Anyone else with gout try Colchicine?
 

My Dr just put me on Colchicine for my acute gout flare-up I've been having for almost 3 weeks. My SUA is 4.3 while taking 300mg of Allopurinol a day, and I started the Colchicine at 2pm yesterday with 2 .6mg tabs, then one an hour until midnight (when I went to bed).

Without going into gruesome detail, the very, very unpleasant side effects are kicking my butt (literally) and this stuff feels like what chemotherapy must feel like. We were supposed to go to the pistol range and shoot our Colt 1903 and Remington 51, but I now doubt if I'll get our of my pajamas and robe, it's that bad!

The toe pain has subsided, but the Colchicine side effects are almost as bad as the gout. My Dr is concerned that my gout is this severe even considering my healthy lifestyle and low serum uric acid. I'm frustrated beyond belief and I'm beginning to lose my positive outlook.

Thanks for letting me vent.... I'm miserable today, really miserable...

Art,
That seems like an awfully high dose. Maybe the dosage is the source of your side effects. I have been taking one 0.6mg tab in the morning for about a year and no gout flare-ups since. Good luck with your treatment!

Best,
Tom

That sounds like the correct traditional dosage, Art. Take a loading dose, and then another tablet every hour (or was it 2 hours?) until the symptoms go away or you can't stand the side effects. Side effects being diarrhea.

My dad (internist) turned me onto another dosing regimen. Take just one colchicine per day, along with the normal daily allopurinol.

He showed me a study in which they had 3 groups: high dose colchicine, low dose colchicine, and placebo (no colchicine). In all 3 groups the patients also took allopurinol. The high dose colchicine was several tablets (can't recall the exact number, but it wasn't as much as the one tab every hour regimen). THe low dose colchicine was just one tablet per day. The placebo was obviously no colchicine.

They stopped the study because the low dose colchicine was as effective as the high dose, yet had fewer side effects. The authors didn't think it was ethical to continue the study and subject the high dose group to the continued higher side effects without added benefit. Interestingly the placebo group had GI side effects comparable to the low dose group. Anyway (for now) I'm sold on the low dosing regimen for acute gouty flares.

Sounds like you used a high dose regimen. About a year ago recommendations changed to a low dose regimen because of the side effects you have noted. The new low dose regimen is two tablets (1.2mg) then a single dose of one tablet an hour later.
Medical News: Low-Dose Colchicine Effective, Safe in Acute Gout - in Rheumatology, General Rheumatology from MedPage Today

I dose my dad this way when he flares up and he tolerates this regimen w/o any side effects. Since he usually waits to say anything until his hand is so swollen he can barely use it I continue one tab 2X a day for 2 or three days depending upon how his hand looks.

Dsclaimer: I'm not a rheumatologist nor did I sleep at a Holiday Inn last night.

Thanks guys! The dose I took was 1.2mg, than .6 every hour, but appatrently it was enough to cause the well-known side effects. My Dr may send me to a rheumatologist after some labs have been done (after the flare). She is concerned that my gout is so severe after lowering my SUA to 4.3 from 6.5 and eating a low fat, low sugar, no red meat or alcohol diet... Thanks for the good info here, I really appreciate it!

I'm taking my wife and daughter to the range today, the hell with the gout!!

Not a DIY project, but Tobra's recommendation for an intra-articular steroid injection has been a godsend for me. I consistently get 80-85% pain relief by the next day and wonder why I waited so long for it to be done.

I dont waste time with the colch, I go right to my GP and have him inject my toe. Sure the pain is massive for about 5 minutes but the pain from the gout is gone in a few hours.

I can't tolerate steroids, they cause kidney pain and my liver reacts badly, so that's not an option. My 24 hours of pure hell ended this AM and I'm trying to get back to "normal". My brother also has gout and I talked to him at my father's birthday party today and he also tried Colchicine and it had the same effect on him that it had on me.

I'll try the once daily Colchicine .6mg next weekend and see if that helps as my toe still hurts, it's about a 2-3 on a scale of 1-10, with 10 being the worst. I just drove 93 miles to my apt to start my work week and my clutch pedal did a number on my toe, so it's throbbing and sore right now...Aleve helps a little.

The steroid injection worked well for me as well, sorry you can't use it.

My doctor switched me to Uloric after I was still getting flares with the Allupurinol. It took a while for the flares to stop, but once they did I haven't flared in 6 months now. I'm sold on the Uloric, and zero side effects. Used Colchicine on big flares while I was on Allupurinol. Uric acid is down to 3.6, and I take 40 mg once a day.

Hope ya feel better soon, we all know how it feels....

Eric

i know what you are talking about with the coltricine but it works quicker for me than alipurnol when i first feel it coming on in any joint i take one of each pill but if you take too many coltricine in a short period you will be spending alot of time in the bathroom till you are cleaned out each episode is different most time a severe bout will take 3 to 5 days to recover from. a home remedy is to buy concentrated cherry juice and put 2 teaspoons in a 20 oz. soda bottle with water and drink it once a day. or eat cherries everyday. i see tv comercials about a new drug but have never tried it. they say men will get attacks as early as 30 years old and then continue to have attacks from then on. people who have never had it can not imagine the severe pain it gives you. if you get it in your ankle or knee you can not walk without crutches and it can come on overnight. one of the many problems with age. good luck regards tom

Good luck getting the stuff, we are almost out at work and cant seem to source any more...

I too am on Uloric, but like Art, my serum uric acid is low, and I'm sure like Art, blood work every 6 to 8 weeks:mad: and I gave up drinking close to 2 years ago..

Getting harder to find virgins these days, and I like mine over 20;) which makes finding good looking ones a real challenge:p

Been there, done that, and yes, it hurts like a MFer.....
I never thought that I would have to add crutches to my modes of transport, and my anklec(even though I'm on some other new drugs, along with the uloric) is acting up...

I don't have any negative reaction to colchicine. It works fairly well to stop flares, for me.

Unfortunately, due to my liver condition, I can't take Uloric. I drink tart cherry juice almost every day and I do not eat red meat, or high fructose corn syrup or fatty foods and I haven't had any alcohol at all in over 3 years. I only have fish or chicken once a week, no other meat at all, just fruit and veggies. I drink 3 liters of water a day and according to the Dr's I've seen "I'm doing everything right", which makes this even more frustrating.

I cannot possibly imagine going through another weekend like last weekend, I felt like I was in chemotherapy I was so sick. I can't live like that!

I'm trying the "1 Colchicine a day with 300mg Allopurinol" and see if that helps...

I have been reading these Gout threads with great interest, and I gotta tell you, this thing sounds AWFUL!! I am 46 and do not have Gout, thankfully!! I am just wondering why some people get it, and others don't. Will some people get it no matter what they do (like Art), and others NEVER get it, no matter what they do!!

I don't have anything to offer here, but wish you guys the best with this brutal suffering. Interested to learn more about the causes and ways to prevent EVER getting it.

Thanks,

JA

It's inherited, so it's passed down from generation to generation. My great aunt has it, my brother has it and my wife's father has it and I pray that our children don't develop this disease, which is a specific form of arthritis.

My wife's aunt and her family have rheumatoid arthritis and that can very bad, too!

I was on 300 Allupurinol, doc upped it to 600 last fall when flare ups increased.

Have a stiffness in my wrist that I'm close to sure is gout, been trying to tolerate a colchicine per day, but it tears me up.

I consume no red meat, very little alcohol.

Going to the doc tomorrow...

Hopeful we all recover from this terrible condition.

Art, I would be quite surprised if you had the liver or kidney issues you describe with an intra-articular injection of steroid(dexamethasone or whatever). I have seen issues you describe in systemic steroids, like oral prednisone, but the drug tends to stay where you put it, expecially if inside the joint. Hurts like a mother getting that shot, but the relief is very impressive, expecially with a little local anesthetic mixed in, which I usually do.

RA is way worse than gout IMHO. More accurately rheumatoid disease, because it is a connective tissue disorder, not just an arthritic process.

Colchicine is some nasty stuff, no doubt.

Tobra,
I had steroid injection in my foot for treatment of a Morton's Neuroma and it caused telangectasia, allergic reactions, etc.. and the Dr said "no more steroid injections". when given IM steroids, I had more systemic reactions, so I avoid them now... I'm on the 1st day of 300mg Allopurinol and .6mg Colchicine and we'll see if that works...

I started Colchicine .6mg a day, along with my Allopurinol 300mg yesterday and today I have no pain. I'm cautiously optimistic... Gout comes and goes, so I'll have to see if this new regimen helps.

Art,
I am on that same regimen. No pain, no side effects!
Gutes Besserung!

Tom,
Thanks, you're one of the reasons I've decided to try it. After my disastrous experience last weekend, I'm getting desperate for some relief! Thanks again!!

I have had a few episodes of gout..

Cannot imagine the pain of getting an injection of steroids into the joint.. a slight breeze over the toe is painful.. let alone trying to put a shoe on...sticking a needle in the joint and increasing the pressure.....

I can't imagine that sort of pain.... which is why I never went for the steroid injection..

Sour cherries work wonders for me...Amazing actually.. I can eat a few cherries, or down some extract, and relief is almost at hand..

Then again I don't have chronic gout.... an episode every few years, and I can pretty much predict when it will happen... If I "fall off the wagon" regarding my weight... diet... alcohol.. I run up the pounds..and then get that twinge in my big toe that lets me know I have two weeks of misery ahead of me..

The low dose daily Colchicine is making me sick, lots of nauseaand I feel like I'm being poisoned, so I am going to stop taking it and stick with daily Allopurinol by itself.

Sorry to hear that, Art. I hope the Allopurinol does it for you. It's nasty when the cure is as bad as the disease. Were you required to make any life-style changes?

I've made every lifestyle change possible to no avail. No red meat, no alcohol, no high fructose corn syrup, no fried foods, 3-4 liters of water daily, not overweight, etc... For almost 4 years and the gout has been unstoppable...

Sounds like you've done it all. No changes left to make.

Yep, my new Dr is concerned that my gout has not responded at all even with my SUA at 4.3, it's very strange...

Gout is a poorly treated disease, a study shows 65-70% of patients treated for gout with allopurinol and colchicine do not reach sUA < 6mg/dl and 60-65% still have flares.

There is another approved gout drug from Takeda, Uloric (febuxostat), that you could ask your doctor or a rheumatologist to consider. AFAIK, used to reduce sUA more effectively than allopurinol, no apparently improvement in flares, so not obviously a silver bullet for you, but your doctor may have more insight.

Regeneron is developing Arcalyst (rilonacept), specifically to reduce gout flares. Phase 3 trial showed patients on the drug had 73-80% fewer flares than patients on placebo. This drug is on the market already, as it is FDA-approved for a different (auto-inflammatory) disease. It will likely be approved by the FDA for gout in mid/early 2012, but you could ask your doctor to consider prescribing it off-label.

Go here for general Arcalyst info - REGENERON >Clinical Pipeline > Rilonacept IL-1 Trap

Go here for the press release on the latest of multiple phase 3 trials of Arcalyst in gout - Regeneron Pharmaceuticals, Inc. - ARCALYST® (rilonacept) Meets Primary and All Secondary Endpoints in Second Phase 3 Trial for Prevention of Gout Flares in Patients Initiating Uric Acid-Lowering Therapy - I assume you and your doctor will want to examine the liver safety signals, if any.

A third drug is being developed by Ardea, RDEA594. Phase 2 trials show significantly better sUA reduction and somewhat better flare control than allopurinol or febuxostat alone, but drug is still 1+ year from market.

I am no doctor, just an investor, so I follow new drugs in development but can't/don't give any actual medical advice. I don't know how conservative your doctor is, or if he/she follows pre-approval drugs and is interested in trying off-label uses. You sound like you're in significant pain.

Hang in there Art. We are thinking about you.

Jyl. Thanks for the valuable info, I'll research those mess!

Chris,
Thanks!

My last post should have been "meds" instead of "mess". I hate trying to post from the iPhone!

Funny, I didn't notice.

You seen this site?

Damn You Auto Correct! - Funny iPhone Fails and Autocorrect Horror Stories

That's funny! That auto-correct feature is horrible and I wish I could disable it!

There is a setting, General > Keyboard > Autocorrect ON/OFF

Thank you!!!

Major gout attack this week. I could barely drive yesterday and today I went to my Dr. she gave me a shot of Tramadol and a proscription for pills. She wanted to give me a steroid but I can't take those as I have a reaction to them. My SUA was 4.3 in February, so the Allopurinol is lowering that and that's good but we can't figure out why I'm in almost constant gout pain. I'm still taking 300mg of Allopurinol a day and I WILL NOT take Colchicine again!

She mentioned Uloric and a few other meds, but my liver specialist will have to give his permission 1st and he's very concerned about my liver enzymes and wants to keep them low.

My Dr gave me a referral to a rheumatologist since we're both out of ideas. Hopefully, the specialist will figure something out and help me. I'm in a lot of pain, but the shot helped and I take Aleve (naprosen) so I can walk around...

Wait, you are just now being referred to a Rheumatologist?

You should have been seeing a rheumatologist all along. Glad you are getting to one now, but for me anyway there has always been a substantial wait to get in as a new patient. When you call for an appointment, emphasize that you are having a severe flare right now - it may speed up the process. Print out the info I linked and bring w/ you, the rheumatologist may already be familiar w/ Arcalyst as it is on the market for a disease typcially treated by rheumatologists. Good luck, sorry about the pain.

Tobra,
Yep... The attitude about gout seems to be "just give them a steroid injection and tell them to avoid rich foods and alcohol"... My situation is a little different in that my liver specialist actively managed my gout until he was convinced that the Allopurinol and Colchicine wouldn't cause my liver enzymes to become elevated again. Once that was done, he said I should see my family doctor for the gout. This was my second visit to my new family doctor and she mentioned the referral right away, especially when I told her about my reaction to the Colchicine.

What I'm concerned about is that I'm having almost constant gout pain with frequent flare-ups, even with my SUA at 4.3. We're wondering if the gout is related to my liver condition ("atypical" NASH)... Hopefully, the rheumatologist will know what to do. There aren't any in my immediate area and it may take weeks to get in to see the specialist... The nurse who took care of me today has RA and she sees this specialist and speaks very highly of him.