Gout Pain Relief — Tips for Taking Allopurinol and Colchicine

By: | | Topics : About Gout, Gout Flare Prevention,

Whether you are newly diagnosed with gout or have been living with the disease for a while, chances are your doctor has recommended two gout medications:1

  • A urate-lowering therapy (ULT) such as allopurinol to reduce the amount of uric acid in your bloodstream 
  • An anti-inflammatory medicine such as colchicine to help prevent gout flares

Many doctors prescribe allopurinol for their patients with gout because it helps control uric acid, which is the root cause of the disease.1 But how exactly does allopurinol work? And why is it important to take an anti-inflammatory medication like colchicine when you first begin taking allopurinol?1 Read on for answers to these questions and more, as well as tips for taking allopurinol and colchicine for gout. 

The connection between gout and uric acid

As our cells die, they release compounds called purines.2 Purines can also be found in certain foods and beverages like beef, pork, shellfish, organ meats, beer and products sweetened with high-fructose corn syrup.2 Your body produces uric acid when it breaks down purines.3 Sometimes, the uric acid level in the bloodstream can become abnormally high.2 This can happen when either the body makes too much uric acid or the kidneys cannot remove enough of it.2 If the uric acid level in the body remains abnormally high for a long time, urate crystals can start to form around a joint.2 These crystals can trigger painful gout attacks.2

How allopurinol reduces uric acid

Allopurinol is a prescription drug that belongs to a class of medicines called xanthine oxidase inhibitors.4 Xanthine oxidase is an enzyme that helps your body make uric acid.4 Allopurinol helps decrease the amount of uric acid in your bloodstream by blocking this enzyme.4 A ULT medication like allopurinol is an important part of gout management for many people who suffer with the disease.5

How colchicine prevents gout flares

Many healthcare professionals agree that taking a ULT like allopurinol is the best way to manage gout long-term.1 However, it should be noted that gout attacks are not uncommon when a person first begins ULT.2 They can happen because the reduction in the uric acid level in the bloodstream achieved with ULT can disturb the urate crystals in the gouty joint.6 When these crystals are disturbed, they can trigger the sudden and intense pain, redness and swelling known as a gout flare.3,6 A colchicine medication like Mitigare® (Colchicine) 0.6mg Capsules or Authorized Generic Colchicine 0.6mg Capsules can help prevent gout flares by inhibiting the body’s response to this disturbance.1,7,8 

Gout Pain Relief is Possible

Tips for taking allopurinol

Most people who are prescribed allopurinol take it once or twice daily by mouth. Consider these tips for taking allopurinol:

  • Do your best to take your allopurinol around the same time(s) every day, preferably with a meal.9 
  • Drink at least eight 8-ounce cups of water each day while taking allopurinol unless your doctor instructs you otherwise.9
  • Continue to take your allopurinol as directed, even if you have a gout flare.10
  • If you forget a dose, take it as soon as you think of it. If it’s almost time for your next dose, skip the missed dose and continue your regular dosing schedule.9 Do not take a double dose to make up for the one you missed.9
  • Understand that it may take several months to achieve the full benefit of allopurinol.9
  • Have the uric acid level in your bloodstream measured every six months (or as often as recommended by your doctor).11

Tips for taking colchicine

Most people who are prescribed colchicine take it once or twice daily by mouth.8 Consider these tips for taking colchicine:

  • Take your colchicine around the same time(s) every day.
  • If you forget a dose, take it as soon as you think of it.8 If it’s almost time for your next dose, skip the missed dose and continue your regular dosing schedule.8 Do not take a double dose to make up for the one you missed.8
  • You can take colchicine with or without food, but do not eat grapefruit or drink grapefruit juice while taking colchicine.8

Regular medication updates are important

Be sure to keep your doctor up-to-date on all of the medications and supplements you take. Never start or stop a medicine without talking with your doctor first. Tell your doctor right away if you are experiencing bothersome side effects, continuing to suffer with gout flares, or are having other gout-related problems. 

 

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.

HK-2205v1

References

  1. 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.
  2. What Causes Gout? Gout Education Society website. Available at: https://gouteducation.org/what-causes-gout/. Accessed May 11, 2023.
  3. Gout/Symptoms & causes. Mayo Clinic website. Available at: https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897.html. Accessed May 11, 2023.
  4. Allopurinol tablets [prescribing information]. Congers, NY: Chartwell RX, LLC.; 2023.
  5. Gout Flare Triggers. Gout Education Society website. Available at: https://gouteducation.org/what-is-gout/gout-flare-triggers/. Accessed May 11, 2023.
  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. Latourte A, Bardin T, Richette P. Prophylaxis for acute gout flares after initiation of urate-lowering therapy. Rheumatology. 2014;53:1920-1926.
  8. Mitigare® (Colchicine) 0.6mg Capsules [prescribing information]. Columbus, OH: West-Ward Columbus, Inc.; 2019.
  9. Allopurinol. Medline Plus website. Available at: https://medlineplus.gov/druginfo/meds/a682673.html/. Accessed May 11, 2023.
  10. Treatment of gout flares. UpToDate website. Available at: https://www.uptodate.com/contents/treatment-of-gout-flares/. Accessed May 11, 2023.
  11. Uric Acid. Gout Education Society website. Available at: https://gouteducation.org/uric-acid/. Accessed May 11, 2023.

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

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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.