The Most Misused Gout Drug, Colchicine


Gout is a disease that medical science obsessed over for, well, since medical science came into being.  Only in the last fifty years has gout become a “forgotten” disease.  Through this long and amazing history, gout has had a more or less faithful companion: the autumn crocus flower.  It’s from the bulb of this flower that colchicine comes.

Some reports say that colchicine has been in use for over 6000 years while other reports say its a much newer drug that has only been in use for 2000 years.  Regardless, it is still considered to be a first line drug by many doctors.  Unfortunately, those doctors are grossly out-of-date.  Not only in using colchicine first, but also in how they use it…

Because colchicine comes from the bulb of a flower, one could consider it a “natural” or “herbal” remedy and they would be correct.  However, this does not mean that it is good for you.  In fact, colchicine is a highly toxic substance.  People have died from ingesting just 6 mg of the stuff.  It’s a drug that lingers in the body for a long time only slowly being metabolized by the liver and filtered out by the kidneys.

One study found that every single patient treated with colchicine showed symptoms of toxicity, including severe nausea, vomiting and/or diarrhea.  Not only that, but 80% had these symptoms before they saw any relief from gout pain.  There is nothing worse in the world then having severe nausea, vomiting and diarrhea while in the middle of a already extremely painful gout attack.  There is an old medical proverb that says, “people treated with colchicine often run before they can walk”.

However, this study was conducted using the old way of treating with colchicine.  The old way was: “take two tablets at the first sign of gout pain than one tablet every hour until diarrhea occurs.”

This method of administering colchicine is no longer accepted by the vast majority of gout experts! If this is the way you use colchicine then you really should, at the very least, try the currently accepted method, which is: “take one tablet 3 or 4 times a day starting at the first sign of pain.” That’s it.

This method works just as well as the once an hour method but causes far fewer and less severe side effects.  Unfortunately, most doctors are unaware of this new method.  They probably learned the old method in medical school 20 years ago and have not kept up with the latest methods.  I don’t blame them. There has been a lot to keep up with in the last 20 years.  Medical science is moving very fast.

Through most of colchicine’s 2000-6000 year history, it was the only drug that doctors had at their disposal that actually worked against gout but that all changed about 60 years ago.  With the advent of non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, doctors had much more powerful means of controlling the pain inducing inflammation of gout and colchicine was demoted to a second tier drug.  Unfortunately this information is still unknown to many doctors.

That said, colchicine does still play a few important roles.  NSAIDs and corticosteroids do have risks and some people should not take them.  People with heart problems or gastrointestinal problems (including ulcers) should not take NSAIDs and those with infections or that are at risk for infection should not take corticosteroids.  In these cases, colchicine can step up to it’s historic role as a first line drug for an attack.

In fact, this is often the reason emergency room doctors give colchicine rather than other medications – it is safer when the patients medical history is less clear.  If a patient “forgot” to tell the ER doctor about his ulcers or heart condition, the patient could be seriously injured or even die, “so why take the chance?  Just prescribe the less effective but safer colchicine,” is what these doctors reason and rightly so.

Of course the best way of avoiding the side effects of all of the medications used to treat gout attacks is to stop having gout attacks. It drives me crazy when I read over and over about “foods to avoid with gout” and “safe diets for gout”.  This implies that gout is caused by diet but this is almost always not true! In the vast majority of cases gout is a genetic disease. Diet does play a role but it is much smaller than most people, including most doctors, think.

The key to stopping gout attacks is to lower uric acid levels in the body and the most effective way to do that is with medication.  Allopurinol, febuxostat and probenecid are the medications to look at.  Also, vitamin C and some other natural substances such as burdock root are powerful at lowering uric acid but even with these, medications might be needed to do the job completely.

Colchicine plays a powerful roll here as well.  When you first start lowering uric acid levels, gout attacks will actually increase as “pools” of uric acid in your body dissolve and “move” out of the body.  This causes strong fluctuations in uric acid levels in the body that can trigger attacks.  In this case, colchicine can be used as a daily “prophylaxis” to prevent these attacks for 3-12 months.  After that time, it can be discontinued and hopefully, never seen again.  Note: If you use a daily dose of colchicine, you should NOT also use it to treat an attack!  The risk of overdose is too high!


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