Colchicine: Doctor's Don't Seem To Know The Dosage

[gumboil]

Having succumbed to the intense pain of gout over the last few months, I've never seen such confusion over the correct dosage of colchicine to abate an attack. One GP advised two 500mcg tablets at the first sign of attack then a further two per day for no more than three days. This ties in with the patient leaflet dosage which emphasises the toxicity of colchicine. Another GP recommends one four times a day as long as I'm in pain. My cardiologist advises one twice a day indefinitely (I can't take NSAID drugs due to heart failure).

A total dose of 7g has resulted in fatalities according to the RX List. The BNF online says their dosage regimes "may differ from the product literature". Currently, two days treatment at three tablets daily gives me horrendous diarrhoea and I've got to stop the colchicine. The 100mg of Allopurinol daily I've been prescribed about 10 days ago is making no difference and I'm currently having an "attack" about once a fortnight. I'm at the end of my tether.

What can I do please? The gout is in the ankle area of both feet although not in both feet at the same time and takes between four and seven days to subside. Uric acid levels seem normal but the doctors are convinced its gout as the colchicine eventually works. I spend my days either laid up or on walking sticks.

[gumboil]

Incidentally, I'm taking 5mg metolozone, 100mg spironolactone and 5mg bumetanide daily and I know that these diuretics are almost certainly responsible for the gout. The trouble is that my cardiologist thinks the dosages are justified due to my severe fluid retention.

[Sqad]

Just a few pointers:

There are several dosage regimes of Colchicine all very effective if started within 4 days of the onset of pain and each depends upon the opinion of the doctor.

I understand why Nsaids are contraindicated in your case.

Alopurinol is not meant to ease the pain in the acute attack, so no surprise that it is not having any effect, as it is purely for prophylactic use ( to prevent attacks)

Uric acid levels in the blood may be normal in gout, particularly if you have been taking Alopurinol for a length of time.

What can you do? Get a referral to a Rheumatologist for a battery of tests and X-Rays to confirm the diagnosis of Gout as it could well be acute rhematoid arthritis.

These ar general comments that i have made on your post.

[gumboil]

Thank you Sqad. I'll make a GP appointment to get a referral to a Rheumatologist as soon as possible.