Need Advice on Gout Medication
Posted , 5 users are following.
I had a gout flare before and I had not have one for couple years. I had a flare up beginning of December and my Dr. put me on Colchicine and Allopurinol. Colchicine .06mg twice a day as needed. Allopurinol 100mg twice a day. This is my first time being on these medication. I used NSAID for my previous flare up.
I took both Colchicine and Allopurinol as directed for a week and I finally was able to walk. I stopped taking Colchicine per Dr. order and direction of as needed only. My big toe although swelling around joint has subsided it is still tender when I put pressure on it. I continued with my Allopurinol medication.
My question to all is how long should I take the Colchicine? As long as I take Allopurinol? When does one stop Colchicine since it is a as needed medication. Will stopping Colchicine prematurely trigger another gout flare up?
Any advice is very much appreciated. Thank you in advance and I look forward to hearing from all.
0 likes, 26 replies
jx41870 jay14409
Posted
I think you're just about on target, when you can walk again stop the colchicine, and unless there's another flare you just stay on the allopurinol for some time, including at least until your blood tests say your blood urates are down to a normal level.
jay14409 jx41870
Posted
rustygecko jay14409
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As for the allopurinol it will eventually sort you out. The most common dose during the cleaning out phase (fist couple of years) is 300mg. You may find 200 is enough, but you need blood tests to confirm it.
NB as a gout sufferer you need to get the urate down to under 4, not under 6.5 as per a normal male.
NB2 the faint gout you have now could be the crystal release or it could be long term damage already done to the joint. I thought for a year or so I had permanent damage done to the joint but after a couple of years of allopurinol it 98% disappeared (leaving a small pain if I push my toe up hard).
Merry Christmas and good health.
jay14409 rustygecko
Posted
Cheers and Happy New Year
rustygecko jay14409
Posted
The Dr is doing the right thing.
The only additional advice would be drink plenty of water and during the first couple of weeks look out for a skin reaction. It’s very unusual in Caucasians, but it does happen - all your skin falling off. If you’ve been On allopurinol and not had it yet, you’re in the clear.
The colchesine is there to stop gout flairs by calming down the immune system. I found I took one from time to time as needed. In my experience if you take a colchesine as soon as a hint of a problem it stops it.
Allopurinol is for life. For probably a genetic reason (and age) your kidneys aren’t removing Uric acid properly and it builds up in the tissues. As your blood urate falls more is released from the tissues, which may trigger gout (hence the colchesine. This process will take time. Only 30% of people stick to the allopurinol possibly because they think they are cured or because they don’t understand that gout not only attacks the joints,?but causes damage to the arteries (and kidneys), which years down the line leads to heart attack and stroke.
It would be beneficial for you to get your body down to its correct BMI (around 22-24) if you’re overweight. If you drink alcohol it’s sensible for everyone but even more so with gout to drink occasionally and moderately.
You need to have blood tests probably 2 x a year to check you’re on the right does of allopurinol.
With allopurinol you can eat whatever you like. Can’t emphssise enough to drink plenty of water - helps the body to flush the excess urate.
Taking The allopurinol will become as easy as cleaning your teeth.
NB I found that allopurinol made me very tired for the first few weeks.
Colchesine will give you diarrhea if you over do it. If that happens, stop a few days before you take another.
Oh yes - don’t take aspirin as it exacerbated gout.
jay14409 rustygecko
Posted
Thank you Rusty for the comprehensive explanation of Gout and its medication. Like my replied on the other post above, I quit taking Colchicine after a week when the swelling subside but the joint is still tender. I started the Allopurinol regime with the Colchicine and the only thing I am taking is the Allopurinol. My question is I read somewhere that for some going on Allopurinol for the first time can at times trigger a gout attack. My tender spot never did go away, its still a little sore to walk but not enough to debilitate me. Am I experiencing the side effect of Allopurinol (triggering a gout attack)? Should I start taking the Colchicine again? Do I need to stop Allopurinol until all signs of Gout is gone? Any advice is greatly appreciated.
Just a FYI, I actually lost 40lbs after starting a low carb diet so my BMI is the best I ever been. I don't drink alcohol and no sugar for me since July. I drink PLENTY of water during the day so I am just confused as to what is going on that is causing this sore/tender area to linger. Thanks again Rusty for your advice and reply. Seasons Greeting and Happy Holidays.
rustygecko jay14409
Posted
If the soreness continues you may be stuck with it, but I found that the residual soreness in one toe (and thumbs) went after a good year or more. I’d describe mine as sore rather than pain. Colchesine helped it.
david78147 jay14409
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jay14409 david78147
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rustygecko jay14409
Posted
The crystals don’t cause pain. What causes the pain and swelling is the white blood cell immune attack. The colchecine inhibits that attack, thus reducing swelling etc till the body has a chance to flush out the crystals causing the problem.
The advice in the past was to stop the allopurinol. This advice has long since been superseded.
Wulongheyot jay14409
Posted
Jay,
Sorry to hear about your flare up. They are the worst. Take it from someone who has suffered them for years, and sometimes a new flare up every week! I've actually had an attack simultaneously in the big toe and knew of the same leg!! Which has to be the worst combination.
You should never take Allopurinol while taking Colchicine. Allopurinol technically is for long term control, while Colchicine should only be taken during a flare up. During your flare up, typically 6 -12 days (1 pill a day) of Colchicine should clear it up. After the symptoms are gone, that's when you get back on the Allopurinol. If youre in a full blown flare up, the Colchicine can take 2 days until you notice a difference.
Another tip- If you're insurance provider is like mine, they won't pay for Colchicine. If that is the case, checkout the Good RX app, they have a coupon code that can knock 40%-50% off the price.
And as far as things to do to keep the flare ups away. I read all about the diets, meats, alcohol, etc, etc. I cut all those out systematically to see if any of them made a difference. And cutting them out didn't keep my weekly attacks from occurring. Just recently I cut out all caffeine and bam, the attacks stopped. Strange right! Hopefully that info helps, if not I hope you find your trigger!
Good luck!
jx41870 Wulongheyot
Posted
Hey W, sorry to hear about your flares. You ever try taking celery seed (or just plain celery), before, during, or after? I've got to try that GoodRX for another condition, actually.
?My worst attacks, of gout or pseudo-gout, are when the get into the tiny joints in the foot! It doesn't even hurt as badly as some other but you just can't use it.
?I seem to be clear of regular gout now but have had what must have been pseudo-gout, now that I'm taking celery seed continuously I haven't had either and hope to keep it that way.
jay14409 Wulongheyot
Posted
Thank you Wulongheyot for the advice. I did stop taking Colchicine for now as I am taking the Allopurinol. Hopefully it will keep a flare up away. The GoodRX is a great way to save. At times it has better price than if I go through my own's prescription plan from work. The pharmacist where I go was kind enough to run through Good RX and my own. I wonder why am I paying for prescription plan when I can get discounts for free. As for caffeine, I hope that is not my case as I love coffee. Thanks again for the advice and reply.
jay14409 jx41870
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Wulongheyot jx41870
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jx, never tried Celery seed, but yes I've eatin my weight in celery. I think once or twice it helped with an attack, but in all honesty it's so difficult to say whether or not that was the one thing that actually helped. Mainly because, when in paid I'd try every remedy possible, which I'm sure is counter-productive. I'm more than confident (for me at least) it's the caffeine. Maybe i'm allergic to it? Jay, I have to say i'm a Debbie-downer (wahh wahh) when it comes to Allopurinol. It never did anything for me. Little disheartening when you're taking a medication that is suppose to assist with keeping an attack from occurring while constantly getting an attack. Colchicine on the other hands is gods gift to gout sufferers. It has always been my best friend to clear an attack up, but again not very sustainable when you go off of it and the attack is just waiting around the corner. Hence the reason I've been more focused on cutting things out of the diet versus relying on remedies.
jx41870 jay14409
Posted
Jay, yes celery seed comes in convenient capsules. It also comes loose, for cooking, and I rather like it actually!
?I tried cherry juice and dried cherries, and for me it did nothing. I don't know that there is any known active ingredient in cherries, the way there is in celery seed, "3nb".
jx41870 Wulongheyot
Posted
W, have you ever looked seriously into pseudo-gout? It works off calcium, it is not supposed to be linked to any particular diet, and allopurinol won't touch it. Neither will celery seed. That's why I finally started paying attention, and concluded much of what I have had is the pseudo- variety. I think colchicine would still work on an attack as it's a general anti-inflammatory or pain-killer or something.
rustygecko Wulongheyot
Posted
It is completely 100% normal to take allopurinol and colchesine.
It is the standard advice by NICE.
rustygecko Wulongheyot
Posted
Following this regime it is not surprising that you have weekly attacks. What you are doing is constantly turning the system off and on, this almost guaranteeing gout.
Additionally the dosage advice for allopurinol is also wrong.
Wulongheyot rustygecko
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Hey Rusty. I don't think there is a right or wrong when it comes to asking for advice on sites such as this (as I'm not a doctor), but to answer your question - I received my directions from my doctor. However, there are 100's of articles on the subject if you just do the research. Here are several doctors on this link concurring with my doctors instructions: https://www.healthtap.com/topics/can-you-take-colchicine-and-allopurinol-together[/b]
Furthermore, I didn't give advice on dosage for Allopurinol. I was offering my advice on the Colchicine. I had one doctor tell me to take 1 pill for every hour until I started to have diarrhea and another doctor tell me once a day. I found through plenty of testing - once a day is equally as powerful as doing the latter.
My prescription for allopurinol is twice a day, however I stopped taking this altogether.
Wulongheyot jx41870
Posted
I have, the issue (for me is), it's a moot point on the differences. Colchicine is still the active treatment for both Gout and CPPD (pseudo gout). Blood work would suggest gout, the last test I had abnormally high uric acid level. But again, that really doesn't say much either. The only true test is an injection in the site, and there is no way in hell I'm doing that during a flare up. I'd prefer an amputation before I'd submit to a poking in the middle of a gout attach. They have some very cool prosthetics available
Plus, knowing my luck they'd do the injection and the findings would be inconclusive.
david78147 Wulongheyot
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Wulongheyot david78147
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My attacks have actually completely gone away since I've cut out all caffeine. Hopefully, it stays that way. Since my attacks have stopped, I stopped taking allopurinol. David, I hope you find what ever it is that is causing your flair ups.
david78147 Wulongheyot
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Wulongheyot rustygecko
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Rusty, I tried replying back to you earlier but noticed a hyperlink reference to a page that has multiple doctors concurring with my reply is being moderated by this sites admin. I presume they wont allow any third party references in these forums. I hope my advice isn't new news to you as it is a common discussion in Gout topics among medical professionals - And to be clear: The discussion I'm referring to is simultaneously taking Allopurinol while taking Colchicine. And the general consensus from medial professionals claiming taking Allopurinol during an attack can prolong a flair up. Their is more literature that supports this than the latter.
Furthermore, I never gave dosage advice for allopurinol, which leads me to believe if you didn't thoroughly read my post there is a good chance you didnt thoroughly read the articles published by NICE.
As for "who told me this" - two different doctors, both my personal doctors. I don't quite understand your position on "this advice is totally incorrect", considering that the medical profession in general is a "practice" and secondly, this is a web forum in which people give advice on past experiences. Now i'm not discounting your position on what you think you may have read. I'm sure there are different positions on this subject as there are in all things medical.
Ultimately, I'm sure prior to Jay's decision to post in a forum like this was post a medical professionals opinion and now he's seeking advice from sufferers.
rustygecko Wulongheyot
Posted
Excuse the delay in reply.
There are right and wrong answers in some questions and if your doctor told you to stop taking allopurinol during an attack he is giving advice which is not supported by those that write the management of gout for doctors. Also it shows a lack of understanding of how allopurinol works which is more worrying. Having said I’m told that it was the advice in some medical schools 40 years ago.
I read the link which you gave (its long I only read half), but all the advice I saw disagrees with your doctor.
Quote from NICE
<<For long-term control of gout the formation of uric acid from purines may be reduced with the xanthine-oxidase inhibitors allopurinol or febuxostat alternatively the uricosuric drug sulfinpyrazone may be used to increase the excretion of uric acid in the urine. Treatment should be continued indefinitely to prevent further attacks of gout by correcting the hyperuricaemia. These drugs should never be started during an acute attack; they are usually started 1–2 weeks after the attack has settled. The initiation of treatment may precipitate an acute attack, and therefore an anti-inflammatory analgesic or colchicine should be used as a prophylactic and continued for at least one month after the hyperuricaemia has been corrected. However, if an acute attack develops during treatment, then the treatment should continue at the same dosage and the acute attack treated in its own right.>>
And another reputable source:
<<Never start or stop this drug during a flare.
Stop taking medication at the first sign of a rash, which may be a sign of an allergic reaction.
Take immediately after a meal.>>
If your doctor suggests you should stop taking allopurinol during an attack - go and see a rheumatologist - and change your doctor to one who has a better understanding of gout.