Should I Take Allopurinol or Colchicine to Prevent Gout Attacks?

allopurinol

If you have gout, your friends and family members probably try to give you all kinds of advice:

“Drink more water.”

“Stay away from red meat and shellfish.”

“Get some exercise.”

But what about medication? Some people might want to know if you’re taking urate-lowering therapy, or ULT. Others may ask if you’re taking colchicine. If your friends or family members have asked you these questions, maybe you’ve started to wonder, “Should I take allopurinol or colchicine to prevent gout attacks?” The answer may be yes. Read on to find out why.

 

 

 

The cause of gout attacks

Gout, a condition caused by excess uric acid in the bloodstream, can cause sudden, intensely painful episodes called attacks, or flares.1 Although attacks typically come on suddenly, the process that leads up to them can be very gradual.2 When the uric acid level in the bloodstream remains high for an extended period (months, years—even decades), sharp, needle-like urate crystals have an opportunity to slowly grow around certain joints.1,2 At some point (typically in the middle of the night), perhaps during a period of intense stress or after a steak dinner where you shared a bottle of wine, these crystals can trigger an excruciatingly painful gout flare.1

 

How allopurinol can help

Allopurinol is a medication known as a urate-lowering therapy (ULT).3 It works to treat gout by reducing the amount of uric acid in the bloodstream.3 Allopurinol achieves this by limiting the amount of uric acid your body makes.3 Although other types of ULT are available, the medical community considers allopurinol and other drugs that work like it (such as febuxostat) to be the standard of care for reducing uric acid levels in people with gout.3

 

An unexpected gout flare trigger

Ironically, the start of treatment with allopurinol is associated with an increased risk of acute gout flare.3 It is suspected that the initial reduction in uric acid level that occurs after the onset of treatment may cause urate crystals around the joints to trigger a gout flare.3 This increased risk of flares could be the reason why more than half of people with gout stop taking ULT within 12 months of starting treatment.3 After the first year of treatment, however, the risk of attacks tends to decrease.3 Furthermore, gout flares resulting from ULT are extremely rare after five years of appropriate therapy.3

 

How colchicine can prevent gout flares

A colchicine therapy such as Mitigare® (Colchicine) 0.6mg Capsules or Generic Colchicine 0.6mg Capsules) is an important part of the flare prevention plan, especially for people starting ULT.3 Colchicine is one of the most frequently used drugs for preventing the inflammation associated with acute gout flares.4 It helps to prevent the swelling, redness and pain you experience during a gout flare by blocking the immune system’s response to the gout crystal disturbance caused by the reduction of uric acid in the body.3,5 According to gout management guidelines from the American College of Rheumatology, flare prevention with a drug such as colchicine should continue for a minimum of three to six months after the start of ULT.6

 

Regular gout doctor visits are important

If you have gout and regularly experience gout attacks, visit your doctor every six months and have your uric acid level checked at each appointment.7 A healthy uric acid level is usually at or below 6.0 mg/dL, so your doctor should work with you to get your number around that level or lower.7 If you are not taking medication, be sure to ask your doctor how allopurinol and a colchicine therapy like Mitigare® (Colchicine) 0.6mg Capsules or Generic Colchicine 0.6mg Capsules) might be able to reduce your risk of flares.5

 

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

 

Colchicine 0.6mg 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 February 1, 2021.
  2. Gout Symptoms. Gout Education Society website. Available at: https://gouteducation.org/what-is-gout/symptoms/. Accessed March 31, 2021.
  3. Tilleman JA, DeSimone EM, McAuliffe R. Urate-Lowering Therapy for the Prevnetion and Treatment of Gout Flare. US Pharm. 2017;42(3):33–37.
  4. Latourte A, Bardin T, Richette P. Prophylaxis for acute gout flares after initiation of urate-lowering therapy. Rheumatology. 2014;53:1920-1926.
  5. Mitigare® (Colchicine) 0.6mg Capsules [prescribing information]. Columbus, OH: West-Ward Columbus, Inc.; 2019.
  6. Clinical Practice Guidelines. American College of Rheumatology website. Available at: https://rheumatology.org/Practice-Quality/Clinical-Support/Clinical-Practice-Guidelines. Accessed January 14, 2020.
  7. Treatment and Monitoring. Gout Education Society website. Available at: https://gouteducation.org/recurring-gout/treatment-and-monitoring/. Accessed March 31, 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.