Indomethacin gave me breathing problems!

[Al O’Purinol]

Hi all, I’m new to this forum but not to gout – for 10 years it’s been giving me problems 🙁

Just a note to say after using Indomethacin for several years I developed breathig problems – shortage of breath mainly. I have seen a specialist who ruled out the usual suspects & the conclusion was constant use of Indomethacin.

I must admit I was taking it almost every day for ages, as like the rest of you I assume I have been in almost constant pain for?permanently – at least ?it seems like that.

It’s a funny thing Gout – you don’t notice when you don’t have it but certainly DO notice it when you do.

My problem is now that I am in pain again and am worried about taking any Indomethacin at all – what do you think? I am taking Colchicine but it isn’t getting rid of the pain & I dont want to overdose on that!

I am by the way taking Allopurinol, which I started a few months ago.

cheers

Chris

[KeithTaylor]

Hi Chris,

First of all, I’m sorry about the problems you had posting your message. I had a filter on first posts which meant that all new members needed a post approved before they could post without restriction. I’ve removed this now, so you have already helped fellow gout sufferers by making this service easier for those that follow you here.

I’ll comment on your final paragraph first, before I get to your immediate pain control problem.

Allopurinol has two purposes. It’s main, well recognized purpose is to maintain your uric acid level at 0.30 mmol/L (5mg/dL). You should be getting tested to make sure your uric acid level is no higher than this. I hope your doctor is more enlightened than 2 or 3 that I have seen, who are quite happy to accept a level of 0.40, which is absolutely unsafe. I mention this because too many doctors fail to ensure allopurinol dose is high enough to maintain safe uric acid levels. Safe uric acid is universally recognized as 0.30 mmol/L (5mg/dL), though in exceptional circumstances, the patient might have to settle for 0.36 mmol/L (6mg/dL). Out of all the cases of continuing gout pain that I have seen, failure to prescribe correctly is the biggest cause, with the second biggest being patients forgetting to take the meds. [aside to those people: You don’t forget to eat, drink, or visit the bathroom do you? Allopurinol is more important than all those!]

The second purpose of allopurinol is to help you get rid of old crystals. It is most effective at it’s maximum dose. During early months on allopurinol, even at 0.30 mmol/L, you are exposed to gout attacks. The time varies according to how long you have had gout, and other personal factors. It is impossible to say how long this will last, but one thing is certain in every case. The lower you get uric acid, the faster you get rid of old deposits. This will shorten the time you are exposed to the risk of gout attacks.

I recommend the first six months at least is on maximum allopurinol dose. This is after 2 weeks on 100mg to discount allergic reactions. It should be backed up with liver and kidney function tests whenever you have a uric acid test. This should be monthly at first, extending as you stabilize uric acid, but never less than once a year.

As for pain relief, you have to understand the process,

Colchicine stops inflammation spreading, but it does nothing for immediate pain, and it does nothing to reduce inflammation. It should be taken at the first sign of an attack, with a second pill an hour later if attack has not resolved. Do not take more than two a day. It will not help gout, but might kill you.

If you have not caught the attack soon enough, or as soon as pain becomes unbearable, you need something to block it. People react differently, so you have to work out your own package that suits you best, in conjunction with your doctor and pharmacist.

Chris, as you cannot see your GP, you can get to a pharmacist today. I know from behind-the-scenes stuff that you are in the UK. You should be able to get to see a chemist this morning. If not, you can make an online pharmacy appointment, but it will cost ?25. The upside is, it will help support GoutPal, and help keep my gout support services free. To be clear, I’m recommending you visit someone local, and only offering the paid link as a last resort if you cannot get your own professional help.

With advice from your doctor or a pharmacist, you need to find a combination package out of all the hundreds of pain meds. It is a package that includes one drug to reduce inflammation, and a compatible drug to block pain. It is my job to help you understand that, but your doctor / pharmacist’s job to advise the exact package.

Colchicine is holding back the inflammation as much as it can. 2 pills will safely control most gout pain, but if uric acid is not controlled as outlined above, you will need to block pain, and reduce inflammation ( in your case, with a tolerable alternative to indomethacin).

It is your choice which you do first. Whatever your pharmacist recommends, take either the inflammation reducer or the pain blocker, and alternate two hours later (or as advised by the professional).

[Al O’Purinol]

Hi Keith,

thanks for your response. ?I gave up last night & had an Indomethacin and seem to be OK so I’m going to just try one a day to control the pain for the next couple of days at the most. I was trying to get hold of my results from a blood test I had 2 weeks ago to see if my UA had dropped since I went up to 300mg Allopurinol, but I’ll have to wait until I come back off holiday next week. I have only got 300mg tablets now otherwise I would try 400 for a couple of days – I’m not sure if 600 would be too much? Do you think 600 would hurt for a few days to try & drop my UA level?

cheers

Chris

ps yes that is my shop!

[KeithTaylor]

I’m glad you are OK Chris.

I do not recommend playing about with your allopurinol dose without results of uric acid, kidney function, and liver function tests. Best to make an appointment with the doctor for when you return. That is not to say there is anything wrong with 600mg allopurinol. I actually prefer 900mg (800mg in USA) in order to get the old crystals dissolved as soon as possible. But I only did that on the back of clear liver function.

That also applies to Uloric (febuxostat) – get on the max as soon as you can, but keep testing liver function. That way you get healthier quicker, with minimum risk.

[Author]

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