Which is Better for Gout, colchicine or allopurinol

Which one will it be, colchicine or allopurinol?

Gout is a condition that can cause excruciating and unbearable pain in the upper extremities and the feet. If you’re suffering from gout, it’s important to understand which type of medication is best for you.

Colchicine and allopurinol are two different types of medications that may be helpful for people who have a gout flare episode. Understanding both will help you make intelligent choices.

What are Gout Flares?

Gout flares are an episode of the excruciatingly painful and debilitating inflammatory arthritis known as gout. Gout flares typically affect just one joint, although they might, on occasion, affect two or more joints.

When a flare occurs, the objective of treatment is to end the pain and incapacity as quickly and safely as possible.

A gout flare is triggered by high uric acid levels in your blood, which results in acute gout attacks. The intense pain caused by acute gout flares is a result of the buildup of uric acid crystals in your joints.

Colchicine or Allopurinol?

Colchicine or allopurinol are two popular drugs to treat gout flares.

However, there are many misconceptions about colchicine or allopurinol. For example, many people think colchicine lowers uric acid levels in the body. It does not.

Many people also think that allopurinol is a pain reliever that quickly relieves pain. That is a myth and untrue.

The reason I am writing this article is to shed light on these common misconceptions of colchicine or allopurinol with the hope that understanding gout will lead to a pain-free life.

What is Colchicine?

Colchicine relieves pain in the afflicted joint by lowering swelling and the growth of uric acid crystals (s).

The medication, which is derived from the Colchicum autumnale, has been used to treat joint swelling since 1500 BC, but it wasn’t until 1961 that colchicine for acute gout received medical approval in the United States

You may wonder what is colchicine used for besides gout. Before going any further, be warned that colchicine is not a pain reliever. In addition to curing acute gout, flares, and Behçet’s illness, it is also used to control conditions like pericarditis and familial Mediterranean fever.

With colchicine, overdosing is a considerable problem due to its narrow therapeutic index.

Gastrointestinal upset is one of colchicine’s typical side effects, especially at high doses. Low blood cells and rhabdomyolysis are two severe adverse effects that may occur, and an overdose of the drug can be fatal.

Although it’s uncertain if colchicine is safe to take when pregnant, it seems to be safe to take while breastfeeding.

 

What is Allopurinol?

Allopurinol is a drug used to lower elevated blood uric acid levels; it is not a pain reliever. It is primarily used to avoid gout, certain kinds of kidney stones, and excessive uric acid levels that can come with chemotherapy. It can be ingested or administered intravenously.

Itching and redness are frequent adverse reactions when taken by mouth. When administered by injection, nausea and renal issues are frequent side effects.

In the United States, allopurinol received medical approval in 1966.

Allopurinol is seen to be quite safe to take for a very long time, according to the nhs.uk website. Any long-term effects are unlikely to occur.

Colchicine for Gout

Will colchicine stop a gout attack? In most instances, yes. If it doesn’t, you must see a doctor right away to prevent harm to your joints and overall health of your body.

How long does colchicine take to work on gout? Gout attacks can be efficiently treated with colchicine within the first 36 hours of the gout episode. Unfortunately, how fast does colchicine work for gout is an issue because it can take up to 24 hours for it to start working properly.

If you can’t use NSAIDs and need to treat your gout, consider colchicine is an alternative.

“NSAIDs” is an abbreviation for “nonsteroidal anti-inflammatory medications.” Ibuprofen, naproxen, and diclofenac are three examples of NSAIDs.

The colchicine dose for attacks seems to be well taken in small dosages, and it may lessen gout pain and symptoms (1.2 mg in one hour, followed by 0.6 mg an hour later).

The effectiveness of colchicine for treatment in low dose may be comparable to that of NSAIDS, but adverse effects such vomiting, nausea, and diarrhea can develop with higher doses.

Dose of Colchicine for Gout

There is preliminary evidence that daily colchicine (0.6 mg twice daily) may be useful for long-term gout prevention of gout attacks when used with allopurinol to lower the risk of elevated uric acid levels and acute flares. However, it should be noted that adverse gastrointestinal symptoms may occur.

According to the website medsafe.govt.nz, when treating an acute gout attacks, the recommended maximum dose of colchicine is 6 mg (10 tablets). Colchicine should be taken at an initial dose of 1.2 milligrams, and then one tablet should be taken every two hours after that.

Colchicine should be taken at an initial dose of 1.2 milligrams, and then one tablet should be taken every two hours after that. In individuals who are over the age of 65, weigh less than 50 kilograms, or have a preexisting condition that affects either their kidneys or livers, an alternative treatment method or a maximum dose of 3 milligrams of colchicine should be utilized.

When a patient has signs of an overdose, they should be taken to a place that provides critical life support services.

Recent research has shown that it is possible to take a lethal amount of colchicine before experiencing any relief from the symptoms of gout or producing diarrhea.

Because of this, the recommendations for how much colchicine to take have been changed.

6mg maximum dose in acute gout

The medsafe.govt.nz website continued by stating that a starting dose of 1.2 milligrams (two 0.6 milligram tablets) of colchicine is now recommended in the approved dosage instructions for the treatment of acute gout.

Then, one tablet is given every two hours until the pain is gone or until diarrhea or other stomach problems start to show up. The maximum dose is 6 milligrams, which is 10 tablets.

3mg maximum dose for at risk individuals

Other treatments, such as a non-steroidal anti-inflammatory agent (NSAIA) or high dose (20-40mg) short-term oral prednisone or prednisolone, should be considered for elderly patients, patients weighing less than 50 kilograms, and patients with renal or hepatic impairment.

These patients should be treated with caution. In the event that these patients are prescribed colchicine, the most cumulative dose that should be given is 3 mg.

The medsafe.govt.nz clearly stated that it is not recommended to repeat the intensive regimen for at least three days.

According to medsafe.govt.nz, it is not recommended to resume a rigorous course of colchicine treatment until there has been a break of at least three days between the individual treatments.

On the other hand, maintenance therapy, which consists of taking one tablet every day, can be started the day after an acute episode has been treated.

Let me reiterate that the purpose of this article is to provide information. You must consult your doctor about medication.

Colchicine Generic Name

Colchicine is the generic name of the drug and is sold under various brand names. Some of the popular brands of colchicine are Colcrys, Gloperba, and Mitigare in the United States. 

According to the website www.tctmd.com, colchicine costs only 26 cents per pill in Canada which is why cheaper compared to the prices in the United States where it is sold at $4 to $6 per tablet.

How Long Does Gout Last with Colchicine

Colchicine will alter the function of your white blood cells, and this contributes to a reduction in inflammation. After around 30 minutes to 2 hours, colchicine may begin to show its effects.

On the other hand, it is possible that it will be at least two days before you notice that the inflammation and discomfort in your body are beginning to improve.

Gout cannot be cured with colchicine, although taking it regularly can help prevent future accute gout flare episodes. When there is an abnormally high concentration of uric acid in the blood, gout can develop.

When uric acid in a joint creates inflammation (which is characterized by pain, redness, swelling, and heat), a gout attack will ensue.

It is important to keep in mind that colchicine is not a typical painkiller and will not alleviate the majority of types of pain.

Alternative to Colchicine for Gout

While there is no certain cure for gout, there are a few home remedies that may help alleviate symptoms quickly.

However, if the pain is severe, abrupt, or getting worse, you should see a doctor immediately.

Analgesics are available without a prescription.

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) and naproxen (Aleve) can help relieve the pain and swelling that come with gout.

There could be a delay of up to 24 hours before you feel any improvement.

Applying a topical rub to the painful and swollen areas

Aspercreme, or one with capsaicin or other calming ingredients, can help with the pain and swelling.

Ice the injured joints until the pain subsides.

Applying ice to the affected area is one of the simplest and natural ways to relieve inflammation during a gout attack.

Applying ice to the region may also help dull the discomfort.

Get enough fluids in your system.

While this probably won’t help right away, research has linked dehydration to the formation of urate crystals.

Uric acid crystals may be eliminated through urination.

Some preliminary studies suggest that reducing the frequency of gout attacks can be achieved by drinking plenty of water in the 24 hours prior to an attack.

Pharmaceutical Medication

Used for a short period of time, corticosteroids such as prednisone or methylprednisolone may also be beneficial.

While there are concerns over the long-term effects of corticosteroid use, their use for shorter periods of time is generally safe.

If your gout symptoms are severe and you have tried over-the-counter and home treatments without success, it may be time to contact a doctor about the possibility of a prescription medication.

Avoid Grapefruit if Taking Colchicine

By raising the amount of colchicine in your body, grapefruit and grapefruit juice may intensify the effects of this medication. While taking this medication, you shouldn’t consume grapefruit or grapefruit juice because doing so would be equivalent to taking an overdose.

Suggested reading: (Colchicine) Colcrys Side Effects- Its Improper Use Can Be Deadly”

Allopurinol for Gout

Allopurinol is not a pain reliever. Allopurinol is used to lower elevated blood uric acid levels. It is primarily used to avoid gout, certain kinds of kidney stones, and excessive uric acid levels that can come with chemotherapy.

In tablet form, it can be swallowed or administered intravenously.

Allopurinol was approved for use in the United States in 1966 and is listed as one of the essential medicines by the World Health Organization. 

With more than 15 million prescriptions written in 2019, it was the 43rd most prescribed drug in the US.

Itching and redness are frequent adverse reactions when taken by mouth. When administered by injection, nausea and renal issues are frequent side effects.

Allopurinol looks to be safe to begin taking during a gout episode, despite it not traditionally being advised. It should be continued even during an acute gout attack in patients who are currently taking the drug.

Although it doesn’t seem to be harmful, usage during pregnancy hasn’t been thoroughly researched. The class of drugs known as xanthine oxidase inhibitors includes allopurinol.

How Effective is Allopurinol for Gout?

The drug allopurinol is very good in lowering uric acid levels.

Depending on sex, uric acid levels can differ. For women, the normal ranges range from 1.5 to 6.0 milligrams/deciliter (mg/dL) and for men, 2.5 to 7.0 mg/dL.

The good news is that research on these drugs revealed that the majority of participants were able to reduce their uric acid levels to below 6.5 mg/dL.The majority of doctors think that using these drugs can successfully stop gout problems.

However, the research didn’t examine that enough.

Therefore, it is impossible to predict precisely what gout sufferers can anticipate from long-term treatment with these drugs, such as how frequently gout attacks can be prevented or how effectively the medicines can prevent joint deterioration.

Gout Attack While Taking Allopurinol?

Does Allopurinol Cause Gout Flare? Taking colchicine with allopurinol has been an issue I have come across.

There is a common misconception that allopurinol causes gout, and I think this misconception is based the experience of a gout flare getting worse before it gets better.

Allopurinol does not work instantly, and the drug is not a pain reliever.

What the drug does is lower the uric acid level in the body. It may take several days, if not weeks, to reduce the level of uric acid. You may have more gout attacks for some time after starting allopurinol.

How Long Should You Take Allopurinol for Gout

It depends on a variety of factors how long one should take allopurinol, and one shouldn’t self-medicate. A patient’s condition should always be evaluated by a doctor.

To put it simply, there is no one size fits all when it comes to drugs. To manage their uric acid level and stop gout attacks, however, many gout patients take allopurinol for an extended period of time as a maintenance drug.

Stop Allopurinol During Gout Attack?

Although it has been suggested that those who are on allopurinol and colchicine should cease taking one or the other, I haven’t come across any articles that support this.

Colchicine is used to reduce uric acid crystals in order to relieve discomfort. Both medications work well together because the goal of allopurinol is to lower uric acid levels in the body.

Gout affects more than eight million people in the United States today. If you fall within this category, your doctor may have advised you to take an allopurinol-based urate-lowering medication (ULT).

Allopurinol reduces uric acid production in the body, which can help to prevent gout flare-ups.

But allopurinol is only one component of the treatment. In addition to colchicine, your doctor might advise it if you take allopurinol.

Allopurinol and colchicine, or another anti-inflammatory drug, are frequently used by individuals with gout as part of a therapy plan for gout flare prevention. Ask your doctor what is best for you.

Which is Better for Gout Colchicine or Allopurinol?

Both colchicine and allopurinol help alleviate gout pain and may even prevent disabling acute gout flare attacks from occurring again. It is important to be aware that both medications serve different purposes to avoid gout attacks.

The evidence is clear that colchicine and allopurinol work like a team, and if your doctor tells you to take it, it is best to follow medical advice and not self-medicate.