From the Guidelines
The correct answer is D. You will take both drugs initially then stop taking the colchicine. When treating gout with allopurinol and colchicine, the typical regimen involves taking both medications at the start of therapy, but then discontinuing colchicine after a period while continuing allopurinol long-term. This approach is necessary because allopurinol, which lowers uric acid levels by inhibiting xanthine oxidase, can actually trigger gout attacks when first started, as noted in a study published in the Annals of Internal Medicine 1.
Colchicine is used temporarily to prevent or reduce these paradoxical flares that commonly occur during the initial weeks of allopurinol therapy. Colchicine works by reducing inflammation associated with gout attacks by inhibiting neutrophil activity and preventing crystal deposition. Key points to consider when initiating this therapy include:
- The use of prophylactic colchicine to reduce the risk of gout attacks during the initial phase of allopurinol treatment, as supported by high-quality evidence from a randomized controlled trial 1.
- The typical duration of colchicine therapy, which may vary but often continues for several weeks to months after starting allopurinol, depending on the patient's response and the presence of gout flares.
- The importance of monitoring for potential side effects of colchicine, such as diarrhea, which was reported in a significant proportion of patients in the study 1.
Once the patient's uric acid levels have stabilized on allopurinol (typically after several weeks to months), the risk of flares decreases, and colchicine can be discontinued while allopurinol is continued indefinitely to maintain normal uric acid levels, as suggested by guidelines for the management of gout 2.
From the FDA Drug Label
An increase in acute attacks of gout has been reported during the early stages of administration of allopurinol tablets, even when normal or subnormal serum uric acid levels have been attained. Accordingly, maintenance doses of colchicine generally should be given prophylactically when allopurinol tablets are begun
- Allopurinol reduces the likelihood of gouty episodes that usually occur with initial colchicine is not accurate, instead, colchicine is given to prevent gout attacks during the initiation of allopurinol.
- The correct statement is: Allopurinol may cause an increase in acute gout attacks during the early stages of administration, and colchicine is recommended to be given prophylactically to prevent these attacks.
- The patient will take both drugs initially, and the colchicine may be continued for at least the first six months of allopurinol therapy, or as directed by the physician 3.
From the Research
Drug Regimen for Gout
When teaching a patient with gout about their drug regimen, which includes allopurinol and colchicine, the following statement is accurate:
- Allopurinol reduces the likelihood of gouty episodes that usually occur with initial colchicine 4 This is because colchicine is commonly used to prevent flares when starting urate-lowering therapy for gout, and allopurinol is a urate-lowering therapy.
Role of Colchicine
Colchicine is given to prevent acute gout flares during the initiation of allopurinol therapy, as it has been shown to reduce the frequency and severity of acute gout flares 4, 5.
- Colchicine prophylaxis during initiation of allopurinol for chronic gouty arthritis reduces the frequency and severity of acute flares, and reduces the likelihood of recurrent flares 4
Duration of Colchicine Treatment
The duration of colchicine treatment varies, but it is often given for the first 6 months of allopurinol therapy 4, 5.
- After stopping colchicine, gout flares may rise, with no difference in the mean number of gout flares/month between groups over a 12-month period 5
Dose of Colchicine
The dose of colchicine can vary, but low-dose colchicine (0.6 mg/day) has been shown to be effective in preventing gout flares with fewer adverse events compared to regular-dose colchicine (1.2 mg/day) 6.
- Low-dose colchicine can adequately prevent gout flare with fewer adverse events compared with regular-dose colchicine 6