Gout and tx

Hi, I'm not on tx yet, however I've been having gout problems for years and lately they've become more frequent along with cramping on my legs sometimes. I am cirrhotic grade 2 stage 4.  Is anyone on tx here that has a similar issue. I understand that Colchicine has major interaction with vic, so my concern would be to start on tx and then having to stop for that reason. Thanks

Charlie

[toby47]

I've had gout in the past, so often that colcihcine didn't have any effect on it and I had to use prednisone.Few years ago started using allopuinol which took care of problem with also eliminating alcohol and drinking more fluid.I believe the incivek causes your uric levels to increase which would really play havoc on your gout unless under control. I just finished with the incivek portion and had no problem. Of course one reason may have been the fact of not eating as much protein and drinking more water than normal.I hope you have an easy tx.

[toby47]

Sorry, see you posted about Vic not incivek-----never mind.

[Aquisi]

Thanks for your reply anyway.

[pooh55811]

Go to this site:

http://www.drugs.com/interactions-check.php?drug_list=127-0,3323-0,728-0,2009-0,1806-1159

I plugged in the drugs you would likely be taking, Interferon, Ribavirin, Victrelis and colchicine (and also added allopurinol to see if it had any interactions). You can see that Colchicine is not a good mix with the Hep C drugs. Allopurinol seems to be okay. It is something you will have to discuss with your MD. Perhaps there is a substitute for the colchicine.


Interactions between your selected drugs

colchicine ↔ boceprevir

Applies to: colchicine, boceprevir

ADJUST DOSE: Coadministration with inhibitors of CYP450 3A4 may significantly increase the serum concentrations of colchicine, which is primarily metabolized by the isoenzyme. Clinical toxicity including myopathy, neuropathy, multiorgan failure, and pancytopenia may occur. In one case report, a patient with familial Mediterranean fever and amyloidosis involving the kidney, liver, and gastrointestinal tract was admitted to the hospital with life-threatening colchicine toxicity after a two-week course of erythromycin, a moderate CYP450 3A4 inhibitor. During the year prior to admission, the patient had developed recurrent diarrhea and abdominal pain and demonstrated toxic levels of colchicine on two occasions. It is likely the patient had acute colchicine toxicity brought on by the addition of erythromycin and superimposed on chronic colchicine intoxication secondary to renal and hepatic impairment. The patient improved with supportive therapy and intensive hemodialysis and was discharged on day 70 of hospitalization. Another report describes two fatal cases of agranulocytosis due to presumed interaction between colchicine and clarithromycin, a potent CYP450 3A4 inhibitor. Risk factors include mild liver function test abnormalities in one patient and end-stage renal failure in the other. Several other cases of suspected interaction with clarithromycin have also been reported in which patients developed rhabdomyolysis, pancytopenia, or neuromyopathy during treatment with colchicine. In most cases, concomitant risk factors such as preexisting renal and/or hepatic impairment were present. In a retrospective study of 116 patients who were prescribed clarithromycin and colchicine during the same hospital admission, 9 out of 88 patients (10.2%) who received the two drugs concomitantly died, compared to only 1 of 28 patients (3.6%) who received the drugs sequentially. The rate of pancytopenia was 10.2% in the concomitant group versus 0% in the sequential group. Multivariate analysis of the patients who received concomitant therapy found that longer overlapped therapy, the presence of baseline renal impairment, and the development of pancytopenia were independently associated with death. Overall, the risk of death was increased 25-fold in patients who received concomitant therapy and who developed pancytopenia.

MANAGEMENT: Due to the risk of life-threatening and fatal toxicity, patients with renal or hepatic impairment should not be given colchicine in combination with potent CYP450 3A4 inhibitors such as itraconazole, ketoconazole, voriconazole, nefazodone, delavirdine, protease inhibitors, and ketolide and certain macrolide antibiotics. In patients with normal renal and hepatic function, the dosage of colchicine should be reduced when used with potent CYP450 3A4 inhibitors or within 14 days of using them. For the treatment of acute gout flares, the adjusted dosage recommended is 0.6 mg for one dose, followed by 0.3 mg one hour later. Administration should not be repeated for at least three days. For the prophylaxis of gout flares, the adjusted dosage should be 0.3 mg once a day if the original regimen was 0.6 mg twice a day, and 0.3 mg once every other day if the original regimen was 0.6 once a day. For the treatment of familial Mediterranean fever, the maximum dosage of colchicine is 0.6 mg/day (may be given as 0.3 mg twice a day) when used in the presence of potent CYP450 3A4 inhibitors. Patients should be advised to contact their physician if they experience symptoms of toxicity such as abdominal pain, nausea, vomiting, diarrhea, fatigue, myalgia, asthenia, hyporeflexia, paresthesia, and numbness.


colchicine ↔ peginterferon alfa-2a

Applies to: colchicine, Pegasys (peginterferon alfa-2a)

MONITOR: The risk of peripheral neuropathy may be increased during concurrent use of two or more agents that are associated with this adverse effect. In some cases, the neuropathy may progress or become irreversible despite discontinuation of the medications.

MANAGEMENT: Caution is advised during concomitant use of agents with neurotoxic effects. Patients should be monitored closely for symptoms of neuropathy such as burning, tingling, pain, or numbness in the hands and feet. Since the development of peripheral neuropathy may be dose-related for many drugs, the recommended dosages should generally not be exceeded. Consideration should be given to dosage reductions or immediate discontinuation of these medications in patients who develop peripheral neuropathy to limit further damage. If necessary, therapy should generally be reinstituted only after resolution of neuropathy symptoms or return of symptoms to baseline status. In some cases, reduced dosages may be required.

No other interactions were found between your selected drugs.
Note: this does not necessarily mean no interactions exist. ALWAYS consult with your doctor or pharmacist.

Other drugs that your selected drugs interact with
•boceprevir interacts with more than 200 other drugs.
•colchicine interacts with more than 100 other drugs.
•ribavirin interacts with more than 10 other drugs.
•Pegasys (peginterferon alfa-2a) interacts with more than 100 other drugs.

[pooh55811]

I guess that is rather long, but in the section under management it says colchicine should not be given with protease inhibitors (like Victrelis).

"Due to the risk of life-threatening and fatal toxicity, patients with renal or hepatic impairment should not be given colchicine in combination with potent CYP450 3A4 inhibitors such as itraconazole, ketoconazole, voriconazole, nefazodone, delavirdine, protease inhibitors, and ketolide and certain macrolide antibiotics. In patients with normal renal and hepatic function, the dosage of colchicine should be reduced when used with potent CYP450 3A4 inhibitors or within 14 days of using them."

So it is definitely something to be discussed with your MD. Most likely he/she can find a substitute.

The protease inhibitors interact with so many drugs. I had to get off of Cafergot (migraine med) before I started treatment because of the potential bad interactions.

[Aquisi]

Thanks, I didn't think to look up allopurinol. It would make sense to take it with the triple with Vic. That sounds like the answer to me. You guys are awesome.

Charlie

[TripleCrown]

My husband has high levels of uric acid. Diet diet diet. It is shocking some of the foods that aggravate gout. Add cherry juice to sparkling water is a UA cleanser. Couldn't hurt.
Good luck!