Colchicine to Colcrys dilemna

[Rxnupe]

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Have many of you run into issues where you converted a patient who was formally on colchicine and now that you have switch to Colcrys the co-pay is astronomically high? It seems like I am getting one or two of these week and the most difficult thing is that there's no alternative for colcrys and the Colcrys coupons are invalid if you have Medicare and don't work for cash paying customers- what a headache!

 

[xiphoid2010]

Have many of you run into issues where you converted a patient who was formally on colchicine and now that you have switch to Colcry the co-pay is astronomically high? It seems like I am getting one or two of these week and the most difficult thing is that there's no alternative for colcrys and the Colcrys coupons are nvalid if you have Medicare and don't work for cash paying customers- what a headache!

Colchicine is no longer recommended by the VA as first line for long term gout management. In my book, it's a PRN med for acute attacks. Where I am at, we are converting all patients off of chronic colchicine See if you can thin the rank first from that angle.

 

[Rxnupe]

Colchicine is no longer recommended by the VA as first line for long term gout management. In my book, it's a PRN med for acute attacks. Where I am at, we are converting all patients off of chronic colchicine See if you can thin the rank first from that angle.

well of course medically Colchicine was an as needed "flare up" medication and never designed to be used as maintenance like Zyloprim(allopurinol) so what are you guys using to treat gout patients with acute flare ups?

 

[eagles22]

well of course medically Colchicine was an as needed "flare up" medication and never designed to be used as maintenance like Zyloprim(allopurinol) so what are you guys using to treat gout patients with acute flare ups?

NSAIDs

 

[rph3664]

Indomethacin is the drug of choice for a gout flare, and Celebrex is the alternate if the patient can't take indo for whatever reason.

Jay Leno's "Headlines" once had an RX bottle with the label "Take 1 tablet every hour for acute attack until you feel sick" and sure enough, it was colchicine.

 

[Praziquantel86]

It's amazing to think that we've come so far from drugs having directions "Take until pain relieved or GI disturbance results" or "Take until pain relieved or ears begin ringing". The wonders of modern medicine.

 

[Rxnupe]

Indomethacin is the drug of choice for a gout flare, and Celebrex is the alternate if the patient can't take indo for whatever reason.

Jay Leno's "Headlines" once had an RX bottle with the label "Take 1 tablet every hour for acute attack until you feel sick" and sure enough, it was colchicine.

Thanks for that info- at least I know Indomethacin is affordable on most plans

 

[Old Timer]

Thanks for that info- at least I know Indomethacin is affordable on most plans

Three Colocrys for an acute attack is also not out of the realm of affordable....

 

[rph3664]

Thanks for that info- at least I know Indomethacin is affordable on most plans

Indomethacin is one of the cheapest drugs out there; it would almost certainly be on the $4 plan, and even if it isn't, it doesn't cost much more than that.

My dad's had a couple of diet-induced gout flares, and he couldn't take indomethacin because he once had a bleeding ulcer. His doctor gave him a sample card with 6 Celebrex capsules, and he only needed one or two before the flare abated. If he has another, they'll probably put him on allopurinol.

 

[WhiteSnows]

NSAIDs

NSAID will increase uric acid and worsen gout.

 

[rph3664]

NSAID will increase uric acid and worsen gout.

They're the best thing for the pain, however. Gout is rare in women, but women who have had it have told me that the pain compared to childbirth.

 

[Praziquantel86]

NSAID will increase uric acid and worsen gout.

Is that a problem associated with chronic or acute use?

 

[meister]

NSAID will increase uric acid and worsen gout.

NSAIDs and indomethacin specifically are the drugs of choice. Are you thinking of aspirin?

 

[TemSirolimus]

NSAIDs and indomethacin specifically are the drugs of choice. Are you thinking of aspirin?

Aspirin will compete with uric acid secretion and exacerbate gout. Other NSAIDs are OK to use.

 

[owlegrad]

Asprin makes gout worse. NSAIDs are the DOC. Indomethacin has no benefit over other NSAIDs and in fact the side effect profile may be worse. It historically was the NSAID used to treat gout, but it has no benefit over other NSAIDs in the treatment of gout.

Evidence-based medicine. Gotta love it. 👍

 

[xiphoid2010]

well of course medically Colchicine was an as needed "flare up" medication and never designed to be used as maintenance like Zyloprim(allopurinol) so what are you guys using to treat gout patients with acute flare ups?

I was taught allopurinol for maintenance, Indocin 50 TID or steroids for attacks. But plenty of patients at my institution are maintained on daily colchicine. I don't agree with it, but that's the way it is.