

    d q
    Participant
    Ŧallars: Ŧ 363.41

    Colchicine is used for both prophylaxis treatment(preventative) and as an acute attack treatment when you feel a gout attack coming.

    Generally speaking, it is administered when starting new uric acid controlling medication such as allopurinol or febuxostat AND when increasing your dose of allopurinol or febuxostat (if required) to prevent attacks whilst those medications begin working and dissolving uric acid crystals or tophi.

    It is also taken on the first feeling that a gout attack is about to begin to stop the spread of inflammation and to minimize the length of the attack.

    The dosages should be set by your rheumatologist when prescribing it to you. There are generic dosages that you can use but I would recommend you don’t follow them as colchicine can be toxic if administered incorrectly

    Take a look at Acute Gout Attack Treatment Plan for a little information.

    It is best to seek rheumatologist advice before taking any colchicine.

  • #4911

    nobody
    Participant
    Ŧallars: Ŧ 502.46

    Other situations in which you might want to take colchicine while you know you could experience an attack at any time:
    Say you’re planning a business trip and you realize that an attack right before or during that trip would be extremely inconvenient. Take colchicine a few days before and during the trip.
    Say you’re planning to do something which has triggered attacks before such as a bit of trekking. Take colchicine from the day before to the day after.
    You get the idea. Just because you don’t need a prophylactic every day doesn’t mean you never need it.

    You might also use colchicine if you are afflicted with a persistent attack which indo can’t seem to quell fully or a seemingly unending series of short attacks.

  • #4913

    Eric Bolvin
    Participant
    Ŧallars: Ŧ 19.58


    Thanks all!

  • #4927

    Keith Taylor
    Keymaster
    Ŧallars: Ŧ 1173.53

    Hi Eric,

    Am now taking just allopurinol and doing fine. Uric acid is controlled.

    If that’s true, you don’t need colchicine. But is your uric acid below 6mg/dL (better below 5)? Because 6 is the maximum safe level, and 5 gives a good safety margin.

    Finally, if you’ve only just got down to that level, you might still get occasional flares until more old uric acid crystals dissolve. But if Indocin is working OK for you, there’s no need for colchicine.


  • #2756

    Phil Hambrook
    Participant
    Ŧallars: Ŧ -1.72

    Colchicine – As a course or adhoc?

    Hi
    I have Suffered with gout for about 5 years no medication taken but since an op to remove my right kidney 9 months ago I have had frequent attacks since, probably due to my eGFR dropping to 40 after my op (its now holding steady at 43). About 5 weeks ago Doctor put me on 0.5mg twice a day colchicine to clear a recent gout attack then after 6 gout free days go onto Allopurinol 100mg per day (forever!).
    I am happy to take allopurinol, I have read its kind to the kidney and see it as a possible way out of gout but the colchicine I am a bit worried about. The first time I took colchicine for 3 days, the gout pain disappeared, although foot still red and puffy the pain had gone but I never got the 6 gout free days as gout came back again so had to go back on them again. I then got my 6 gout free days and I have been on allopurinol now for 2 weeks but another gout attack hit several days ago. More colchicine has improved it so stopped taking it but as I write this I feel gout twinging my big toe! so not sure if I should take another colchicine to nip it in the bud.
    Any advice? can Colchicine can be taken adhoc on the first signs of a flare, stopping and starting doses, or should it be taken as a block and not stopped until several days after gout pains and swelling has gone. My instincts tell me the second but I don’t want to put any unnecessary strain on my kidney. I am sure I have read colchicine is a poison.
    My UA according to the doctor is only slightly raised but they have diagnosed it as gout. I am scheduled for another blood test in 4 weeks to review allopurinol doses, I have no intention of coming off allopurinol now I’m on it!
    Regards
    Phil.

  • #950

    Gout Patient
    Participant
    Ŧallars: Ŧ 1.46

    So I finally had my uric acid level tested on February 4/16 and much to my delight I have gone from a level of 416 umol to 249 umol in the course of taking 300 mg daily of allopurinol since November 11/15. As I told my doctor last week what really seems to be keeping me flexible and pain free in this treatment is taking 1.6 mg daily of colchicine. I have in the past few weeks tried to abstain from taking any colchicine and then get a mild flare up, take 2 tablets of colchicine daily again and within a couple of days back to healthy. So my doctor is trying to wean me down on colchicine,which I agree with, I am not a big fan of any long term medication but my question is this, what would be the long term effect of taking daily colchicine anyways? It is an ancient, naturally derived pharmaceutical that has been used since the times of ancient Greek civilization, apparently, so would it be damaging to take a low dosage for the rest of my living days? I understand that it reduces your white blood cell count and not a whole lot is known about it. I am very thankful that I don’t live in the U.S. as what the FDA has allowed to happen to this very effective treatment is criminal, to say the least.

  • #2759

    Keith Taylor
    Keymaster
    Ŧallars: Ŧ 1173.53

    Phil, thanks for taking the time to explain your situation.

    I can’t give specific help without a proper history of your uric acid test results. I need dates and numbers. For uric acid results, “slightly raised” is in the same ballpark as “a little bit pregnant”. It tells you which medical condition you have. But it’s meaningless in terms of treatment and care.

    Generally, there are two dosing schedules for colchicine. And, anything I say must be cleared with your nephrologist. First, you are right to say colchicine is a poison. It stops your immune cells from replicating, because that is what leads to inflammation. But, it does nothing for existing pain.

    So, if you are taking it ad-hoc, take it at the first suggestion of a twinge. But, if the flare has taken hold, you need anti-inflammatories as well. Otherwise, it can take 2-3 days for the existing inflammation to subside naturally.

    That’s why, when you start allopurinol, most doctors advise preventative pain relief for up to six months. It has to be managed case-by-case, and depends on your reactions and test results. Personally, I was advised to take colchicine for two months as a preventative, then review. In fact, I was confident enough with my pain control procedure that I changed the colchicine to ad-hoc very quickly. But for anyone not confident, I’d recommend preventative colchicine, if you get no adverse events.

    My main worry, from what you’ve said, Phil, is that your colchicine prescriptions haven’t been supported with anything for when you take the colchicine after the flare has started.

    I’m sorry it’s not as simple as colchicine as a course, or ad-hoc. I understand that doctors don’t have the time to explain different pain control combinations. But I feel, once you understand how different drugs work on different aspects of gout pain, you can control it better.

    I think we might have to go back-and-forth with more bits of information before we can tie things together properly.

    To summarize:
    1. Your uric acid test result history will give me a better picture of where you stand now.

    2. Your future uric acid test schedule will give me more confidence that you have an effective uric acid control plan.

    3. Your attitude to (and tolerance for) colchicine and anti-inflammatories is important. Colchicine alone is rarely enough to support gout patients during the first six months of uric acid lowering.

  • #2760

    nobody
    Participant
    Ŧallars: Ŧ 502.46

    In addition to what Keith said:
    -one advantage that comes with taking colchicine as a course is that it is effective from the very start of a flare (no waiting for you to notice the problem, to take the pill and finally for the pill to work its way into your system).
    -if you are taking colchicine ad hoc, discontinuing it too early after a flare (or lowering the dose too quickly) may lead to a comeback or to new flares.
    -if you are cleared to take 1.0 mg per day you may want to try to take only 0.5 as a course and the second 0.5 ad hoc.

    Colchicine is something you will have to experiment with a bit (within individualized guidelines provided by your doctors) for best result with the lowest possible dose.

  • #2777

    Phil Hambrook
    Participant
    Ŧallars: Ŧ -1.72

    Thanks Keith and other poster for such detailed replies,
    I have asked the doctor for a referral to a Nephrologist on 2 occasions but been told they only deal with CKD stage 4 or 5. Mine is stage 3B but I think I am falling foul of NHS spending cuts. I have attended a Urologist clinic once since my op, I only saw the nurse not the consultant. Only advice I received about gout was not to eat game! I have been told that a urologist consultant is probably not the best to advise about gout anyway, so I am on the verge of paying to privately see a Nephrologist if my gout continues to cause me problems, from what you have said he should fill in the gaps that I have in my gout medication plan.
    I will ring my medical centre to see if I can get a historic UA record. I remember a while ago the doctor saying that my blood test did not show gout but that it did not mean I have not got gout.
    Thanks again for your advice

  • #2814

    Phil Hambrook
    Participant
    Ŧallars: Ŧ -1.72

    Well Keith, previously I have only taken over the counter paracetemol or anadin for the pain, so no real pain control before.

    I am pleased with the way the colchicine has dealt with the last few episodes but I seem to have only a short time between those attacks. Last one was last Wednesday for a few days, the colchcine (2 x 0.5mg per day) worked well. The last couple of days though I am feeling twinges in both big toe joints with a bit of a burning sensation but its not making me limp. I am hoping its on its way out…..

  • #2819

    Keith Taylor
    Keymaster
    Ŧallars: Ŧ 1173.53

    Phil, if you are coping OK with just the colchicine, it’s probably best to stick with that. Also, best to talk with your doctor about additional pain relief, if you need it. But, let’s hope you are over the worst.

  • #967

    Gout Patient
    Participant
    Ŧallars: Ŧ 1.46

    Colchicine is not an innocuous medication. It interferes with microtubules involved in cell division. See standard warning below. As to it being ‘natural’…aresenic is natural as well. The ‘natural’ label just means occurring naturally in nature; it does not mean ‘safe’.

    WARNING: Colchicine can damage the bone marrow causing severe anemia, low white blood counts, and low platelets. Reduced white blood cell counts may increase the risk of infections. All patients taking colchicine long-term require monitoring of their blood counts.

  • #979

    Keith Taylor
    Keymaster
    Ŧallars: Ŧ 1173.53

    Colchicine Safety
    Linda is absolutely right to warn about colchicine safety. It works by poisoning the immune system. The overview of that is, it’s a balance of pain control over toxicity risks. This is common in treatment of many severe pain diseases.

    I look at it this way:
    If colchicine helps you during your uric acid lowering treatment, it’s a good thing. But, I have several caveats:
    1. Uric acid lowering should be managed properly to make the period when you get benefits from colchicine as short as possible.
    2. Never take more than 2 colchicine in 24 hours.
    3. Avoid colchicine if your immune system is compromised. That might mean some other viral or bacterial disease that you are fighting. It also might mean exposure to sick people.
    4. Colchicine should be part of a comprehensive pain management package that also reduces inflammation, and blocks residual pain. Without that, patients are tempted to take too much colchicine, which is wrong. It’s wrong because it’s not safe, but also colchicine above 2 per day has little or no effect, other than to poison you.

    Colchicine during lowering uric acid
    Kevin, Great news with your uric acid test results! 🙂
    I think it’s important to understand why you take colchicine when you start with allopurinol. Until most of your uric acid burden has reduced, you are at risk of a gout flare. It takes time for old uric acid crystals to dissolve. The way to reduce that time is to go even lower on your uric acid levels, but that’s a different topic.

    What you should find, is a decreasing need for colchicine. There are different ways to manage that. You could go ‘as required’ now, or reduce to one tablet per day. Whichever you chose, I think it’s best to make a note of your gout symptoms. You can post that here if you like. Or, I’ll set up a personal profile area for you. That gives you historic data to help planning colchicine dose in future. It also focuses the mind. When you reduce dose, or go ‘as required’, it’s important to act fast if you do get signs of a gout flare.

    Personally, I reduced my colchicine to zero within a few weeks of starting allopurinol. But, there’s no right or wrong way. Just reduce colchicine at your own pace, Kevin. You can be happy in the knowledge that uric acid is reducing. Any discomfort you get at your uric acid levels is a sign that old crystals are dissolving. It will become less as the days pass.

    Thanks for inspiring http://www.goutpal.com/8959/gout-medication-names-colchicine/

  • #984

    Gout Patient
    Participant
    Ŧallars: Ŧ 1.46

    Thanks Keith very much for the thoughtful reply and subsequent article which directly addresses my issue. Again I am recovering from a mild flare up which I recovered from Feb 13/16 and which initiated on Feb 10 and was focused on my right big toe although it did not seem to really settle into any of the joints there, it almost seemed as if it was really settled on the side tissue of the right big toe if that makes any sense. Leading up to that flare up I was trying to reduce to 1 tablet, 0.6 mg, daily and within 4-5 days of that reduction a flare up. Over the flare up period I was taking 4 tablets daily, unfortunately, which I will abstain from from here on in. Five years previous to that when I first actually started taking colchicine for gout I was told to take a tablet every 2 hours until diarrhea (ugh!) resulted. At those times I can’t begin to estimate what my actual dosage was, only to say it was a lot. In September of 2014 I was told by a pharmacist that advice was no longer valid and only to take 2 tablets upon flare up and one more in 2 hours and no more within 24 hours as it is basically useless beyond that.

    From reading your article you have just posted there is possibly one thing that I maybe doing wrong in dosage and that is taking colchicine in the morning as opposed to before bedtime as you recommend. I am going to start today dosing at bedtime and again work towards reducing my colchicine intake, ideally towards zero at some point.

    As stated earlier in another post I had my first flare up at the age of 30, so I have suffered with gout for nearly 17 years now and up until very recently had never had a correct diagnosis from any doctor and I have found that the doctors I have had in Canada here don’t seem to be overly knowledgeable on the affliction. Within the three months of taking daily allopurinol I have definitely noticed great improvement and I am thinking that after suffering with gout over that many years without correct treatment my recovery will be a little longer than some. Thanks again for your input Keith, it is greatly appreciated.

  • #970

    Gout Patient
    Participant
    Ŧallars: Ŧ 1.46

    Thanks for that Linda, I suppose I should have asked my doctor the same question. I am trying to reduce my colchicine daily intake to 0.6 mg currently, with such a reduced uric acid level I am not sure as to why I would be suffering any type of flare ups, certainly, however, the duration and intensity of the flare ups is greatly reduced. As I stated before I am not a fan of long term meds of any kind so I am certainly hoping to stop taking colchicine asap.

  • #2776

    Keith Taylor
    Keymaster
    Ŧallars: Ŧ 1173.53

    Colchicine is something you will have to experiment with a bit (within individualized guidelines provided by your doctors) for best result with the lowest possible dose.

    That’s very true. In fact, it’s true for all gout pain therapies. Find what works for you!

  • #2783

    Keith Taylor
    Keymaster
    Ŧallars: Ŧ 1173.53

    Sorry, Phil. I didn’t realise you are a fellow Brit. So, I assumed you would have a nephrologist, as I’ve been led to believe that’s common in The States. All I meant was, I’m not a doctor, so you should make sure any pain meds you take are compatible with your surgery.

    If there are complications, the gout specialist should be a rheumatologist. But, the only complication here seems to be medical staff who advise about gout. But, they haven’t read the professional gout guidelines that our taxes paid for.

    Don’t bother with paying private consultants yet. Send me the train fare from Yorkshire. Then, I can take you step-by-step through the guidelines that frontline medical staff should read. I know we can do it here in the forum. But, I fancy a day out! 🙂

    Joking apart (i.e. ignore that last paragraph), we can probably fill in the gaps here, online. Have you ever had any other pain control, besides colchicine?

  • #2818

    Carroll Lee
    Participant
    Ŧallars: Ŧ 1.50

    Pre-allopurinol Pain Treatment

    Should pain treatment (prednisone/naproxen.etc) be initiated prior to allopurinol treatment or be delayed?

    If it is prior, how long before the first dose of allopurinol.(100 mg)?

    Have said it before will say it again……..excellent website.

  • #2822

    Keith Taylor
    Keymaster
    Ŧallars: Ŧ 1173.53

    Personally, I don’t think steroids such as prednisone have a place, but that obviously depends on personal circumstances.

    Where pain control is take as a preventative, it is best to start the day before starting allopurinol. But, if pain control is “as required”, then start allopurinol first.

  • #5387

    urankjj .
    Participant
    Ŧallars: Ŧ 28.04

    Is colchicine really effective to relieve gout symptoms?

    I am assuming that it must be since there are so many people using it. After a quick online Wikipedia (Wiki) inquiry about it though, I must say that I am a bit skeptical about its safety and its necessity for gout treatment.

  • #5399

    d q
    Participant
    Ŧallars: Ŧ 363.41

    Colchicine for the first time

    @keith @nobody

    So the swelling has generally come all the way down but the pain still persists after long walks mainly on the base of my foot and around the top of the toe. As you know I’ve discussed this with two separate rheumatologists and have a professor to see in September. Anyway, I finally decided to give Colchicine a try and took my first 0.5mg tablet this morning to see how my body reacts should I need it.

    Anyway, 2 hours into taking it everything seems OK actually. I’m not expecting anything in the way of getting my foot back in shape from the one tablet. It was just to see if I can tolerate the stuff in the event of a flareup prior to starting Febux.

    Only side effects I’ve noticed is a dry mouth and throat and an increased urge to drink water, I’ve also noticed a slight headache and a very slight loss of voice. Otherwise things seem OK. I was wondering if these side effects are something you guys experienced the very first time you took Colchicine or every time you took it.
    If any side effects did occur during your use, how long did they take to settle down?

    Thanks guys.

  • #5402

    nobody
    Participant
    Ŧallars: Ŧ 502.46

    I don’t recognize the side effects you mention but I might have misattributed “urge to drink water” to stress and/or inflammation when it’s actually a colchicine side effect. Drinking water is healthy anyway.
    I might also have shrugged off slight headaches.

    I’d put the side effects I experienced in two categories:
    -weird initial side effects
    -dose-dependent gastrointestinal side effects and liver stress
    The second category does not go away quickly even if the dose is lowered and and should not be triggered by a single pill. It seems I typically need to take quite a lot of colchicine before such effects become noticable. These are potentially serious side effects and I’ve been told to see them as a hint that I might be taking too much colchicine.
    The first category though, I can get that on the first pill especially if I take a full 1.0 mg (I often cut these pills in half and spread the intake over time). In fact, I often get them only on the first pill after a while off colchicine. The most noticeable side effects in that category are itching eyes and feeling like I’ve got a slight fever. But I got other seemingly nonsensical and harmless side effects which go away on their own within hours to a day even in the face of dose increases.

  • #5405

    Rebecca Nahid
    Participant
    Ŧallars: Ŧ 87.26

    I am one of these weird people that always seems to get Side Effects nobody else gets when I first took Koko Jean I had a big loss of appetite and that’s how I lost a few pounds and yes I was I had a dry mouth and a bit of insomnia I have my body got used to it after a while

You should log in to GoutPal to reply to this topic.


If you need more information, get it from Keith Taylor’s Log-in Help.