Do I Need Gout Medicine?

Doctor giving a medical prescription to male patient stock photo

If you have gout, your first flare probably came as quite a surprise.1 Maybe you went to sleep feeling fine, only to be awakened in the middle of the night by a big toe that was burning hot, tender and swollen.1 Although the redness, pain and swelling of the flare most likely went away eventually1, your memory of the episode probably did not. In the days and weeks following the flare, you may have asked yourself, “Do I need gout medicine?” or “What is the best medicine for gout?” Read on to find out more about gout medicine and how it may help if you suffer with the condition.

What is gout?

Gout is the most common form of inflammatory arthritis.2 It typically affects only one joint at a time (usually the big toe).3 The condition is caused by a buildup of uric acid in the bloodstream and can cause sudden, intensely painful episodes called gout flares or gout attacks.1,2 Gout affects more than nine million Americans, and typically strikes in middle age.1,4 It is more common in men than it is in women.4

 

What causes the pain of gout?

The body produces uric acid when it breaks down purines, which are chemicals in certain foods and drinks.1 Purines are naturally present in our bodies as well.1 When there is too much uric acid in the bloodstream, urate crystals can form in the body’s joints, fluids and tissues.1–3 These sharp, needle-like urate crystals can trigger the painful attacks you may know as gout flares.1–3

 

Why might I need gout medicine?

If you occasionally experience sudden, intensely painful gout attacks, you may need medicine to help you manage the condition.1 If left untreated, gout flares can start to happen more often and become more severe.1 You might also develop tophi, which are lumps of urate crystals that can form around a joint and actually become visible under the skin.1–3 

 

What kind of medicine is good for gout?

Two kinds of gout medicines commonly prescribed to help people manage the condition are:

  • Urate-lowering therapy (ULT)1—Allopurinol, which a specific type of ULT, can help to reduce the amount of uric acid in the bloodstream by preventing the body from making excess uric acid.1 Another kind of ULT, a medication called probenecid, can help to reduce the amount of uric acid in the bloodstream by helping the body flush it out in the urine.1 Other ULTs are available besides allopurinol and probenecid. Your doctor should know which ULT is best for you.
  • Anti-inflammatory medicine—A colchicine treatment such as Mitigare® Colchicine 0.6mg Capsules can help prevent gout flares by inhibiting the inflammation that can occur during these episodes.5 (Generic Colchicine 0.6mg Capsules are also available and may cost less, depending on your insurance coverage.) People with gout may use other anti-inflammatory medicines besides colchicine. Similar to ULT, your doctor should know which anti-inflammatory medicine is right for you.

 

Why might I need both ULT and an anti-inflammatory medicine?

ULT is effective because it reduces the amount of uric acid in the bloodstream.1 It is important to note, however, that ULT may trigger a gout flare—especially when a person is just starting it.6 This can happen when the reduction in the uric acid level in the bloodstream disturbs the urate crystals in a joint.6 This potentially higher risk of gout flares is why experts recommend that people with gout who are beginning treatment with a ULT start an anti-inflammatory medicine such as colchicine and continue taking anti-inflammatory medicine for at least three to six months during ULT treatment.7

 

What else should I do if I have gout?

In addition to medication, your doctor may also recommend lifestyle changes to help you manage your gout.1 These may include a low-purine diet, increased water intake and regular exercise.1 Be sure to visit your doctor for a check-up every six months and get your uric acid level checked at each visit.8 A healthy uric acid level is 6.0 mg/dL, so your doctor should be working with you to achieve this goal.8 While gout can be a lifelong condition, it may be controlled with a careful management plan and consistent care.8 

 

Mitigare® is a registered trademark of Hikma Pharmaceuticals USA Inc.

Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4. Combining these dual inhibitors with colchicine in patients with renal or hepatic impairment has resulted in life-threatening or fatal colchicine toxicity. Patients with both renal and hepatic impairment should not be given Mitigare®.

Fatal overdoses have been reported with colchicine in adults and children. Keep Mitigare® out of the reach of children.

Blood dyscrasias such as myelosuppression, leukopenia, granulocytopenia, thrombocytopenia and aplastic anemia have been reported with colchicine used in therapeutic doses.

Monitor for toxicity and, if present, consider temporary interruption or discontinuation of colchicine.

Drug interaction with dual P-gp and CYP3A4 inhibitors: Co-administration of colchicine with dual P-gp and CYP3A4 inhibitors has resulted in life-threatening interactions and death.

Neuromuscular toxicity and rhabdomyolysis may occur with chronic treatment with colchicine in therapeutic doses, especially in combination with other drugs known to cause this effect. Patients with impaired renal function and elderly patients (including those with normal renal and hepatic function) are at increased risk. Consider temporary interruption or discontinuation of Mitigare®.

The most commonly reported adverse reactions with colchicine are gastrointestinal symptoms, including diarrhea, nausea, vomiting and abdominal pain.

 

Please see the full Prescribing Information and Medication Guide for Mitigare® for complete product details.

 

NOTE: This article was not written by a medical professional and is not intended to substitute for the guidance of a physician. These are not Hikma’s 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.

References

  1. Gout/Symptoms & causes. Mayo Clinic website. Available at: https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897. Accessed December 8, 2021.
  2. What Is Gout? Gout Education website. Available at: "https://gouteducation.org/what-is-gout. Accessed December 8, 2021.
  3. Gout. University of Washington Medicine/Orthopaedics and Sports Medicine website. Available at: https://orthop.washington.edu/patient-care/articles/arthritis/gout.html. Accessed December 8, 2021.
  4. Chen-Xu M, et al. Contemporary Prevalence of Gout and Hyperuricemia in the United States and Decadal Trends: The National Health and Nutrition Examination Survey, 2007-2016. Arthritis Rheumatol. 2019 June;71(6):991-999.
  5. Mitigare® (Colchicine) 0.6mg Capsules [prescribing information]. Columbus, OH: West-Ward Columbus, Inc.; 2019.
  6. Aung T, Myung G, FitzGerald JD. Treatment approaches and adherence to urate-lowering therapy for patients with gout. Patient Prefer Adherence. 2017;11:795-800.
  7. FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res. 2020;72(6):744–760.
  8. Treatment and Monitoring. Gout Education Society website. Available at: https://gouteducation.org/recurring-gout/treatment-and-monitoring/. Accessed December 8, 2021.

Important Safety Information for Mitigare® (colchicine) 0.6 mg capsules

  • Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4. Combining these dual inhibitors with colchicine in patients with renal or hepatic impairment has resulted in life-threatening or fatal colchicine toxicity. Patients with both renal and hepatic impairment should not be given Mitigare®.
  • Fatal overdoses have been reported with colchicine in adults and children. Keep Mitigare® out of the reach of children.
  • Blood dyscrasias such as myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, and aplastic anemia have been reported with colchicine used in therapeutic doses.
  • Monitor for toxicity and if present consider temporary interruption or discontinuation of colchicine.
  • Drug interaction with dual P-gp and CYP3A4 inhibitors: Co-administration of colchicine with dual P-gp and CYP3A4 inhibitors has resulted in life-threatening interactions and death.
  • Neuromuscular toxicity and rhabdomyolysis may occur with chronic treatment with colchicine in therapeutic doses, especially in combination with other drugs known to cause this effect. Patients with impaired renal function and elderly patients (including those with normal renal and hepatic function) are at increased risk. Consider temporary interruption or discontinuation of Mitigare®.
  • The most commonly reported adverse reactions with colchicine are gastrointestinal symptoms, including diarrhea, nausea, vomiting, and abdominal pain.

Indication

Mitigare® is indicated for prophylaxis of gout flares in adults. The safety and effectiveness of Mitigare for acute treatment of gout flares during prophylaxis has not been studied.

Mitigare® is not an analgesic medication and should not be used to treat pain from other causes.

For Full Prescribing Information please CLICK HERE and for Medication Guide CLICK HERE.

You are encouraged to report negative side effects of prescription drugs to the FDA.

Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Manufactured by: West-Ward Columbus Inc., Columbus, OH 43228

Important Safety Information for Mitigare® (colchicine) 0.6 mg capsules

  • Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4.