Hi all,

I have been on a treatment of Allopurinol (300mg daily) and taking Colchicine as a supplement (0.5mg daily) for 12 months to treat my Gout. I stopped the Colchicine 3 weeks ago and in that time have had separate flare ups. Is this normal? I would have thought that the build up of Uric acid would have subsided by now. I have taken anti-inflammatory’s for the flare ups, but am concerned. I know that Allopurinal treatment will cause flare ups initially, so was wondering whether stopping the cochicine has caused the flare ups…will they stop? Should I continue with the cochicine?

Please, any advice will be much appreciated.

1 Comment

  • Hi stewartv72,

    Your question is very interesting to me at the moment, as I am revising my allopurinol guidelines to try and highlight your situation, which is very common.

    My thoughts are:

    Allopurinol dose is quite meaningless as a general number. Obviously, as a gout patient, your prescription is vital to you, but the dose on that prescription only applies to you. Unlike many medications, there is no such thing as a standard dose of allopurinol.

    Unfortunately, most gout patients, and many doctors, find this difficult. Doctors think they are treating the problem by prescribing 300 mg allopurinol, and gout patients think they are controlling gout. For a lucky few, this is OK, but over half of gout patients need more than 300mg per day.

    I do not even like discussing 300mg, because I regard it as an evil. It falls into the same category as “normal uric acid”. Meaningless nonsense that causes more harm than good.

    Quite frankly, doctors, who are supposed to be above average intelligence, should know better. To be fair, many doctors do know better, but it is a lottery.

    As a gout patient, you have to take control. If your doctor does not understand gout, you have to decide what allopurinol dose is right for you, and insist that you get it.

    Get a uric acid test result immediately, and keep a diary of your test results. Allopurinol must be increased to reduce uric acid to safe levels. Safe levels should be determined on a case-by-case basis, but I will give you the basics, and we can decide if your circumstances suggest a variation from normal treatment.

    I recommend an aggressive approach for 6 to 12 months. Increase allopurinol by 100mg each month until you reach the maximum dose (900mg UK, but you might get stopped at 800mg in America and elsewhere). Ensure uric acid is below 3mg/dL, or investigate other options such as addition of probenecid.

    After 6 months, assess if another 6 months is required (e.g., still getting gout flares, or visible tophi present). If uric acid is well controlled, relax dose very slowly until uric acid test result is 5mg/dL. Maintain 5mg/dL for life, adjusting allopurinol dose as necessary. Test uric acid at least once a year, and insist on liver function tests and kidney function tests at the same time. Testing is more frequent when you are changing allopurinol dose.

    In the first few months, you should take colchicine for two weeks when changing dose, then as required.

    All the above is general stuff based on my experience and typical allopurinol dosing procedure. I have therefore assumed that your uric acid has not yet reached 5mg/dL (0.30 mmol/L). If you can supply more detail, including a history of uric acid test results and allopurinol doses, then I can give a more personal assessment.

Comments are closed.