What are the appropriate discharge instructions for a 73-year-old female with a first-time gout flare prescribed colchicine (Colcrys)?

Discharge Instructions for 73-Year-Old Female with First-Time Gout Flare Prescribed Colchicine

For a 73-year-old female with a first-time gout flare, colchicine should be taken at a loading dose of 1.2 mg (two tablets) at the first sign of the flare followed by 0.6 mg (one tablet) one hour later, with careful attention to renal function and potential drug interactions. 1, 2

Medication Instructions

Acute Flare Treatment

• Take colchicine as prescribed: 1.2 mg (two tablets) at the first sign of flare, followed by 0.6 mg (one tablet) one hour later
• Do not exceed the maximum dose of 1.8 mg over a one-hour period
• Take medication with or without food
• Start treatment as early as possible for best results (ideally within 36 hours of symptom onset) 3, 1

Renal Function Considerations

• For patients with mild to moderate renal impairment (CrCl 30-80 mL/min), monitor closely for side effects
• For severe renal impairment (CrCl <30 mL/min), dose adjustment is required - consult your physician 2
• Inform your doctor if you have any known kidney problems

Potential Side Effects

• Common side effects: diarrhea, nausea, vomiting, abdominal pain
• Report severe gastrointestinal symptoms, muscle weakness, or numbness immediately
• Diarrhea often occurs before pain relief in many patients 4

Monitoring and Follow-Up

When to Seek Medical Attention

• If symptoms worsen despite treatment
• If you develop severe diarrhea, vomiting, or abdominal pain
• If you experience muscle weakness, numbness, or tingling
• If the gout attack doesn't improve within 24-48 hours

Follow-Up Care

• Schedule follow-up appointment in 1-2 weeks
• Discuss potential long-term urate-lowering therapy (ULT) at follow-up
• Consider prophylactic colchicine (0.6 mg once or twice daily) if starting ULT 3, 1

Lifestyle Modifications

Dietary Recommendations

• Limit alcohol consumption, especially beer
• Reduce intake of purine-rich foods (organ meats, shellfish, red meat)
• Avoid high-fructose corn syrup and sugary beverages
• Stay well hydrated with water (at least 8 glasses daily)
• Consider weight loss program if overweight/obese 1

Pain Management

• Apply ice to affected joint for 20-30 minutes several times daily
• Elevate the affected joint
• Rest the affected joint, avoid weight-bearing if possible
• Take medication exactly as prescribed

Medication Interactions

Important Drug Interactions

• Inform your doctor about all medications you are taking
• Colchicine has serious interactions with certain medications:
  • Strong CYP3A4 inhibitors (clarithromycin, ketoconazole, ritonavir)
  • P-glycoprotein inhibitors
  • Certain statins (increased risk of muscle toxicity) 2

Special Considerations for Elderly Patients

• Higher risk of side effects due to age-related decrease in kidney function
• Careful monitoring for gastrointestinal side effects
• Dose adjustment may be needed based on renal function 5

Future Prevention

Long-Term Management

• Discuss with your doctor about urate-lowering therapy (ULT) at follow-up
• If ULT is started, prophylactic colchicine (0.6 mg once or twice daily) may be prescribed for 3-6 months 3, 1
• Regular monitoring of serum uric acid levels to maintain target <6 mg/dL 3

Warning Signs of Future Flares

• Recognize early warning signs: joint discomfort, redness, swelling
• Start treatment at the first sign of a flare for best results
• Keep colchicine available for immediate use if prescribed for prophylaxis

This comprehensive approach to managing your gout flare with colchicine focuses on proper medication administration, monitoring for side effects, lifestyle modifications, and planning for long-term management to prevent future attacks and improve your quality of life.