Can colchicine be taken with allopurinol (Zyloprim)?

From the Guidelines

Taking colchicine with allopurinol is not only safe but often recommended during the initial weeks of allopurinol therapy. When starting allopurinol for gout management, doctors typically prescribe colchicine (usually 0.5–1 mg/day) for the first 6 months to prevent gout flares that can occur as uric acid levels begin to change, as recommended by the 2016 updated EULAR evidence-based recommendations for the management of gout 1.

Key Considerations

• Allopurinol works by reducing uric acid production, while colchicine prevents the inflammatory response to urate crystals.
• This combination approach is particularly important because paradoxically, when first starting allopurinol, patients may experience more gout attacks as uric acid crystals begin to dissolve and shift within joints.
• The medications work through completely different mechanisms, so they don't interfere with each other.
• However, both medications can cause gastrointestinal side effects, and colchicine requires dose adjustment in patients with kidney or liver impairment, as noted in the study by Richette P, et al. 1.

Important Precautions

• Always take these medications exactly as prescribed by your doctor, and report any unusual side effects promptly.
• Patients with severe renal impairment should avoid colchicine, and those with renal impairment or statin treatment should be aware of potential neurotoxicity and/or muscular toxicity with prophylactic colchicine, as recommended by the study 1.
• Co-prescription of colchicine with strong P-glycoprotein and/or CYP3A4 inhibitors should be avoided, according to the guidelines 1.

From the FDA Drug Label

While adjusting the dosage of allopurinol tablets in patients who are being treated with colchicine and/or anti-inflammatory agents, it is wise to continue the latter therapy until serum uric acid has been normalized and there has been freedom from acute gouty attacks for several months Maintenance doses of colchicine generally should be given prophylactically when allopurinol tablets are begun

Colchicine and Allopurinol Interaction:

• It is recommended to continue colchicine therapy when starting allopurinol until serum uric acid has been normalized and there has been freedom from acute gouty attacks for several months 2.
• Maintenance doses of colchicine should be given prophylactically when allopurinol is begun 2.
• Yes, colchicine can be taken with allopurinol, but it is essential to monitor and adjust the dosage as needed to maintain normal serum uric acid levels and prevent acute gouty attacks.

From the Research

Colchicine and Allopurinol Interaction

• The use of colchicine with allopurinol is a common practice in the treatment of gout, as colchicine can help prevent acute flares when initiating allopurinol therapy 3.
• A study found that 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 3.
• However, patients with gout are frequently concurrently prescribed other medications that may interact with colchicine, increasing the risk of adverse events 4.
• Another study suggested that low-dose colchicine can adequately prevent gout flare with fewer adverse events compared with regular-dose colchicine 5.

Adverse Events and Interactions

• Adverse events such as diarrhoea, nausea or vomiting, myocardial infarction, neuropathy, myalgia, myopathy, rhabdomyolysis, and bone marrow suppression can occur when taking colchicine with allopurinol 4.
• Statins, which are commonly prescribed with colchicine and allopurinol, were not associated with increased adverse events in one study 4.
• Other medications, such as those with potential to interact with colchicine, were associated with some adverse outcomes 4.
• Diarrhoea and myocardial infarction were associated with more comorbidities and more severe chronic kidney disease 4.

Clinical Characteristics and Health Care Utilization

• Patients with gout who are newly prescribed allopurinol, febuxostat, or colchicine often have significant comorbidities and high health care utilization 6.
• The mean age of patients with gout is around 53 years, and 83-87% are men 6.
• More than one-half of the patients have hypertension and hyperlipidemia, 20% have diabetes mellitus, and 10% have cardiovascular disease 6.
• The use of gout-related drugs such as opioids, steroids, and nonsteroidal antiinflammatory drugs is common in patients with gout 6.