If You Are Having Repeated Attacks See Your Doctor
Some patients can go a long time between attacks. In fact, for 62 percent of patients the next attack will be more than a year away, and some won’t have another attack in the next 10 years. However, if you begin to have more frequent attacks, talk to your doctor about escalating treatment. People think its normal to have flares every now and then, but its not. The gout can be doing damage to your joints. It means you still have too much uric acid, says Shakouri. In particular, ask about allpurinol. It wont help with an acute attack but will help prevent future attacks by reducing uric acid production.
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.
Ways To Deal With Painful Gout Attacks
Its difficult to focus on work or other daily activities when youre experiencing gout inflammation and pain. Symptoms can last for a few days or even weeks, with the worst pain usually occurring in the first day or two.
While the best thing to do is talk to your physician, there are several steps you can take right away ease your gout symptoms:
Excess uric acid in the bloodstream can lead to the formation of uric acid crystals in one or more joints, resulting in gout.Read:All About Gout – Symptoms, Diagnosis, Treatment
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Applying Ice To Affected Joints
Applying a cloth-covered ice pack to the joint can help reduce gout-related inflammation.
Try applying an ice pack wrapped in a thin towel for 1015 minutes at a time to help relieve pain.
If gout is affecting the feet, a person can also use a pack of frozen vegetables covered with a washcloth, as this may drape more easily over the feet.
Heightened stress can worsen a persons gout symptoms. While it is not always possible to eliminate all sources of stress, the following tips might help:
- exercising, such as taking a brief walk, if the pain does not limit movement
- asking for time off from work
- journaling or reading a favorite book
- listening to music
How And When To Take It
The usual dose of allopurinol is 100mg to 300mg a day. Follow your doctor’s advice on how many tablets to take, and how many times a day.
You’ll have regular blood tests to monitor your uric acid levels. If your uric acid level does not come down far enough, your doctor may increase your dose .
If you have kidney or liver disease, your doctor may prescribe a lower dose and will monitor you more closely.
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Warning Signs Of A Gout Flare
Some people with gout, also known as gouty arthritis, say an attack begins with a burning, itching, or tingling feeling in a joint maybe an hour or two before the flare-up starts. The joint may feel a little stiff or a bit sore. Not long after, the telltale signs of gout begin. If you get repeated attacks, you’ll learn your body’s signals that one is about to begin.
Sometimes, people with gout have no early signs that a flare is about to start. They may just wake up in the middle of the night with a very painful joint.
When the flare starts, most people have redness, swelling, and severe pain, usually in one joint. The most common place for gout is the base of the big toe, but it can happen in other joints such as the elbow, knee, wrist, ankle, and instep.
What Should I Do If I Forget A Dose
Take the missed dose as soon as you remember it. If you are taking colchicine on a regular basis and it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
However, if you are taking colchicine to treat an attack of gout that happened while you were taking colchicine to prevent gout attacks and you forget to take the second dose, take the missed dose as soon as you remember it. Then wait at least 12 hours before taking your next scheduled dose of colchicine.
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How To Use Colchicine Oral
Read the Medication Guide provided by your pharmacist before you start taking colchicine and each time you get a refill. If you have any questions regarding the information, ask your doctor or pharmacist.
Take this medication by mouth with or without food, exactly as directed by your doctor. Dosing recommendations vary widely and may be different from the following recommendations. Taking more than the recommended dose may not increase this drug’s effectiveness and may increase your risk for side effects. Ask your doctor or pharmacist for more details.
If you are taking this medication to treat a gout attack, carefully follow the directions given by your doctor. This medication works best if you take it at the first sign of an attack. The recommended dose is 1.2 milligrams at the first sign of an attack, followed by 0.6 milligrams one hour later. The maximum recommended dose is 1.8 milligrams taken over a 1-hour period. Ask your doctor ahead of time about how soon you can repeat treatment with this medication if you have another gout attack.
If you are taking this medication to prevent gout attacks or for pericarditis, ask your doctor about the dose and schedule you should follow. Carefully follow your doctor’s directions.
If your doctor directs you to take colchicine regularly, use it regularly to get the most benefit from it. To help you remember, take it at the same time each day.
How Should This Medicine Be Used
Colchicine comes as a tablet and solution to take by mouth with or without food. When colchicine is used to prevent gout attacks or to treat FMF, it is usually taken once or twice a day. When colchicine is used to relieve the pain of a gout attack, one dose is usually taken at the first sign of pain and a second, smaller dose is usually taken one hour later. If you do not experience relief or have another attack within several days after treatment, talk to your doctor before taking additional doses of medication. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take colchicine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
It is important to use an oral syringe to accurately measure the correct amount of liquid for each dose do not use a household spoon.
If you are taking colchicine to treat FMF, your doctor may start you on a low dose and gradually increase your dose. Your doctor may decrease your dose if you experience side effects.
Colchicine can prevent attacks of gout and control FMF only as long as you take the medication. Continue to take colchicine even if you feel well. Do not stop taking colchicine without talking to your doctor.
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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.
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.
What Other Information Should I Know
Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your response to colchicine.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
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What If I Forget To Take It
If you take allopurinol:
- once a day take the missed dose as soon as you remember. If you do not remember until the following day, skip the missed dose.
- twice or more a day – if you do not remember until your next dose is due, skip the missed dose and take the dose that is due.
Never take a double dose to make up for a missed dose.
If you often forget to take your medicines, it may help to set an alarm to remind you. You could also ask a pharmacist for advice on ways to help you remember to take your medicines.
What Is The Fastest Way To Get Rid Of Gout
- Nonsteroidal anti-inflammatory drugs : These can quickly relieve the pain and swelling of an acute gout episode. They can shorten the attack, especially if taken in the first 24 hours.
- Corticosteroids: These drugs can be taken by mouth or injected into an inflamed joint to quickly relieve the pain and swelling of an acute attack. Corticosteroids usually start working within 24 hours after they are taken.
- Colchicine: An anti-inflammatory medicine that works best if taken within the first 24 hours of a gout attack.
Medications for reducing uric acid levels: These are usually prescribed after an acute attack ends to reduce uric acid levels in the body to prevent future attacks.
- Colchicine: Regular and low doses of colchicine may be given along with other medications below to prevent flare-ups.
- Allopurinol: It reduces uric acid production in the body.
- : It reduces uric acid production in the body.
- Probenecid: It acts on the kidneys to help eliminate uric acid.
- Pegloticase: This is a medication that is injected every 2 weeks. It reduces uric acid quickly and used when other medications fail.
Lifestyle and home remedies to treat acute gout and can prevent recurrent attacks:
- Limiting or avoiding alcohol consumption and drinks sweetened with fructose
- Limiting intake of foods high in purines, such as red meat, organ meats, and seafood
- Drinking plenty of fluids
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Medicines To Prevent Recurrent Gout Attacks
If you have repeated attacks of gout, your doctor may recommend preventive medication. This helps to prevent further attacks of gout and damage to your joints and organs such as your kidneys.
Because gout is caused by raised uric acid levels in the blood, preventive medications work by reducing uric acid levels. This is also called urate lowering therapy.
The goal of these medicines is to reduce the uric acid levels below 0.36mmol/L. If the uric acid level is kept at this level long-term, the gout crystals will dissolve, and the risk of gout attacks and joint damage from gout will gradually reduce. The options include:
What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture .
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
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Medicines For Gout Attacks
The main goal of treatment during a gout attack is to decrease pain and swelling. Some medicines are safe for people with kidney disease, and some are not. Talk to your doctor about which medicines make the most sense for you to try.
Nonsteroidal anti-inflammatory drugs
NSAIDs are medicines that decrease pain and swelling. Some NSAIDs are available over the counter, like ibuprofen and naproxen sodium. Stronger NSAIDs like indomethacin and celecoxib must be prescribed by a doctor.Taking NSAIDs can lead to kidney disease in time or make kidney disease worse. NSAIDs may not be recommended when you have kidney disease even for the treatment of gout attacks.
Colchine is a medicine that can relieve pain. Your doctor may recommend taking colchine during a gout attack, or low doses of colchine every day if you have chronic gout. Colchine may not be recommended for people with kidney disease. Talk to your doctor about whether colchine is right for you.
Corticosteroids, also known as steroids
Steroids are strong medicines used to decrease swelling and pain. Steroids are usually only given for gout if you cannot take NSAIDS or colchine. Steroids can be taken as a pill or given as an injection. Talk to your doctor about whether steroids are safe for you.
Who Can And Can’t Take Colchicine
Colchicine can be taken by most adults aged 18 and over.
It can sometimes be prescribed for children by a specialist doctor.
Colchicine is not suitable for some people. To make sure it’s safe for you, tell your doctor if you:
- have ever had an allergic reaction to colchicine or any other medicines
- have a severe blood disorder
- have severe kidney or liver problems
- have problems with your heart or digestive system
- are pregnant, think you might be pregnant or are trying for a baby
Women who could become pregnant will usually only be prescribed colchicine if they are using suitable contraception.
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Important Information About All Medicines
This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.
If you buy any medicines ‘over-the-counter’, always check with a pharmacist that they are suitable for you to take alongside your other medicines.
If you are having an operation or any dental treatment, tell the person carrying out the treatment which medicines you are taking.
Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.
If you have any questions about this medicine ask your pharmacist.
Take Caution With Supplements For Gout
As for the many supplements and other purported home remedies available for gout, including turmeric and bromelain, there is no significant evidence backing them up as of now, and theres no adequate evidence showing that supplements have any effect even comparable to that of medicines.
From my point of view, says Dr. Fields, the home remedy concept to gout is often harmful because it keeps patients from taking medications that we know are effective.
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How To Prevent Gout Flare
In addition to taking specific medications, there are a few things you can do to prevent recurrent gout:
- Limit your intake of alcoholDiscuss with your doctor the appropriate amount of alcohol, if any, that is safe for you. Studies show that alcohol, especially beer, and sugary drinks link to an increase in gout symptoms, so try to limit consumption of these whenever possible.
- Maintain a healthy weightConsume healthy meal portions, exercise regularly, and avoid fasting or crash diets.
- Drink plenty of waterThe guideline is to drink at least eight glasses of water a day and limit your intake of beverages with high fructose levels.
- Limit your intake of meatEating high-purine foods, such as veal, venison, liver, fish, and scallops can increase your uric acid levels and lead to a gout attack.
- Eat more low-fat dairy foodsThese can be alternatives to some of the protein youre getting from meat.