How Long to Take Colchicine When Starting Allopurinol

March 11, 2024

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Allopurinol is a commonly prescribed medication used to lower uric acid levels and prevent gout attacks. However, when first starting allopurinol, it can actually increase the risk of acute gout flares in the beginning. For this reason, prophylactic treatment with colchicine is often recommended when initiating allopurinol therapy. But how long should colchicine be taken alongside allopurinol at the start of treatment?

Why Take Colchicine With New Allopurinol Therapy

  • Allopurinol works by reducing uric acid production. This causes uric acid crystals to mobilize out of tissues and into the bloodstream initially.
  • Mobilization of these crystals can trigger painful gout attacks and inflammation.
  • Taking colchicine helps calm this inflammation and prevent gout flares.
  • Colchicine is an anti-inflammatory drug that works well for gout prevention.

Starting colchicine prophylaxis 1-2 weeks prior to allopurinol is ideal. The recommended duration of colchicine treatment ranges from 3-6 months when beginning allopurinol.

Guidelines For Colchicine With New Allopurinol Therapy

Major treatment guidelines provide recommendations on concurrent colchicine therapy to prevent gout attacks when first prescribing allopurinol:

American College Of Rheumatology Guidelines

  • Start colchicine 0.6 mg twice daily 1-2 weeks before allopurinol
  • Continue for at least 6 months while titrating to target allopurinol dose

European League Against Rheumatism Guidelines

  • Start colchicine 0.5-1 mg daily 1-2 weeks before allopurinol
  • Optionally, give NSAIDs for first 6 weeks instead
  • Continue prophylaxis for 3-6 months

Overall, most major societies suggest 3-6 months of colchicine or NSAID prophylactic treatment when initiating allopurinol for gout management.

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Dosing Of Colchicine With Allopurinol

The standard colchicine dose for gout prophylaxis is 0.6 mg once or twice daily. Some guidelines are as follows:

  • ACR: 0.6 mg twice daily
  • EULAR: 0.5-1 mg once daily
  • BNF: 500 micrograms 2-4 times daily

Lower doses may be used in certain patients:

  • Elderly
  • Impaired liver/kidney function
  • Taking interacting drugs

When using colchicine with allopurinol, typical duration is between 3 to 6 months consecutively. Determine duration based on clinical situation.

Titrating Allopurinol Dose

The starting dose of allopurinol is usually 100 mg per day. It can take 3-6 months to titrate up to target maintenance dose, based on uric acid level testing.

This titration phase is when the risk of gout flares is highest, making concurrent colchicine important.

Aim to reach target serum urate level below 6 mg/dL. Common target allopurinol doses:

  • 100-200 mg per day for mild gout
  • 300 mg per day for moderate/severe gout
  • Up to 800 mg per day for patients with organ damage or tophi

Closely monitor uric acid levels and gout symptoms to guide duration of colchicine treatment during allopurinol titration.

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Tapering Off Colchicine

Once the desired maintenance dose of allopurinol is reached and urate levels normalize, colchicine can be tapered off. No set guidelines exist, but reasonable approaches include:

  • Reduce frequency (twice daily to once daily) x 1-2 weeks
  • Take every other day x 1-2 weeks
  • Then discontinue colchicine if no gout attacks

Flare prophylaxis for 6 months is recommended, with 3 months seen as minimum duration. Closely monitor symptoms as colchicine is tapered.

Key Takeaways

  • Start colchicine 0.6 mg daily 1-2 weeks before allopurinol
  • Continue for 3-6 months during titration to maintenance allopurinol dose
  • Taper colchicine over 1-2 weeks once stable urate level reached
  • Duration depends on multiple clinical factors
  • Watch for gout attacks as colchicine is discontinued

Using colchicine prophylaxis when starting allopurinol therapy can significantly reduce gout flares during this high-risk initiation phase. Careful monitoring of gout symptoms and uric acid levels allows for proper timing of colchicine tapering.

FAQs

Here are answers to some frequently asked questions about taking colchicine when beginning allopurinol treatment:

How long should I take colchicine with new allopurinol?

Between 3 to 6 months of colchicine is recommended when starting allopurinol, with 6 months typically being preferred. Taking colchicine helps prevent painful gout attacks which can occur when first lowering uric acid levels.

Can I take NSAIDs instead of colchicine?

Yes, NSAIDs like naproxen or indomethacin can be used rather than colchicine for gout prophylaxis with new allopurinol therapy. Guidelines state NSAID use for 4-6 weeks, but some inflammation may still occur after discontinuation.

Should I stop allopurinol if I have a gout attack?

No, you should continue taking allopurinol even if a gout attack occurs. Stopping allopurinol will just prolong reaching target uric acid levels. Use colchicine, NSAIDs or steroids short-term to treat gout flares instead.

When is it safe to stop taking colchicine?

It’s generally safe to stop colchicine once at least 3-6 months of allopurinol therapy is completed and uric acid levels normalize. Taper colchicine over 1-2 weeks while monitoring for recurrent gout symptoms.

Can I take colchicine long-term with allopurinol?

Yes, some patients continue colchicine long-term if unable to taper off without recurrent gout attacks. However, long-term use does increase risk of side effects like diarrhea or muscle damage in rare cases.

Key Points To Remember

  • Colchicine helps prevent gout flares when first starting allopurinol
  • Take colchicine for 3-6 months, starting 1-2 weeks before allopurinol
  • Typical colchicine dose is 0.6 mg once or twice per day
  • Taper colchicine over 1-2 weeks once at steady allopurinol dose
  • Monitor gout symptoms and uric acid levels closely
  • Talk to your doctor about specific recommendations for your situation

Proper use of colchicine when initiating allopurinol therapy allows uric acid levels to be lowered while controlling painful gout attacks. Work closely with your healthcare provider to establish optimal timing of colchicine based on your individual case.

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