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There’s new approaches to colchicine (Colcrys), these days. Six months is the maximum for most people on uric acid lowering treatment. And, if you are not lowering your uric acid, you should be if it is above 5mg/dL
It’s great for getting you through the early months of uric acid lowering, but never take unnecessary colchicine.
Is it ever a good idea to take colchicine when you are taking Z-Pak, or any other antibiotic?
If your immune system is fighting an infection, why compromise it with colchicine. I agree that, in most case, colchicine is absolutely the best first line attack against gout pain, but at times of infection, personally, I’d go straight to anti-inflammatories / analgesics.
See more information about azithromycin in the prescribing information for Colcrys within the colchicine guidelines.
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.
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).
Thank you, @frank-mcauley – an interesting start to my week.
Before I think about allopurinol, I’d like to express a few thoughts about uric acid lowering in general.
I find it helps to realize that our bodies are experiencing massive change. When we reduce uric acid concentration in the blood, crystals that have grown slowly over many years start to dissolve rapidly. Most of these simply melt away, and the dissolved uric acid is flushed through our kidneys. But White Blood Cells are vigilant, and they react aggressively to any sign of a uric acid crystal. We may well experience a gout attack, and there have been many discussions here about gout attacks during uric acid lowering treatment. Keep calm and take the pain relief is the best response to this. However, also be aware of the changes taking place in your body, and do not be alarmed by the associated stress, feverishness, and generally “not feeling right.” This will pass. You can minimize it with plenty of fluids, and as much gentle exercise as you can find time for. Also maxing out on the fruit and veg will give you a better quality of general nutrition that leaves you better placed to meet the challenges of reducing your “urate load” (the total of all the uric acid deposits that have built up during the years plus the dissolved uric acid circulating in your body). Steak with salad rather than steak with fries is an acceptable compromise you will grow to love.
But ringing in the ears and cramps should not be part of that, so let’s try allopurinol.
First off, you need to choose your target. I like your 2.2 mg/dL, and as you have visible tophi, that is the best target to maintain for six months, then review. However, any number between that and 5 is viable.
Start with 100mg allopurinol per day. After two weeks, if you have not experienced rash, and your liver and kidney function tests are satisfactory, start a two-weekly increase until you reach your target uric acid level. 2 weeks is optimum, 4 weeks is acceptable, any longer is time-wasting. The increment should be something you and your doctor are happy with. Personally I went 100, 200, 300, 600, 900. The important thing is to monitor kidney and liver function. Ensure you drink enough fluids to pee around 2.5 liters per day.
Good luck with this Frank. I know you have not had the easiest of times when reducing uric acid. I hope allopurinol reduces your side effects and resulting stress.
Also, I’ve looked in PubMed for all the DECT gout references. Here is a list of institutions:
- University of Auckland, Auckland, New Zealand
- Vancouver General Hospital, 899 W 12th Ave, Vancouver, BC, Canada
- Boston University School of Medicine, Boston, MA 02118, USA
- Department of Radiology, PUMC Hospital, Beijing 100730, China
- Hacettepe University School of Medicine, Ankara, Turkey
- Klinikum Wels Grieskirchen, Osterreich
It is not just a question of where DECT scanners are installed – they also need to be fitted with the syngo DE (Dual Energy) Gout application. I have had great difficulty finding anyone in Siemens who can provide up-to-date installation details.
It is a couple of years since I tried, so the information might be easier to get now. Why not try:
Siemens Medical Solutions USA, Inc.
51 Valley Stream Parkway
Malvern, PA 19355
Phone: +1 888 826 9702
Phone: +1 610 448 4500
Fax: +1 610 448 2554Please let us know if you get anywhere. I would love to offer a locating service, but I do not have the resources for finding a suitable contact and maintaining a dialog.
Having said all that, the best chance of locating an appropriate service must be your rheumatologist. What did he/she suggest after failing to draw synovial fluid? Most rheumatologists have enough experience of gout to be able to diagnose from other criteria.
One thing that DECT has taught us is that crystals often occur in joints that are not currently affected by gout. What is your rheumatologist’s view on drawing a sample from a foot or knee joint?
Finally, what are your uric acid levels? Best taken when you are not having a flare, but in any case, to aid diagnosis, you should get a uric acid blood test every 2 weeks for a couple of months. That, together with the way your symptoms present should be enough to confirm or deny gout.
STOP PRESS
I’ve found some information on syngo installations in the US. This does not mean they have the gout application. Apparently 8 of the top 10 US hospitals have syngo:
John Hopkins Hospital, Baltimore
Massachusetts General Hospital, Boston
Cleveland Clinic, Ohio
Ronald Reagan UCLA Medical Center, CA
New York Presbyterian Medical Center, NY
Brigham and Women’s Hospital, Boston
Duke University Medical Center, Durham, NC
Hospital of the University of PennsylvaniaThe 2 that do not have it (at March 2012):
Mayo Clinic, Rochester, Minnesota
UCSF Medical Center, San Francisco@dlanor, please stick with it.
Until DECT becomes more widely available, it is very difficult to judge hidden deposits of uric acid crystals. If they’ve been building up for 15 years, they are going to take some time to get rid of. My numbers are similar to your, but I went for the maximum 900mg allopurinol (UK – it’s 800 mg per day in USA). My attacks stopped completely after 6 months. Up to that time I went from one or two a week to about once a month, but nothing now for about a year.
A significant part of my success is down to my complete faith in my ability to handle gout attacks, coupled with a recognition that the time between my attacks was getting longer. Though I took preventative colchicine for a few weeks, I soon gave this up in favor of “as required” approach.
As required colchicine works best if taken at the first sign of a gout attack. If not resolved within an hour take one more, with a maximum of two per day. After an hour if discomfort was still too much to bear, I took ibuprofen (800mg), and after a further two hours, paracetamol (US: Tylenol) if required. I cannot remember ever having to repeat the ibuprofen/paracetamol sequence, but if necessary you can repeat up to 4 times a day. Of course, there are alternative anti-inflammatories, and alternative analgesics, but the 3 line attack always works. You should discuss packages to suit you with your doctor or pharmacist.
Another helpful habit is plenty of fluids and gentle exercise as much as possible.
As you can see, I don’t agree with lower allopurinol until you have gone six months without a gout attack. I have maintained my maximum despite no attacks because I still have visible tophi on my right elbow. This is quite a solid lump, so I’m guessing that it will take some time to work through the mass of dead blood cells.
I got uric acid down to around 2, so I reckon you might need a bit longer than the 8 months you have had so far. Everyone is different in this regard. Some people benefit from supporting allopurinol with probenecid to encourage uric acid excretion. Very unscientifically, I chose a pint of skim milk a day, and I’ve no idea if it helped or not, but it certainly did no harm.
Getting rid of 15 years of uric acid deposits is never easy, but better if you fight with everything you can. I’m confident that you will get better soon. Just hang in there. If no improvement in another 3 months, I advise a checkup by a rheumatologist to rule out complications.
Please remember, I’m a gout sufferer not a doctor. I can give you some friendly advice, but that is absolutely no substitute for a medical examination, and professional opinion.
There are lots of things that cause sore feet. Why do your friends suggest gout? Is there a family history, because gout is largely genetic.. Why do you think it isn’t gout? This is the first time I’ve heard that walking five blocks can cause foot pain, but I guess if you have poor footwear, that could happen.
If it is gout, you need to be aware that the pain will get worse. It will spread to more joints, attack more often, and more intensely with each month it is untreated. It is an extremely serious condition that will eventually destroy your joints. It also spreads into soft tissue, damaging skin, kidneys, heart, and eventually all organs.
If you are even mildly suspicious that it might be gout, please see a doctor to get a proper diagnosis. If you make the appointment, but are not sure what questions to ask, come back again for more help.
If you are looking to stop gout, please consider GoutPal’s Stop Gout program for a personal gout treatment plan.
This jogging with gout topic is now closed.
It covers several variations on gout and jogging, including:
- can i run with gout?
- can jogging reduce uric acid?
- Is jogging bad for gout?
Jogging is one form of exercise. Generally speaking exercise is good for gout, but it must be planned on an individual basis. You should get checked by a doctor before embarking on any exercise program. Jogging is particularly significant for knee and ankle stress. If those joints are already damaged by untreated excess uric acid, then you should substitute exercises that are unlikely to cause impact damage.
I will move the relevant parts of the discussion to a new common questions section, as time allows. In the meantime, you can easily search for current discussions, or start a new discussion.
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This Colcrys gout topic is now closed.
It covers several variations on a Colcrys for gout theme, including:
- Can you take Colcrys and allopurinol together?
- What is Colcrys 0.6 mg used for?
- How does Colcrys work for gout?
- Colcrys complaints
Colcrys is a United States brand name for colchicine. Unless you are looking for help with the cost of buying Colcrys, you are better referring to colchicine if you want help about treating gout.
I will move the relevant parts of the discussion to a new common questions section, as time allows. In the meantime, you can easily search for current discussions, or start a new discussion.
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For complete Colcrys information, please see the colchicine guidelines
This allopurinol rash topic is now closed.
It covers several variations on an allopurinol rash theme, including:
- gout rash
- allopurinol rash picture
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Please browse the Allopurinol Side Effects guidelines for best information.
This gout in multiple joints topic is now closed.
It covers several variations on gout in multiple joints, including:
- swollen knee
- gout multiple joints
- gout foot
- gout knee
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This allopurinol 300 mg topic is now closed.
It covers several variations on a theme, including:
- allopurinol 300 mg making gout worse
- allopurinol 300 mg tab for gout
- allopurinol gout treatment 300mg
- does allopurinol tab (300 mg) relieve pain?
Allopurinol 300 mg sounds OK, but so does a car at 30 mph. Dangerous and useless in a shopping mall or on a motorway. Allopurinol exists to get you uric acid to a safe level. Allopurinol dose does not matter, Uric acid level is vital.
I will move the relevant parts of the discussion to a new common questions section, as time allows. In the meantime, you can easily search for current discussions, or start a new discussion.
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Please browse the allopurinol guidelines for best information.
This gout humor topic is now closed.
It covers several variations on a theme, including:
- gout humor
- gout jokes
- gout holidays
The trouble is: it isn’t very funny, and the “joke” was immediately followed by serious stuff. C’mon guys! Where’s the funny?
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This alkaline diet for gout topic is now closed.
It covers several variations on an alkalizing gout diet menu theme, including:
- alkaline diet gout
- uricosuric foods
- acid-alkali (ph) balance in gout
- alkaline food for gout
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This Big Mac gout topic is now closed.
It covers several themes, including:
- Big Mac gout
- 10 months free of gout
- gout “big mac” purine
Sadly, there are no real answers here, because it is all part of a scam by tonyccc, who fooled people into providing serious replies when all he was interested in was self-promotion of the rubbish he peddles.
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This gout diet topic is now closed.
It covers several variations on a theme, including:
- Beef mince and gout
- Bolognese gout
- Can beef mince make gout worse?
- Can i eat spaghetti bolognese with gout?
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This bendroflumethiazide and gout topic is now closed.
It covers several variations on a theme, including:
- Bendroflumethiazide and gout
- Can Blood Pressure (BP) meds cause gout?
- Gout and high BP
- Gout-friendly blood pressure meds
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Please read Diuretics Cause Gout for more information.
This allopurinol side effects topic is now closed.
It covers several variations on a theme, including:
- Allopurinol side effects forum
- Allopurinol dreams
- Is tiredness a side effect of allopurinol?
- Allopurinol side effects fatigue
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This Uloric (febuxostat) topic is now closed.
It covers several variations on a theme, including:
- How long does it take for Uloric to work?
- Alternatives to Uloric
- How long should i take Uloric?
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This topic is now closed.
It covers several variations on a theme, including:
- How colchicine works
- colchicine immune system
- colchicine immunological suppression
- colchicine white blood cell count
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This topic is now closed.
It covers two themes:
- Gout for 2 months / 2 months of gout
- Danzen & gout / allopurinol and danzen
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This topic is now closed.
It covers several variations on a theme, including:
- Gout crutches
- Crutches for gout
- Do people with gout use crutches?
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This topic is now closed.
It covers several variations on a theme, including:
- Gout pain for a month
- Is it gout?
- My gout is back one month later. What to do?
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This topic is now closed.
It covers several variations on a theme, including:
- Can Tophi be removed?
- How long does it take to get gout?
- How long does it take to get over gout?
- Can tophi be surgically removed?
- How long do tophi last?
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This topic is now closed.
It covers several variations on a theme, including:
- My gout won’t go away
- Gout swelling won’t go down
- Gout attack won’t go away
- Why wont my gout go away?
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This topic is now closed.
There are two different themes:
- gout & knee, or gout in knee
- gout & elbow, or gout in elbow
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Those are interesting views about Uloric treatment, from @hansinnm, who has been there and done it. However, I don’t really want to mislead @leonard01 who appears to be something of a newbie.
By the way, @hansinnm, you should take credit for 1b, the function tests.
I agree with your point 3, but those who are new to Uloric usually need some clearer guidance than “as long as it takes”
I’m not saying my advice provides that clarity, but I’d rather discuss the specifics of duration of prophylactic colchicine with respect to @leonard01’s specific needs. The guidelines from the American rheumatology profession, issued last year are a little long-winded. Hence the delay for me summarizing them. They appear to recommend that colchicine should be taken whenever you start allopurinol or Uloric for the longer of the following:
6 months
3 months after achieving target uric acid (5 or 6 as determined by personal case review) if you never had visible tophi
6 months after achieving target uric acid but where visible tophi have now resolvedI believe that the reasoning is as follows:
If a gout patient experiences a gout attack during allopurinol, Uloric, or other uric acid lowering treatment, they are less likely to continue that treatment. In the world of professional medicine, there is strong focus on compliance, so the small risk associated with colchicine for a few months is outweighed by the reduction in risk from failing to maintain uric acid control.Personally, I believe that this should be resolved by clearer personal guidance and support from a doctor who has full access to medical records. In the absence of that access, I can only offer my view on the best compromise. Based on my experience, I suggest a month or two on colchicine to give the best chance of a pain-free transition from uncontrolled gout to controlled gout. I believe “month or two” is vague enough to constitute general advice, especially as this was given in the context of advice prior to full discussion with a doctor.
There is an equally valid view that says take colchicine only as required. I actually switched to this after about a month on daily preventive colchicine, but other people might not have the experience of pain control that I have.
One other point about colchicine before I get back to Uloric treatment. I strongly advise stopping colchicine completely if you have a bacterial or viral infection, or if you are likely to be exposed to one (e.g. if a family member gets infected). Under no circumstances combine colchicine with antibiotics.
What we all must keep focused on is the need to ensure that Uloric Treatment is as effective as it can be. That means maintaining uric acid at 5 in the longterm. During early months, I disagree with rheumatology recommendations that say you should increase dose until you achieve 5 or 6. I believe you should shorten the time it takes to “de-bulk urate” by maximum Uloric for a period of time agreed with your doctor. Your personal plan will have targets determined by the length of time you have had gout, together with your uric acid test results.
