From the Guidelines
Yes, allopurinol and colchicine can be taken together, as evidenced by a study that compared the combination of allopurinol 200 mg daily plus colchicine 0.5 mg twice a day against colchicine 0.5 mg twice a day alone, showing a significantly greater reduction in SUA level in those taking the combination 1.
Key Points to Consider
- Allopurinol is an appropriate long-term urate-lowering therapy, which should be started at a low dose (100 mg daily) and increased by 100 mg every two to four weeks if required, with dose adjustments necessary for patients with renal impairment 1.
- Colchicine is used to reduce inflammation and pain during acute gout attacks, and can be prescribed as prophylaxis (typically 0.6 mg once or twice daily) for the first 3-6 months when starting allopurinol therapy.
- The combination of allopurinol and colchicine has been shown to be effective in reducing SUA levels, with a study demonstrating a significant dose–response relation between allopurinol and SUA 1.
- Patients should be aware of potential gastrointestinal side effects, such as diarrhea, and the importance of taking both medications as prescribed, without stopping allopurinol during an acute attack.
- Dosage adjustments are necessary for those with kidney impairment, and alternative urate-lowering treatments may be considered if allopurinol toxicity occurs 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
Allopurinol and Colchicine can be taken together. It is recommended to continue colchicine therapy when starting allopurinol to prevent acute gouty attacks, and to adjust the dosage of allopurinol based on serum uric acid levels and clinical response 2, 2.
From the Research
Allopurinol and Colchicine Combination
- The combination of allopurinol and colchicine can be taken together, as evidenced by a study published in 1982, which found that patients with primary gout who were treated with a combination of colchicine and allopurinol did not experience a decline in renal function, unlike those who received only colchicine 3.
- Another study published in 2004 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 4.
- A study published in 1993 also supports the use of colchicine as a prophylactic measure when starting allopurinol therapy, citing its preference over NSAIDs due to its lower cost and better tolerability, especially in patients with certain gastrointestinal conditions or those taking anticoagulants 5.
Clinical Considerations
- When initiating allopurinol therapy, it is essential to consider the patient's renal function, as allopurinol can affect urate clearance and renal function, as noted in the 1982 study 3.
- The 2016 study on the management of gout highlights the importance of considering comorbidities and renal function when selecting treatments, including allopurinol and colchicine 6.
- The 2013 study on clinical and health care use characteristics of patients newly starting allopurinol, febuxostat, or colchicine for the treatment of gout found that patients who started these medications generally had hyperuricemia and multiple comorbidities, emphasizing the need for careful consideration of patient characteristics when prescribing these medications 7.