Talk With Your Doctor
Be sure to tell your doctor about all of the medicines and supplements you takeboth prescription drugs and over-the-counter products. Your doctor can tell you which medications can affect gout or raise your risk of gout flares, if any. Your doctor may also be able to recommend alternative treatments.
NOTE: This article was not written by a medical professional and is not intended to substitute the guidance of a physician. These are not West-Wards recommendations for gout flare prevention, but rather facts and data collected from various reliable medical sources. For a full list of resources and their attributing links, see below.
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How To Fight Gout Pain
Gout is an excruciatingly painful form of arthritis that often affects the feet. Dietary factors, such as red meat and alcohol, can trigger gout pain. However, medications and medical conditions can be a problem too, says Kenneth G. Saag, MD, a rheumatologist at the University of Alabama at Birmingham.”Non-food items are the major risk factors for developing gout,” he says. Here are nine such triggers, which could be causing your gout pain.
Why Ults Can Cause Gout Flares
As the ULT reduces the amount of uric acid in the bloodstream, urate crystals in the joints begin to dissolve.7 When the urate crystals start to dissolve, a gout flare can occur.7
The risk of ULT-related gout flares is highest in the first few months of treatment.36 However, certain medications may help prevent flares in gout patients who are beginning ULT.7
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Hospitalisation Essential For Suspected Overdose
If there is a high probability of colchicine toxicity, for example because of intentional overdose or dose in excess of 6mg in high risk patients, prompt admission to a facility with access to intensive supportive treatment is essential.
In overdose, early use of activated charcoal will minimise absorption. Repeated doses of charcoal will assist with the elimination of colchicine reabsorbed into the intestines through enterohepatic recycling. Diarrhoea should not be treated as it is the primary route of elimination. The period 24-72 hours after ingestion is critical and multisystem organ failure may occur. The key to patient management is full supportive care.
Serious toxicity with colchicine is an adverse reaction of current concern. Please report all New Zealand cases to the New Zealand Centre for Adverse Reactions Monitoring.
Dietary Changes To Minimize Medicines
Although gout may be inevitable for some, dietary and lifestyle changes may reduce gout flare-ups and reduce the needs for drugs. Certain foods, such as red meat, some seafood and alcohol, are known to contain high levels of purines, substances in plant and animal food that your body converts to uric acid. Bhatt recommends a vegetarian, low-purine diet to decrease the likelihood of gout attacks. Low-purine foods include low-fat non-fat dairy products, vegetables, nuts and grains. He also recommends that patients maintain a healthy weight, as obesity is associated with gout.
The Gout & Uric Acid Education Society also recommends limiting intake of fruits that contain a high level of fructose, a naturally occuring sugar, as well as cutting back on soft drinks, which contain high-fructose corn syrup. Fruits high in fructose include apples, grapes, peaches and pears. In addition, you should avoid cereals, ice cream, candy and fast food, as they can be high in sugar and salt.
As part of the long-running Nurses Health Study, researchers looked at the relationship between coffee consumption and the risk of gout in nearly 90,000 women over the course of 26 years. It found a reduced risk for women who consumed coffee, according to a 2010 study published in the American Journal of Clinical Nutrition.
Edwards says drinking cherry juice can decrease gout flare-ups, but patients who need a uric acid medication need to stay with it for life.
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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.
Children Younger Than 12 Years
Dosage should be based on weight. If the childs weight is not known, dosage should be based on age. When using either weight or age, use the following information:
- Children 60-95 pounds : 2 mg to start, then 1 mg after each loose stool that occurs after that. Dont take more than 6 mg per day.
- Children 48-59 pounds : 2 mg to start, then 1 mg after each loose stool that occurs after that. Dont take more than 4 mg per day.
- Children 29-47 pounds : Use Imodium only by the advice of your childs doctor.
- Children under 2 years: Do not give Imodium to children younger than 2 years of age.
Imodium is generally well-tolerated by many people. However, it can sometimes cause some side effects.
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How To Take Colchicine
- Before you start the treatment, read the manufacturer’s printed information leaflet from inside the pack. It will give you more information about colchicine and will provide you with a full list of the side-effects which you may experience from taking it.
- You must take colchicine exactly as your doctor tells you to. Most doctors will recommend that when a gout attacks starts, you should take one tablet 2-4 times a day until the pain eases. It is important that you do not take more than 12 tablets of colchicine as a course of treatment during any one gout attack. It is also important that you leave at least three days between courses of colchicine. If you find you are having frequent attacks of gout, please let your doctor know about this.
- If you have recently been prescribed a medicine to prevent gout attacks and you have been given colchicine to prevent a flare-up attack of gout, the usual dose for this is one tablet twice each day.
- Take colchicine tablets with a drink of water.
- If you forget to take a dose, take it as soon as you remember unless it is nearly time for your next dose, in which case leave out the missed dose. Do not take two doses together to make up for a forgotten dose.
What You Can Do
If you think your condition is getting worse, talk to your doctor. They will give you medicine to keep your uric acid levels low and to try to prevent future attacks and complications.
Allopurinol treats chronic gout by lowering the uric acid produced in your body.
also lowers uric acid production but would be used with caution if you are at risk for heart or blood vessel disease.
Once you start taking these medicines, youâll need to take them for life so that your uric acid stays at the right levels.
Probenecid and lesinurad help the body get rid of more uric acid in your urine. Pegloticase and rasburicase can break down uric acid into a substance that your body can get rid of. They are only for very severe gout that doesnât get better with usual treatments.
Scientists are also testing new treatments for chronic gout. At the same time, researchers are getting a better understanding of how the body makes and breaks down uric acid. Insights from this research could lead to new treatments in the future.
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Colchicine Side Effects And How To Avoid Them
If you are one of the 9.2 million Americans that have suffered from a gout attack this year, your healthcare provider may have prescribed an antigout medication named colchicine to help ease your symptoms. This medication has been around since the ninth century and remains a popular option for patients and healthcare professionals.
Colchicine is a U.S. Food and Drug Administration approved drug that is safe for use in both adults and children. It is a plant-based alkaloid from the autumn crocus and glory lily. Although most commonly used for gout management and prevention, the medication can also be used for the treatment of the genetic condition Familial Mediterranean Fever and helps to manage the symptoms of Behcets syndrome, pseudogout, and pericarditis.
Currently, colchicine can only be acquired by a prescription from a healthcare provider. There are many forms of colchicine available. It can be prescribed in either a capsule , tablet , or liquid form. It is important to note that colchicine cannot cure any of the medical conditions that it treats and is only used to manage symptoms. This medication also is not recommended for long-term use for pain management.
When Is Surgery Considered For Gout
The question of surgery for gout most commonly comes up when a patient has a large clump of urate crystals , which is causing problems. This may be if the tophus is on the bottom of the foot, and the person has difficulty walking on it, or on the side of the foot making it hard to wear shoes. An especially difficult problem is when the urate crystals inside the tophus break out to the skin surface. This then can allow bacteria a point of entry, which can lead to infection, which could even track back to the bone. Whenever possible, however, we try to avoid surgery to remove tophi. The problem is that the crystals are often extensive, and track back to the bone, so there is not a good healing surface once the tophus is removed. In some rare cases, such as when a tophus is infected or when its location is causing major disability, surgical removal may be considered.
Since it is hard to heal the skin after a tophus is removed, a skin graft may be needed. For this reason, we often try hard to manage the tophus medically. If we give high doses of medication to lower the urate level, such as allopurinol, over time the tophus will gradually reabsorb. In severe cases, we may consider using the intravenous medication pegloticase , since it lowers the urate level the most dramatically, and can lead to the fastest shrinkage of the tophus.
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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.
How To Take Allopurinol
Use Allopurinol exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.
Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.
Allopurinol oral is taken by mouth.
Take allopurinol oral with a full glass of water. To reduce your risk of kidney stones forming, drink 8 to 10 full glasses of fluid every day, unless your doctor tells you otherwise.
Take allopurinol oral after a meal if allopurinol upsets your stomach.
Allopurinol injection is given as an infusion into a vein if you are unable to take the medicine by mouth. A healthcare provider will give your first dose and may teach you how to properly use the medication by yourself.
You may need to mix allopurinol injection with a liquid in an IV bag. When using injections by yourself, be sure you understand how to properly mix and store the medicine. Ask your doctor or pharmacist if you don’t understand all instructions.
Prepare an injection only when you are ready to give it. Do not use if the medicine has changed colors or has particles in it. Call your pharmacist for new medicine.
You may need frequent medical tests. Even if you have no symptoms, tests can help your doctor determine if this medicine is effective.
Store at room temperature away from moisture and heat.
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How Long Does Medication
Medication-induced diarrhea can last for a few days , or as long as 3 to 4 weeks . Medication-induced diarrhea most often occurs right after starting a medication. Less often, a medication can cause diarrhea even if youve been taking it for a while.
If the diarrhea is caused by a medication, it tends to continue unless you stop taking the medication. In some cases though, diarrhea can resolve on its own.
Take Medication As Directed By Your Healthcare Professional
Do not take more or less of this medication without the guidance of your physician. Even small increases of colchicine can be life-threatening and may not improve symptoms. Taking colchicine will vary based on your age, the medical condition being treated, medical history, and how you react to the medication. If your symptoms are not improving, do not take more medication or take them for longer than recommended.
- Acute gout: When taking colchicine for an acute gout flare, usually larger doses are prescribed initially. The medication should be discontinued as soon as the pain has cleared up. If any acute symptoms of diarrhea, vomiting, nausea, or stomach pain occur, the medication should be discontinued immediately.
- Gout prevention: When taking colchicine for an extended time for gout prevention, smaller dosages will be given but for longer periods of time. This medication may be given in addition with other gout medications like allopurinol. Depending on other medical conditions that may need to be treated, colchicine may be prescribed for the rest of someones life. Close monitoring may be required in this scenario along with laboratory testing.
6. Monitor symptoms closely
Overdose of colchicine can be fatal. Contact your physician immediately if you notice any of the following:
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Supply Your Healthcare Provider With A Complete Medical History
Because colchicinetoxicity poses a higher risk for those with certain medical conditions, a complete history should be provided so that it can be determined if you are a good candidate to take this medication. Disclosure of liver disease, kidney disease, pregnancy, or if you are breastfeeding is important.
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Interactions That Increase Your Risk Of Side Effects
Taking colchicine with certain medications raises your risk of side effects from colchicine. Examples of these drugs include:
- Cholesterol drugs, such as atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin, fibrates, or gemfibrozil. Increased side effects can include serious muscle damage. Your doctor may reduce your dosage of colchicine to avoid this.
- Digoxin, an antiarrhythmic drug. Increased side effects can include serious muscle damage. Your doctor may reduce your dosage of colchicine to avoid this.
- Heart drugs, such as verapamil or diltiazem. Increased side effects can include stomach pain, constipation, diarrhea, nausea, or vomiting. Your doctor may reduce your dosage of colchicine to avoid these problems.
Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Colchicine oral tablet comes with several warnings.