Health Tips

Having a gout flare again? Colchicine to the rescue! Colchicine is one of the commonly used medications in gout. 

Image credit: https://creakyjoints.org/about-arthritis/gout/gout-symptoms/gout-flare-up/

In this article, we outline a few important facts about colchicine.

Colchicine treatment regimen

Colchicine is mainly used in gout for two purposes: preventing gout flare during initiation of urate-lowering therapy and treating gout flare when it happens. 

Preventing gout flare during initiation of urate-lowering therapy

A person who is about to start urate-lowering therapy for gout (take medication such as allopurinol), there is a higher chance that acute gout attack may happen during that initiation period. 

That’s because studies have shown that reducing urate level too fast may actually precipitate gout attack. Therefore, doctors would usually prescribe painkillers or colchicine for patients during initiation of urate-lowering therapy, just in case they develop gout attack. The dosage usually goes by 0.5mg of colchicine tablet (1 tab) once or twice daily.

Treating gout flare

When a gout flare happens, colchicine is usually taken as 0.5mg twice to four times daily. Make sure you take plenty of fluids while taking colchicine to prevent dehydration.

Image credit: https://imed2.github.io/HTML/Ubat/Colchicine.html

How does colchicine work?

In gout flare/attack, a primary symptom is inflammation, or swelling. Neutrophil, one of the many immune cells, plays a great role in causing such inflammation. Colchicine reduces gout flare by “messing” with the neutrophils’s normal function— disrupts cytoskeletal functions by inhibiting β-tubulin polymerization into microtubules, preventing activation, degranulation, and migration of neutrophils.

Adverse effects of colchicine

Colchicine is a medication with a narrow therapeutic index— small changes in the concentration of the medication in a person’s blood can lead to treatment failures or major side effects. One of the most substantial adverse effects of colchicine is profuse diarrhoea, at which the person should stop taking colchicine immediately if diarrhoea happens. Other side effects of colchicine include nausea, vomiting and abdominal pain. If you experience diarrhoea while taking colchicine, do consult your doctor or pharmacist. 

Taking colchicine in kidney impairment

For gout patients with kidney impairment, their doses of colchicine should be adjusted by the doctor based on kidney performance. The dose of colchicine shall be reduced to 0.6mg once daily or 0.3mg once to twice daily (half tablet).

Do not abandon your gout treatment

While doctors may prescribe colchicine and NSAIDs painkillers for your gout, it’s important to know that they are not the ultimate solution to your gout condition. To control your gout well, make sure you:

• Take your urate-lowering therapy (e.g. allopurinol) according to your doctor’s instruction 

• Avoid high purine content foods

Image credit: https://www.arthritis-health.com/types/gout/what-are-purines

• Follow your treatment for other medical conditions, such as obesity, high blood pressure, diabetes and chronic kidney diseases. All these medical conditions can also increase risk or worsen your gout.

If you would like to learn more about gout, we wrote a detailed article on gout here, happy reading!

A word from DOC2US

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Cover image credit: www.scientificanimations.com/, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons

Written by

Ms Joyce Toh