Allopurinol vs Colchicine: Which Is Best For Gout?

Both Allopurinol and Colchicine are two FDA approved medications that are used to treat gout. While both medications can be successfully used to combat gout, it can be difficult to decide which medication will work best for you. As a result, this article reviews some critical differences between the two medications.

Medications Used to Treat Gout

Treatment of the inflammation and pain associated with gout can be combated through the use of several types of medications. Some of these medications include:

  • Colchicine. Colchicine treats gout by controlling anti-inflammatory pathways associated with gout. By taking control of these pathways, colchicine prevents molecules from joining together and creating gout.
  • NSAIDs. Non-steroidal anti-inflammatory drugs (NSAIDs) block the COX enzyme that causes fever, inflammation, and pain. This class of drugs includes many active substances with varied chemical structures. Allopurinol falls into this category.
  • Corticosteroids. For patients who do not benefit from NSAID usage, corticosteroids are another available choice. These drugs are administered as an injection into the impacted area or applied as a steroid. These steroids are a good option if only one or two joints are impacted and the treating physician injects directly into those joints.
  • Onset. Allopurinol is much more quickly acting than chlorine. Allopurinol reduces blood uric acid levels in one to tw0 days and results in a maximum reduction of blood uric acid in 7 to 10 days. Colchicine results in pain relief in approximately 18 to 24 hours.

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How Colchicine Is Used

Colchicine is most often used to treat acute gout and used in place of non-steroidal anti-inflammatory drugs when an individual cannot tolerate this class of medications. Besides gout flare-ups, colchicine is similarly used to treat atrial fibrillation, Behcet’s disease, canker sores, constipation, and pericarditis.

The Mechanics Behind Allopurinol

Allopurinol increases the elimination of uric acid in a person’s kidney, decreases the production of urate, and converts urate into a more easily disposed of chemical. Most commonly, allopurinol is used to treat chronic gout and decrease the recurrence of gout flare-ups. Besides allopurinol is similarly used to treat things like tumor lysis syndrome, reperfusion injury, epilepsy, and inflammatory bowel syndrome. Allopurinol works by preventing the formation of the enzyme, xanthine oxidase, which creates uric acid.

Other Key Differences

Some of the other substantial differences between allopurinol and colchicine include:

  • Dosage. Allopurinol is available as an intravenous powder for injection and oral tablets. Colchicine is available as an oral capsule and oral tablet. This means that if a patient is not able to take medication orally, allopurinol is a much better option.
  • Disease interactions. Both medications have adverse disease interactions with bone marrow suppression, liver disease, and renal dysfunction. Colchicine, however, also has adverse reactions with cardiac dysfunction and rhabdomyolysis.
  • First approval date. Allopurinol has been in use for much longer than Colchicine. Allopurinol was first approved for use on August 19, 1966, while colchicine was first approved for use on July 29, 2009.
  • Side effects. Allourinol’s most common side effects include allergic reactions, rashes, and pruritus or itching. Colchicine’s most common side effects include abdominal pain, diarrhea, and nausea. The exact side effects that a person notices with any medication, however, can vary greatly. If a person wants to avoid a specific side effect or begins to experience one of these side effects, one medication might become more preferable than another.

Is Allopurinol or Colchicine A Better Treatment Option?

Colchicine is a medication that acts quickly and used only for acute gout flare-ups but also results in various side effects. Consequently, the medication should not be the first option to treat gout. Colchicine should also not be used by individuals with either liver or renal dysfunction. People suffering from gastrointestinal problems and senior citizens should also avoid using medications. Colchicine is also not a good choice for chronic gout treatment and overdose of the medication can be lethal.

Conversely, allopurinol is used to treat chronic gout and to decrease the production of uric acid over a longer period of time. The medication does not have any impact if a person is experiencing a gout attack. Allopurinol is particularly effective if a person is experiencing severe gout and can sometimes have a beneficial impact on renal function. Allopurinol, however, can take longer before a person begins to feel its effects. Kidney stones can also form while a person is taking allopurinol.

When to See a Doctor for Gout

People with gout sometimes experience an initial occurrence that is followed by a period of time when gout goes into remission before appearing again. Over time, gout attacks become more common until the condition becomes a chronic one. Some of the most common symptoms associated with gout and why a person might want to speak with a medical professional include:

  • Pain and swelling in either one or several joints. While gout most often begins in the big toe, it can also occur in a person’s ankles, elbows, fingers, hips, knees, or thumbs
  • Redness and/or warmth in the impacted areas, tenderness, and discomfort
  • Limited range of motion
  • After the most severe pain diminishes, joint discomfort due to gout often lasts for several days to weeks.

Because uric acid builds up over a period of time, it often takes months or years before these symptoms arise. Some gout attacks are so severe that they can last from three to ten days and then do not recur for months or years. Eventually, flare-ups become more common and painful. Based on the symptoms you are experiencing, a doctor might decide to prescribe allopurinol or colchicine.

A Medical Professional Can Help You Make the Best Choice

Many people are uncertain of whether allopurinol or colchicine will work best. One of the best ways to decide which gout medication will work best for you is to speak with a knowledgeable medical professional. By sharing details about these medications with your loved ones, you can make the most informed decision about how to combat gout possible.

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