Dosage And Intake Methods
The proper dosage for colchicine is described below :
- Oral use the initial dosage for gout flare is about 1.2 mg at the first signs of gout followed by a dose of 0.6 mg about one hour later. The dosage with strong CYP450 3A4 inhibitors is about 0.6 mg followed by 0.3 mg dose one hour later. The dose shouldnt be repeated earlier than 3 days. The dosage can also be 1.2 mg orally for one dose only. The dose can also be 0.6 mg for one dose only.
- Dosage for familial mediterranean fever the dosage is about 1.2 mg to 2.4 mg to be administered in 1 to 2 divided doses. The dose can be increased according to the specific needs. Sometimes you can develop tolerance to the drug. You shouldnt discontinue the drug at once in this case but the dosage should be decreased in increment of 0.3 mg/day.
- Dosage for gout the dosage is about 0.5 to 0.6 mg to be administered once a day for 3 to 4 days a week. Some severe cases require doses of 1 to 1.8 mg/day.
Colchicine Vs Allopurinol Which Is Better For Gout Treatment
Gout is a form of arthritis which that can affect anyone. It is characterized by swelling, redness, and tenderness in the joints as well as severe attacks of pain.
The CDC reports that more than 8 million people in the United States are affected by this condition every year. It is the most frequent form of inflammatory arthritis in men, but women also become more susceptible to this painful condition, especially after menopause.
The large joint at the base of the big toe is the most common site for a gout attack. It can also affect other joints including knees, ankles, fingers, wrists, and elbows.
A Drug That Does Exactly What It Says On The Tin The Story Of Allopurinol
If medicines were celebrities, the gout treatment allopurinol would never be on the A list for party invites. A low profile product for a historically embarrassing ailment, allopurinol is equivalent to the actor who is rarely out of work but is never the star. so it may come as a surprise that allopurinol emerged from a research programme that started at Burroughs Wellcome in the early 1940s and, ultimately, gave its pioneering biochemists, Gertrude B Elion and George H Hitchings, a share of the 1988 nobel Prize for Medicine or Physiology.
Allopurinol is a drug which seems to have always been around. It undoubtedly reduces uric acid levels and prevents acute attacks of gout, but its never been used very well. Its often prescribed in doses that are too low and patients dont stay on treatment for long enough. Many are embarrassed about having gout because its still linked to drinking too much port or eating a rich diet, explains Louise Warburton, shropshire GP with a special interest in rheumatology and musculoskeletal medicine, and president of the Primary Care Rheumatology society.
With gout on the increase1 and now considered the most common form of erosive arthropathy , the PCR society has recently joined forces with the British society of Rheumatology to press the national Institute for Health and Clinical Excellence to issue national guidelines on gout management. so allopurinol could well be in for a well deserved boost.
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Allopurinol Oral Tablets For Reducing Uric Acid Levels During Cancer Treatment
Allopurinol oral tablets are FDA-approved to reduce uric acid levels that may be high during certain cancer treatments. These cancers can include leukemia and lymphoma.
High uric acid levels during cancer treatment explained
Certain cancer treatments, such as chemotherapy, can cause tumor lysis syndrome . This is a rapid breakdown of tumor cells. TLS releases harmful substances into your blood, including more uric acid than usual. Allopurinol treatment helps prevent kidney damage that a high uric acid level can cause.
In addition to certain cancers, other medical conditions can affect uric acid levels. Your doctor can tell you more about why your uric acid levels may be high.
Effectiveness for reducing uric acid levels during cancer treatment
Clinical studies show that allopurinol oral tablets are effective for reducing uric acid levels during cancer treatment.
The American Society of Clinical Oncology recommends allopurinol within its guidelines for managing TLS.
Effects On Other Treatments
Some drugs interact with allopurinol, so you should discuss any new medication with your doctor before starting it. You should also tell anyone else treating you that youre taking allopurinol.
Do not use complementary treatments, such as herbal remedies, without discussing this first with your doctor or pharmacist. Some of them could react with allopurinol.
You should avoid taking aspirin while youre being treated for gout. If youre in pain, you can take paracetamol and NSAIDs. But remember you should only take one NSAID at a time so do not take another if you have already been prescribed one to reduce the effects of gout attacks.
Allopurinol can also react with drugs that are often prescribed for high blood pressure, such as bendroflumethiazide, indapamide, lisinopril, ramipril.
Allopurinol reduces the breakdown of azathioprine, which is used to treat conditions such as rheumatoid arthritis and lupus. Your doctor may change your dose of azathioprine to account for this.
It can also reduce the breakdown of the leukaemia drug mercaptopurine, so the dose of mercaptopurine will need to be reduced if you take this drug.
Allopurinol may also increase the risk of developing a rash if you take them with the antibiotics ampicillin or amoxicillin.
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Uricosuric Agents: Probenecid And Sulfinpyrazone
Probenecid and Sulfinpyrazone are used in gout therapy to help prevent further attacks of gout.
These drugs are not given during an acute gout attack but are primarily used to prevent recurrence after the acute attack of gouty arthritis has subsided.
They are, however, continued even during an acute attack if the patient is already taking them. These drugs help to prevent gout attacks but do not cure the gout attack. Required results are obtained in only 75% of the cases.
These drugs lower serum uric acid levels by increasing the excretion of uric acid through the urine. They thus prevent the formation of uric acid crystals in the joints.
These gout medicines are contraindicated
- in patients having kidney disease or stones in the genitourinary tract,
- in cancer patients who are on radiotherapy and/or chemotherapy,
- those on maintenance doses of aspirin.
How Do Xanthine Oxidase Inhibitors Work
Xanthine oxidase inhibitors are medications prescribed for the treatment of gout, a painful condition caused by excessive uric acid levels in the blood . Uric acid is a waste product from the metabolization of purine, an essential chemical compound in the body, also found in many foods. Cells use purine to make the building blocks of DNA and RNA.
Excess uric acid gets deposited as monosodium urate crystals in joints, bones, and soft tissues, inducing an immune reaction that results in inflammation and associated symptoms. Gout most commonly affects the big toes, but can also affect other joints such as ankles, knees, elbows, wrists, and fingers.
Xanthine oxidase inhibitors reduce uric acid production by inhibiting the activity of xanthine oxidase, an enzyme that synthesizes uric acid from hypoxanthine, a purine derivative. Xanthine oxidase inhibitors specifically inhibit xanthine oxidase, without affecting the purines vital for DNA and RNA synthesis.
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How Is It Taken
Allopurinol is taken as a tablet once a day. It is usually better to take it just after eating and the tablet should be swallowed with water. It is important to drink plenty of water during the day because this will help you get rid of more urate through your kidneys.
Your dose of allopurinol may change over time, depending on the amount of urate in your body. Your doctor will monitor your urate levels with blood tests every 2-4 weeks, until they are sure that the dose that youre taking is high enough to reduce the amount of urate in your body.
You may need to remain on a lower dose if you have kidney or liver problems.
Your doctor may recommend that you do not start taking allopurinol until after an attack of gout has passed to avoid triggering further attacks. If this is not possible, it may be started when your inflammation is not too bad.
Allopurinol doesnt treat the immediate pain caused by attacks of gout. But its a long-term treatment to get rid of the urate crystals which causes gout attacks.
It is likely that you will need to take allopurinol for the rest of your life to manage your urate levels. You should keep taking allopurinol even if:
- you are experiencing more gout attacks, or it doesnt seem to help the pain and inflammation at first
- you stop having gout attacks stopping your treatment can cause urate crystals to form again, which will lead to more gout attacks.
- etoricoxib
New Gout Drug Twice As Effective
Nov. 16, 2005 — A new treatment for gout is at least twice as effective at lowering uric acid levels as the standard drug allopurinol, according to results from the longest and largest trial of such drugs ever conducted.
The drug, , will likely be the first new agent available to treat gout in more than 40 years, says researcher Robert L. Wortmann, MD, professor and chairman of the department of rheumatology at the University of Oklahoma in Tulsa.
Exactly when the new drug will be approved is not known, but “personally I am optimistic,” he says.
The research was presented at the annual meeting of the American College of Rheumatology in San Diego.
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What Medications Are Similar
Other medications are sometimes prescribed instead of allopurinol to help lower uric acid levels in people with gout, such as Uloric and Benemid . These medications are given instead of allopurinol, not in addition to it.
Like allopurinol, febuxostat is a xanthine oxidase type of drug that lowers the amount of uric acid in your body. However, healthcare providers usually prefer to prescribe allopurinol. Although the science on this is evolving, research suggests that febuxostat might not be as safe as allopurinol, especially for people with existing heart problems. Additionally, allopurinol is less expensive.
Probenecid is another potential option. Some data suggest that it may be even safer than allopurinol in terms of heart attack and stroke risk. But it may not be a good choice if you have kidney disease.
Other drugs may be used in gout as well. For example, anti-inflammatory drugs, such as colchicine, can help prevent flares . They also reduce pain from any flares that do happen. These should be used in addition to a drug that lowers uric acid levels .
How To Take It
Swallow the allopurinol tablets with water, ideally after food. You’ll usually take it once a day, but if you’re on a high dose, your doctor may advise you to split the dose and take it twice a day.
If your doctor has recommended you take allopurinol with lots of fluid, try to drink 2 to 3 litres of fluids every day.
You can take allopurinol at any time of the day, however, try to take your doses at the same time of day each day.
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Spiros Take On Allopurinol
I admit I am one of those 80% plus gout sufferers who doesnt want to be stuck on this drug for the rest of my life and have experimented by fazing it out and stopping it completely twice already with 2 failed attempts. As I have this developed this blog in the quest for knowledge in defeating this disease, I have learnt from those 2 failed attempts and learned what triggered those past 2 attacks. I am moving forward though since my last attack in the fall of 2012 with 100mg allopurinol daily and dietary changes. Remember that my results are not indicative of what you may experience.
I am hoping to remove allopurinol sometime in the near future again, but not without my doctors permission. Why you ask? Its important to flush out all the crystals in your bloodstream and that can take up to a year, if not it may trigger another gout attack more easily. My plan also consists to not drink a drop of alcohol for a year after the withdrawal of allopurinol and not consume anything that carries high fructose. Mistakes that I paid for in my last 2 failed attempts since my body is personally more sensitive to alcohol and high fructose beverages and/or foods.
2. Roujeau JC, Kelly JP, Naldi L, Rzany B, Stern RS, Anderson T et al. . Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis. N Engl J Med333 : 1600
Mechanism Of Allopurinol Pharmacokinetics
The following steps take place after the intake of allopurinol :
1. Absorption
The peak plasma concentrations of allopurinol after 80 to 90 percent absorption are reached after 1.5 to 4 hours. The infusion takes place over 30 minutes and the peak plasma concentration of allopurinol is reached in about 30 minutes.
The serum urate concentrations in patients suffering from gout decreases slowly within 24 to 48 hours. The minimum concentrations may not reach for about one to three weeks. The substantial uric acid may be delayed up to 6 to 12 hours because of the continuous mobilization of the urate deposits.
People who suffer from geriatric disease have greater peak plasma concentrations and the allopurinol dosage in such patients is 50 to 60 percent higher than in young adults which is related to the renal function in older population.
2. Distribution
Allopurinol is uniformly distributed throughout the body except the brain where the concentrations are about 50% of the concentrations in other tissues. Allopurinol is distributed into the milk. Allopurinol isnt bound to plasma proteins.
3. Metabolism
Allopurinol is metabolized by xanthine oxidase and it is metabolized to an active metabolite known as oxypurinol.
4. Elimination
The drug is excreted through urine and feces as an unchanged drug within 48 to 72 hours. Allopurinol is dialyzable. The half-life of allopurinol is about 1-3 hours.
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Allopurinol Oral Tablets And Children
Allopurinol oral tablets may be used in some children. Dosing for allopurinol in children is based on factors such as the childs age and the condition being treated. Talk with your doctor if you have questions about your childs dose.
Allopurinol is used to reduce uric acid levels in children who are born with or develop some cancers or genetic disorders. These can include leukemia, lymphoma, and Lesch-Nyhan syndrome.
The allopurinol oral tablet dosage your doctor prescribes will depend on several factors. These include:
- the type and severity of the condition youre using allopurinol to treat
- other medical conditions you may have, such as kidney problems
- age
Typically, your doctor will start you on a low dosage. Then theyll adjust it over time to reach the amount thats right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.
The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.
Who Can And Cannot Take Allopurinol
Allopurinol can be taken by adults and sometimes children.
Allopurinol is not suitable for certain people.
Talk to a doctor or pharmacist if you:
- have ever had an allergic reaction to allopurinol or any other medicine
- are of Han Chinese, Thai or Korean origin
- have problems with your liver or kidneys
- currently have an attack of gout
- have thyroid problems
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How Do Antigout Agents Work
Antigout agents are medications prescribed for the treatment of gout, a painful arthritic condition caused by excessive uric acidin the blood that gets deposited as monosodium urate crystals in joints. Gout most commonly affects the big toes, but can also affect other joints such as ankles, knees, elbows, wrists, and fingers.
Antigout agents work in different ways to decrease uric acid production in the body, deposition of urate crystals in the joints, and the inflammatory response that results. Antigout agents work in the following ways:
- Reduce uric acid production by inhibiting the activity of xanthine oxidase, an enzyme that synthesizes uric acid from hypoxanthine, a purine derivative. Purine is a naturally occurring chemical compound in the human body and is also found in many foods.
- Facilitate the excretion of uric acid by blocking its reuptake in the kidneys.
- Controlinflammation by interfering with cellular functions that enable immune cells leukocytes and neutrophils to change shape, migrate to the joints, and release inflammatory substances in the effort to destroy the urate crystals.
Cautions With Other Medicines
Some medicines and allopurinol can interfere with each other and increase the chances of you having side effects.
Tell a doctor or pharmacist if you’re taking any of these medicines before you start taking allopurinol:
- aspirin or medicines used to thin your blood , such as warfarin
- any antibiotics
- medicines used to reduce your immune response
- tablets that make you pee more such as furosemide or ACE inhibitors to treat high blood pressure such as enalapril and ramipril
If you take aluminium hydroxide , leave a 3 hour gap between the aluminium hydroxide and your allopurinol dose.
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Other Uses For This Medicine
Allopurinol is also sometimes used to treat seizures, pain caused by pancreas disease, and certain infections. It is also sometimes used to improve survival after bypass surgery, to reduce ulcer relapses, and to prevent rejection of kidney transplants. Talk to your doctor about the possible risks of using this medication for your condition.
This medication may be prescribed for other uses ask your doctor or pharmacist for more information.