Colchicine for Gout: 'How Does that Work?!' - PHARMACIST Fi Medicine Safety 

Hi Ritten Brake @rittenbrake1613 You are welcome! I'm very glad if it is helpful to find out this info. Best Fi :>

Hi Neal Anderthal @nealanderthal528 You are very welcome, and thanks for commenting! Best Fi :>

Hi aida ebrahimi, I am very glad you found this helpful. Best, Fi :>

Hi Medical Science @medicalscience1528 Thanks so much for your kind words! Best Fi :>

Hi Cthuwu :} @SwedePotato314 You are welcome. I am very glad to hear the info was helpful for you - thankyou for letting me know! Thank you for sharing some of your experience, and I am sorry to hear you had a medicine interaction. I would be interested to know which antidepressant interacted and what type of symptoms happened, if you feel comfortable to share this info (I would prevent the message from being publicly visible), but if you prefer not to share specific medicine details, I totally understand, and that is OK, too. Best PHARMACIST Fi

Hi Renny Chaitlal ( @xreria ) I hope you are well. Only take colchicine if a doctor has prescribed it for you, because some people must not take colchicine (people with some types of kidney or liver problems or some medicine interactions, have become very unwell or died from taking the standard dose schedule of colchicine) - so it is very important to tell the doctor about everything you are currently taking and have taken in recent weeks (including every medicine and herbal medicine and any other health products like supplements - so the doctor can check whether or not you have any serious medicine interactions), and a doctor should check your kidney and liver function (with blood tests) before you start colchicine - to help the doctor know whether or not colchicine may be suitable for you, and if it is suitable - what dose schedule to give you (because dose schedules are different for people with different levels of kidney function or liver function). Please also see my video called ‘Some Need-to-Know Info! Colchicine for Gout (Part 1)’ for some other important things which I advise to talk about with a doctor about colchicine, via this link ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-N6jCa795bLg.html I hope this info is helpful for you. Please note that this RU-vid Channel is for general education about medicines, not personal medicines advice, but you are welcome to ask me any general questions about this info if you like. Best Fi

Hi 15 @user-bg6wx8ix2u Thank you for your question. This is good timing, as I was planning to create a video about indomethacin (which is also called indometacin in some countries; brand names in the USA include: Indocin, Indocin SR, or Tivorbex; brand names in Australia include: Indocid or Arthrexin) in the next month, but now that I know it may be of interest to you, I will try to get that video completed in the next fortnight! Indomethacin is a non-steroidal anti-inflammatory drug (NSAID), so some people with certain types of medical conditions or medicine interactions must not take it, but if a doctor advises indomethacin is suitable for a person to treat gout flares &/or reduce how often gout flares happen, then the person may find indomethacin helps reduce the painful inflammation of gout flares (please note that it is important to tell the doctor about all medical conditions you have ever had - to help them weigh the potential treatment risks versus potential treatment benefits of an NSAID like indomethacin - especially tell the doctor about any history of unusual bleeding or bruising, or any medical conditions affecting the heart, blood pressure, kidneys, liver, stomach, intestines, brain, allergies, asthma, COPD, or any history of not producing enough of some types of blood cells; & also make sure the doctor knows about all medicines, herbs, supplements & other health products you are currently taking and have taken in recent weeks so they can check for any medicine interactions). Like the other medicine options for treating painful gout flares (for example: colchicine or corticosteroids), an NSAID like indomethacin does not get rid of the urate crystals of gout - it only reduces our body’s painful inflammatory immune system response to the crystals, so most people will need to take a 'urate-lowering' medicine life-long to gradually melt the urate crystals and then prevent urate crystals from ever forming again (for example: allopurinol - if their doctor considers allopurinol is suitable for the person), in order to stop gout attacks permanently. During the first 6 months or more of treatment with a urate-lowering medicine (like allopurinol), because urate crystals are being melted, this causes some changes in a person's uric acid level, which may trigger some acute gout flares. So, to reduce or prevent gout flares during this time - a doctor may prescribe an NSAID like indomethacin, or colchicine, or a corticosteroid, and whether one of these 3 types of medicines is suitable or not for a person will depend on things like: what medical conditions a person has, the person’s levels of kidney and liver function, whether the person is taking any seriously interacting medicines, and whether the person is more or less likely to get acute gout flares than other people. Like a lot of commonly used medicines, indomethacin has some potentially serious (and in some cases potentially life-threatening) side effects to watch out for and get emergency medical attention immediately if they ever happened - so I recommend asking your doctor or pharmacist to please print or email you some medicine information about indomethacin, and read the section about side effects - so you know what symptoms to look out for and what to do about side effects if they ever happened to you. Indomethacin also has some risky medicine interactions to try to avoid - so I also recommend asking your pharmacist to please run an interactions check on their computer for you - for everything you are currently taking and have taken in recent weeks (including medicines from the doctor, supermarket or pharmacy, and also any herbal medicines, supplements, and other health products). If any interactions are found, your pharmacist can advise you of whether they may be serious or not, and if any interactions may be significant, your pharmacist could help you contact your doctor to figure out whether any medicine changes may be needed or not, and exactly how to make medicine changes if they are needed. Please check back to this channel for my upcoming video about indomethacin in my ‘Some Need-to-Know Info! ’ playlist, and if you have any further general questions about indomethacin, I will be happy to answer them (please note that this channel is only for general info about medicines, not personal medicines questions). You might also find my upcoming series of 10 SHORTS videos called ’10 Things You May Not Know About Gout’ interesting, too. Best Fi :>

Hi B Rad @brad265 , Thanks for watching and thanks for your question! I am making a ‘How Does That Work’ video about allopurinol in the next month or so, so that may interest you, but for now - I am guessing maybe you mean what is Allopurinol’s role in treatment of gout? Here in Australia, allopurinol is currently the 1st-line treatment to reduce urate level (also called uric acid level) in people with gout requiring treatment, in order to help their body gradually melt the gout crystals in the edges of their joints, in their connective tissue and/or their kidneys - so allopurinol actually treats the underlying problem of gout - which is urate crystals being laid down in various parts of the body (after which flares of inflammation by our immune cells reacting to those urate crystals cause bouts of pain and may gradually damage joints, connective tissues, and kidneys over a period of years (for example, some people get chronic kidney disease (which may happen with or without urate kidney stones) due to urate crystals being laid down in their kidneys)). In contrast to this, depending on whether they are suitable or not (based on what medical conditions a person has or whether they have any interacting medicines), medicines like colchicine or non-steroidal anti-inflammatories or corticosteroids (please note that these medicines don't reduce urate level) may be prescribed to reduce the inflammation of gout flares caused by our immune cells reacting to urate crystals, or to try to prevent gout flares that can happen early in allopurinol treatment (unfortunately gout flares are not just triggered by urate crystals being laid down in various parts of our body - gout flares can also be triggered when the urate level in our blood first starts getting lower from allopurinol treatment - but this tendency decreases over time, so this is why people may need to take a medicine like colchicine or a non-steroidal anti-inflammatory or a corticosteroid for different lengths of time (e.g. 6 months for some people, or more than a year for some people who have really established gout with tophi, etc.) to prevent flares during the early phase of allopurinol treatment). Once urate crystals have been fully dissolved by the allopurinol (this may take a year or more - depending on how established the gout is), flares should no longer happen after that as long as the urate level stays low enough - so a lot of people with gout need to take allopurinol for the rest of their lives (unless there is a reason they should not take it) to keep their urate level low enough that their bodies no longer put urate crystals in their joints, connective tissues or kidneys. By the way, when I mention: ‘1st-line treatment’, I mean the Australian Therapeutic Guidelines and Australian Medicines Handbook (which advise doctors how to prescribe medicines for medical conditions, based on the latest evidence about benefits versus risks of each treatment option; these guidelines are independent/not influenced by drug companies) currently list allopurinol as the first medicine to prescribe to reduce urate level for people diagnosed with gout requiring treatment - unless there is a reason they should not take it (please note that there are some people who should not take allopurinol - please see my Allopurinol video in my ‘Some Need to Know Info’ playlist for info about rare drug reaction symptoms (affecting less than 1 in 1000 people who take allopurinol) which would need emergency medical attention immediately, and medicine interactions to avoid; you are also welcome to ask your pharmacist or doctor for some medicine information about allopurinol, containing info about who should not take it). I hope this info has been helpful for you, and you are welcome to ask questions about what I have written if any of it is unclear. Best Fi :>

@PHARMACIST Fi thank you very much for the well written detailed info. I've been getting gout in my ankles for years now and it gets so bad and painful to the point that I literally can't walk or even stand. I Just recently got diagnosed with gout after dealing w it for about 6 years. Until then Dr's couldn't figure it out because it's not the typical big toe area. They kept referring me to podiatrists who would do X rays and not know what to do other than give me a 5 or 7 day steroid pack. I like that you mentioned the kidneys. No one talks about this. I have kidney pain and kidney stones from time to time as well and thought there might be a connection. I get flare-ups every few months or so. After reading your comments, I'm wondering if I should try allopurinol for a year to remove the buildup of crystals or if I'll need to take it for the rest of my life. I don't see how just eating plant based diet will repair the damage and remove the crystals and I'm worried it will just keep getting worse. I'm only 39 and pretty active. But can't exercise if I can't even walk or stand.... I'm not sure what to do... It's a terrible debilitating thing to live with.

​@@brad265 You're welcome & sorry to hear it sounds like you are going through a lot. Current USA guidelines suggest people with gout flares 2 or more times per year require life-long urate lowering therapy (for which allopurinol is the first option for most people, if it is suitable for them), and Australia's Therapeutic Guidelines currently say: "Lifelong urate-lowering therapy is recommended for all patients with a confirmed diagnosis of gout, but is especially important for patients who present with tophaceous gout, renal manifestations of gout, or chronic gouty arthritis." (note: 'renal manifestations' means kidneys being affected). If a doctor advises that allopurinol is suitable for you, ask the doctor what they think of new protocols with low allopurinol starting dose and slow dose increases of small amounts (this type of protocol has recently been created by rheumatologists to reduce risk of flares and to reduce risk of a rare allopurinol hypersensitivity drug reaction with rash (which would need emergency medical attention immediately & allopurinol to be stopped; please see my 'Allopurinol - Some Need-to-Know Info!' video for more info about this)). Make sure the doctor remembers to test your kidney function (via blood tests) before they prescribe allopurinol, because both the starting dose and dose increases may need to be lower if you have reduced kidney function (& make sure the doctor knows about your history of kidney pain and stones). There are a few medicines which increase uric acid level as a side effect, so consider asking your pharmacist if any of your current medicines are in this category (if so, ask your doctor whether or not it could be switched to a medicine which does not increase uric acid level; and don't make medicine changes on your own - make sure these decisions are made together with a doctor ;>). Also consider asking your pharmacist to please run an interactions check for you of everything you take (including allopurinol if that gets prescribed) and if any significant interactions are found, ask the pharmacist to please help you discuss medicine options with your doctor. Please note that this channel is for general info about medicines, not personal medicines advice, so I recommend asking doctors and pharmacists about the ideas above. Best Fi :>

Hi Doctor, thank you for the information. Most helpful video. I’m suffering from gout flare up and on those two first line treatments. Is it normal for flare ups to occur when starting allopurinol? Does colchicine reduce the pain? You said the NSAIDS can help reduce pain, but I was told that tylenol doesn’t help that much. I’m taking tylenol ultra relief to help with my daily gout pain. What are your thoughts? Thank you!

@@zacharyklein2381 Hi Zachary Klein @zacharyklein2381 You are welcome - I am glad you found this colchicine video helpful, and I am sorry to hear you have a gout flare up. I highly recommend asking a doctor for advice about how to manage your gout flare as soon as possible, because they can advise exactly how much of which medicine/s to take and when, to manage the flare - based on your particular kidney and liver function, plus any other medical conditions, plus what medicines or other health products you take (please note that this RU-vid channel is just for general info about medicines, not personal medicines advice, but please find some general info below). The dose of colchicine taken to prevent gout flares may not be enough to fully ease the pain of an acute gout flare, so some people may also need a different medication, as well as colchicine, to further reduce the pain of an acute gout flare, so ask your doctor for advice about what may or may not be suitable for treating this gout flare, and also ask the doctor how to manage any future gout flares - to try to give you relief as soon as possible in future, as safely as possible (once again, whether certain types of medicines will be suitable or not will be based on medical conditions, kidney & liver function, & whether there are any serious medicine or health product interactions). Please note: there are some people who must not take one or more of the medicine categories of NSAID, corticosteroid, or colchicine - due to certain health conditions, or kidney or liver function levels, or medicine interactions: so it is a good idea to only make decisions about these types of medicines together - with a doctor (not on your own). Also, don't increase colchicine dose unless a doctor has given you specific instructions on how much to take, exactly when to take it, and how much time to leave between doses - because the toxic amount is not much higher than the treatment amount, and the amount of time between doses is also very important to prevent toxicity. In the past it has unfortunately been common for people to experience gout flares early in allopurinol treatment - partly because not all the urate crystals have been melted yet (for the first 6 months or more if treatment is started in early gout, or for 12 months or more if treatment is started when gout is already quite established & has tophi) and also because either sudden increases or decreases of uric acid level may trigger gout flares in people who still have urate crystals - so when a person first starts allopurinol, or when allopurinol dose is changed, or if allopurinol is stopped - any of these things might change uric acid level quickly enough in some people for them to get a flare. For this reason, a new type of allopurinol dose schedule has been designed in recent years with a lower starting dose and smaller dose-increases which are further apart - so allopurinol changes a person’s uric acid level more gradually, to reduce risk of flares. It may be worth asking your doctor about these new dose schedules for allopurinol. It might interest you that there are also a range of other things that may change uric acid level to trigger gout flares, which I will look at in videos in my ’10 Things You May Not Know About Gout’ SHORTS series in the coming weeks. The reason paracetamol (also called acetaminophen, which is the active ingredient of Tylenol) may be less effective for reducing gout pain compared to colchicine, or an NSAID like indomethacin, or a corticosteroid like prednisolone, is because colchicine, or an NSAID, or a corticosteroid have anti-inflammatory effects in our body (so they reduce gout inflammation where it is causing the pain), but paracetamol is believed to have its pain sensation reducing effects mostly via our brain, so it is less likely to reduce inflammation of gout in the body. Some people include paracetamol among NSAIDs because one of its effects is believed to be reducing prostaglandin production in the brain, but it has much less effect in the body than NSAIDs, so when I mention NSAIDs, I am not including paracetamol. I hope your doctor or pharmacist has advised you NOT to take the NSAID aspirin for gout pain (it is OK to take 'low dose aspirin' which doctors prescribe for some people to help prevent blood clots from causing heart attack or stroke, but the doses of aspirin in pain relief products should be avoided by people with gout) because the doses of aspirin in pain relief products may change our uric acid level and therefore may make gout flares worse. I hope this info may be helpful for you, and I hope you get some good relief from this gout flare soon. Best Fi :>

Hi feras almalki @ferasalmalki5925 Thank you for your interesting question. As I mention in this video (ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-ARAc_95da18.html ), because of the very specific way colchicine works, if a neck problem is not from gout, then colchicine is not suitable for most common types of pain (except for a few painful conditions where colchicine is used - like Familial Mediterranean Fever or Pericarditis). However, if a neck problem was due to a gout flare in the neck, then colchicine may reduce the inflammation and pain of that gout flare (but please note that some people must not take colchicine - so only take colchicine if a doctor has prescribed it specifically for you and that doctor knows: *every medicine you are taking (to avoid very risky medicine interactions with some types of medicines), and *all your medical conditions (because colchicine must not be taken with some types of medical conditions), and *how well your kidneys and liver are working (people with reduced kidney or liver function need a lower dose of colchicine). Gout in the neck is not common, but it has happened to some people, as you can see in this article (www.ncbi.nlm.nih.gov/pmc/articles/PMC6745074/ ), which you are welcome to show your doctor, and you could ask the doctor whether or not they might be interested to test for gout (for example via a uric acid blood test), and I also recommend to ask the doctor to consider referring you to a rheumatologist (a rheumatologist is a medical specialist who knows even more about medical conditions of the joints and muscles than regular doctors), who might consider more tests to find out what is causing the neck problem. Please note that in the article above, where they talk about ‘cervical’ disc, they mean disc ‘of the neck’, because doctors call the neck the ‘cervical spine’. Please also note that for treatment of gout, colchicine is only a temporary medicine, for preventing gout flares or for treating gout flares in the early phase of taking the main type of gout medicine: a urate-lowering medicine (for example: allopurinol, if it is medically suitable for a person), and there is more info about gout treatment in these videos: ru-vid.com/group/PLwyYRbsDY3jsgC6QHx6rkExPACfQbu9Du ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-N6jCa795bLg.html ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-ytvAJQxA4c0.html ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-rO6oyMT9PpU.html I hope this info may be helpful for you, and I hope you get a good treatment outcome. You are welcome to ask questions about this info if anything is unclear. Best PHARMACIST Fi :>

@rahul38196 Hi Rahul Pixels, Thankyou for your question. Here is a link for you, to my video about colchicine side effects and interactions (including interactions to avoid with some types of medicines, grapefruit, and grapefruit juice): ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-deO0BMqNwWM.html The medicine interactions part of that video starts from 4 minutes onwards and there is also more info in the description section of that video about some more types of interactions which were not covered during it. I hope the info in the video and description section via the link above is helpful for you, and you are welcome to ask me questions about it if anything seems unclear or needs more explanation. If you found that video helpful, you might also find other videos (including some other videos about colchicine) in my playlist of videos about gout interesting: ru-vid.com/group/PLwyYRbsDY3ju2-aCCW8SBu6fcOxitCfCJ Best PHARMACIST Fi