Understanding Gout Flare Triggers

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If you’re like a lot of adults with gout, your first experience with the disease was probably very sudden.1 Perhaps you awoke in the middle of the night feeling like your big toe was on fire.1 After spending a sleepless night in excruciating pain1, you may have found yourself asking, “What caused this?”

 

Understanding gout and gout flares after a confirmed diagnosis

Gout is caused by hyperuricemia, which is the medical term for a buildup of uric acid in the body.1 The body makes uric acid when it metabolizes purines.2 Purines are chemicals found in many foods.2 They also occur naturally in our bodies.2 

Although that first gout flare probably caught you off guard, the level of uric acid in your bloodstream may have been rising for months or even years.1 When the uric acid in the bloodstream reaches a certain level, needle-shaped urate crystals can begin to form in the joints, causing the episode of redness, inflammation, and severe pain you may now know as a flare.2

 

Recognizing gout flare triggers

Gout flare triggers fall into two categories: medical/health triggers and lifestyle triggers.1

 

Medical/health triggers of gout can include2,3:

  • Joint injury
  • Surgery
  • Sudden, severe illness
  • Infection
  • Certain medications, including allopurinol or other urate-lowering therapy (ULT)
  • Chemotherapy
  • Radiation therapy
  • Sudden weight loss
  • Dehydration

 

Lifestyle triggers of gout can include2,3:

  • Eating purine-rich foods such as red meat and shellfish
  • Drinking alcoholic beverages
  • Drinking sugary beverages
  • Crash dieting and/or fasting

If you have gout and have experienced flares, you may recognize some of the gout flare triggers listed above. However, everyone is different and not every trigger will cause a flare in every adult with gout. For some, a gout flare up might be brought on by a steak dinner.1 Others might be more likely to suffer a flare if they become dehydrated.1

 

Talk with your doctor

If think you have had a gout flare, visit your doctor and talk about the symptoms you’ve been having. You may want to download and complete the Gout Flare Questionnaire (from Resources for Patients) before your appointment.

 

Medication is available

If you have gout and suffer with flares, medication may help. Colchicine, the active ingredient in Mitigare® (Colchicine) 0.6 mg Capsules and Generic Colchicine 0.6 mg Capsules, has been shown to help prevent gout flares in adults.4,5 In a six-month study, adults beginning allopurinol who took colchicine 0.6 mg daily had 82 percent fewer gout flares than those receiving placebo.5 The safety and effectiveness of Mitigare® for acute treatment of gout flares during prophylaxis has not been studied.4 Mitigare® is not an analgesic medication and should not be used to treat pain from other causes.4 The most commonly reported adverse reactions with colchicine are gastrointestinal symptoms, including diarrhea, nausea, vomiting, and abdominal pain.

Consider asking your doctor about treatment options that best meet your individual needs and can help prevent future gout flare ups.

 

Important Safety Information

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®.

Please see 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. Arthritis Foundation website. Gout Causes. Available at: https://www.arthritis.org/about-arthritis/types/gout/causes.php. Accessed February 5, 2019.
  2. Diseases and Conditions/Gout/Symptoms & causes. Mayo Clinic website. Available at: https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897. Accessed February 5, 2019.
  3. Penn State Hershey website. Gout. Available at: http://pennstatehershey.adam.com/content.aspx?productId=10&pid=10&gid=000093.
  4. Mitigare® (Colchicine) Capsules [prescribing information]. Columbus, OH: West-Ward Columbus, Inc.; 2018.
  5. Borstad GC, Bryant LR, Abel MP, et al. Colchicine prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis. J Rheumatol. 2004;31:2429–2432.

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. 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.