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Part of the reason that statins are no longer the WONDER DRUGS OF THE AGES is that they are losing patent protection: Zocor lost its patent and is now simvastatin at a tiny fraction of the cost and the best selling drug of all time, Lipitor loses patent in 2011 to become cheap and lowly atorvastatin.
Soon you'll hear your doctor saying ” Oh NOBODY uses statins anymore, they cause muscle aches …except for CRESTOR which will remain WONDERFUL for a few more years.”
Zyloprim was hailed as a wonder drug until it became allopurinol and then it got poo-poohed, along with gout in general. Look for more and more allopurinol bashing when doctors all get on the Uloric gravy train.
And the opposite is even funnier: “Oh nobody takes colchicine anymore” will become “Yes COLCRYS is a WONDER drug…an INSTANT cure for gout”
It would all be quite hysterical if it wasn't so sad.
Yes trev, I like the colchicine test for statin intolerance…perhaps throw in a macrolide antibiotic.
I don't think there are negatives associated with too low a uric acid level…most species don't excrete any at all any because they have enzymes to instantly convert it to allantoin which is readily soluble.
Excretion of urea, allantoin, uric acid are ALL ways that species get rid of poisonous nitrogenous wastes because ammonia, the first product of protein breakdown, is highly poisonous.
But your doctor is wise because what he is not saying is that while there might not be harm from too low a number there MIGHT be harm by the methodology employed to GET that number. He is operating from the baseline that the less allopurinol, the better.
What is clear is that uric acid is a poison with only a very few useful functions…it helps people with MS MAYBE. It is implicated in hypertension, kidney disease, heart disease, diabetes and the SOLE cause of gout. If we all had serum uric acid of 3.0 we'd all be a lot healthier BUT not if we had to take 1000 mg./day allopurinol and 2 grams of probenecid to achieve it.
These “desirable” uric acid numbers are generated by averages and the averages are for a society that eats far too much meat in the opinion of many. Certainly far more meat than was consumed by the average Joe 200 years ago who had Sunday chicken. The pcsture of Henry VIII with his bandaged leg chewing on a leg of lamb is valid.
It's like somebody in a society where EVERYONE smoked (like 1950 America
) with a horrible hacking cough and his doctor tells him to cut down from 2 packs a day to 1. The FACT is the right amount of cigarettes is ZERO but society accepts norms.Another parallel might be that people live very long if they have blood pressures of 100/60. But if they normally run 150/95 and to achieve the 100/60 they needed to take a beta blocker, an ACE inhibitor, an angiotensin receptor blocker, several diuretics, and a calcium channel blocker while popping nitrates under their tongue, they WON'T live very long.
So your doctor is compromising saying that you could have attacks at 6.0 but probably won't at 5.0, and if you need to get rid of tophi you might need 4.0 but that is good enough. Nothing BAD about a 3 but no need to slave for it.
How LO can you GOUGH?
(Does your paperwork describe what LO means? Can one have minus urate? Antigout perhaps?
)my dr just measured my uric acid to tell me that i have gout, why should i believe that!!
You will have to find a dooctor whom you WILL believe.
A good rule of thumb that most doctors will use is that if you have several attacks in a year or two crippling attacks involving the bunion joint of the big toe along with a high uuric acid THEN you will start on medications. One sore wrist is probably not a good reason to start lifelong medication. I started my medication after my 4th attack, all of which put me on crutches.
My worst problem, as I've said was with clarityromycin but I am okay with azithromycin and even erythromycin but others disagree:
- Group 1 agents include erythromycin and troleandomycin. Both drugs bind strongly to and inhibit markedly CYP 3A4. Since troleandomycin was withdrawn from the market many years ago, this drug will not be discussed further in the present paper;
- Clarithromycin belongs to Group 2 agents. This drug exhibits lower affinity for CYP 3A4 as compared with erythromycin, and form complexes to a lesser extent;
- Group 3 include azithromycin and dirithromycin. These compounds have been shown to interfere poorly with cytochrome P-450 system in vitro.
The discrepancy between what is expected from in vitro data and what may be observed in clinical practice underscores the well-known interindividual variability in the extent of cytochrome P-450 catalytic activity (as much as 10- to 20-fold). This pattern provides some explanation for why some patients appear to be more susceptible than others to a given drug–drug interaction.Clarithromycin has recently appeared to be similar to erythromycin in some drug interactions (e.g. with psychotropic agents), on the basis of the results of some clinical studies. Furthermore, a number of recent clinical case reports demonstrate that azithromycin and dirithromycin still exhibit some potential for drug interactions, although to a much lesser extent than that with erythromycin.But I think that 10 to 20 times variability speaks volumes. It's highly personal and even genetic.On the grapefruit juice, I think it's not quite anathema and it takes a quart or more of juice to cause considerable CYP 450 3A4 suppression. And that's a LOT of sour to tolerate.I have never tried a macrolide with colchicine; all my experiencee is with macrolides and Lipitor…but myalgia or rhabdomyolysis isn't a walk in the park. by any means.Having experienced a murderous reaction between clarithromycin and LIPITOR (arguably the most prescribed drug on the planet for several years) I am convinced that clarithromycin should be BANNED!
I think the VALUE of the test is an absolute, of course subject to error. Mg/dL is a physical measurable quantity…it is NOT relative.
The RANGE given by any lab is an interpretation gleaned by opinion. Thus in the labs of the original original post a 7.3 mg/dL urate concentration would be the same number in all 4 labs if the tests were done perfectly but would be flagged in only the last two as “HIGH.”
It would be good if there was a proviso for two ranges: one for those with proven gout and one for those without gout. Actually there are two ranges commonly used for UA: a low range for womenn and a higher range for men.
It sounds like a good plan Peter. I would add is to take both drugs AFTER a meal rather than on awakening with an empty stomach.
Taking the 100 mg. for two more weeks seems unnecessary to me because it is usually done just to see if one is intolerant to allopurinol (NOBODY gets enough benefit to stay at this dose) but you have ALREADY taken this dosage. But your doctor is the one with the Rx pad.
For the next month, until you have your allopurinol at 300 mg. eliminate organ meats, broths and gravies, eliminate fish, limit meat. Try to get most of your protein your protein from milk and eggs. Drink lots of water.
You know, if that 4.2 is honest, I don't see that you will need any more colchicine. I AM aware that UA drops during an attack and that allopurinol mobilizes deposits but 4.2 is SUCH a nice place to be I might espect things to clear up for you pretty fast.
In any case, just remember that more than half of your arithromycin is available for 3 days.
How's your chest?
Here's what I would consider: finish the Z-pak and forget the colchicine for a week or two. Take as much Aleve as you need …nothing wrong with 800 mg./day.
Taking half an antibiotic dose often gives a dangerous bug the opportunty to transform into something resistant to the drug…and far more dangerous.
Hmm, nothing for New Jersey, eh. Of course you can just GUESS my state!
That's a pretty good markup for ODAN, but fair. How much do they get for shipping…often it's outrageous?
Canadaway has an ugly little addendum at the bottom of their page:
The FDA, due to the current state of their regulations, has taken the position that virtually all shipments of prescription drugs imported from a Canadian pharmacy by a U.S. consumer will violate the law.
So much for the lip service paid to free trade.
Glad you're feeling better. Since it involves logarithms (oy) and I;ve forgotten how to use them but I guess it might be fair to say that 20- 30% of each of the drugs has gone by now.
Is the Aleve continuing to do a good job? I usually take 2 the first day and then one every day for a while for my knees or shoulder My only compaint is it causes weight gain that I HATE and I'm not sure whether it's water weight (tolerable) or FAT weight (which is NOT!)
Ammar,
Summary The concentration of serum-uric-acid (S.U.A.) was determined by a colorimetric method in 1010 male subjects from northern Thailand (710 recruits, 300 prisoners). S.U.A. levels were compared with several constitutional and genetic factors. Body-weight, glucose-6-phosphate dehydrogenase deficiency and haemoglobin E do not seem to influence S.U.A. concentration in this population.
No link to high uric acid found either. But your 445 mg. uric acid (presumably European molar measurement) corresponds to a high 7.5 mg./dL and if a doctor said you have gout, then you really need to be on a treatment plan to lower your serum uric acid by 20% or more (no matter how it's measured.) Keeping your mumbers below 6.0 or 355 will insure that no further damage occurs.
(On that hereditary deficiency, you might consider avoiding beans like the plague but then you probably know that.)
Okay cjeezy get ready for a doozy factoid: the half life of azithromycin is 68 HOURS. The half life of colchicine once it gets into the white blood cells can be 60 HOURS.
It is a good thing that you took only 500 mg zithromax.
I hope you aren't taking a statin too.
Thank you for doing the Aleve experiment. I love the drug and am AMAZED it's OTC but have never used it for gout pain. Maybe if cochicne prices go to infinity, it will become my mainstay.
One confusing thought ruff, Kohler's is a childhood disease.
You might find this blurb interesting:
Kohler's disease was thought by many to be avascular necrosis of the tarsal navicular primarily based on the radiographic signs. It is now a much more controversial subject. Kohler's disease is can be a very confusing and ambiguous entity due to uncertain etiology and often times vague symptoms. A history of trauma is only elicited in approximately 35% of cases and symptoms that correlate with the radiographic signs are very sporadic.
When a diagnosis of Kohler's disease is made, the typical patient is a young male, typically between 3 and 7 years of age. It is unilateral approximately 75% of cases.
The controversy of Kohler's disease stems from the fact that many authorities feel that this process is not a “disease” at all, but rather a process of altered, but completely normal, ossification of the tarsal navicular which leads to the radiographic appearance.
There are two main reasons for the idea that this often times is not osteonecrosis is the fact that 1) there are a lack of symptoms and 2) it is a self-limiting condition.
The radiographic appearance is sclerosis, overall flattening and deformity of the navicular. But, again, it's the associated signs and symptoms, as described that must be present for a confident diagnosis. MRI or bone scan may help confirm the diagnosis, but because of its self-limiting nature, it most likely is not warranted.
It's not an easy call and treatments as well as causes are extremely varied.
I hope you're in good hands.
What is the cause of your neuropathy?
Keflex is a cephaloprin, so probably alright. Colchicine stays in the system for DAYS, just like azithromycin.
The upside, if there is one, is that the Z-pak is preventing the breakdown of the colchicine thus you are getting the the benefit of a much larger dose…good and bad.
How many of each did you take? Do you have the 6 X 250 Z-pack or the 3 x 500.
Quite a coincidence…I'm also waiting for my doctor to get back to me about calling in 90 colchicne…my pharmacist has ONE bottle left so I hope the doctor doesn't fiddle around.
I hope you don't run into a shortage in Denver.
Of one thing we can be sure: now that doctors will be urged (bribed?) to peddle two very expensive drugs like Uloric and Colcrys, they will find that every ache and pain is gout. So it will no longer be the obscure compaint that doctors roll their eyes at but the glitzy new disease that is highly profitable…perhaps the largest prescribers can expect a new Mercedes in their garage as a way of the drug companies saying THANKS!
I predict that within 3 months the New York Times Magazine will have a glossy cover with the word GOUT in 60 point type.
I will write to my two Senators and voice my concern.
We must';t be too quick to assume that Health insurers will be picking up the cost of Killer Colcrys (I LOVE the name).
For one thing, MANY private policies have no provisions for picking up ANY drug costs. I long had a plan that DID but only to the tune of 50%. Now I am on Medicare and I have Medicare D (the awful drug plan of the Bush years) and Colcrys, IF it is even allowed in the federal formulary will be classed as a non-preferred Brand Drug with a $58 co-pay per month's supply…if it is called a PREMIUM drug (not unlikely) my bite will be 33%. (As a preferred generic my cost was $4.)
Several years agon the FDA attempted to bring vitamins under prescription. Congress stepped in and said NO WAY.
I guess we can hope things work this way again.
Perhaps a judge might rule that the patent is not valid…after all, there must be several generic manufacturerrs with deep enough pockets to sue the FDA. It's done all the time.
I have read that the MOST severe drug interaction might be had with clarithromycin and colchicine. Clarithromycin like erythromycin AND azithromycin (Z-pak) are all macrolide antibiotics and interfere with the liver's ability to break down other drugs.
(Hint: they also prevent the breakdown of Cialis…with the most pleasant of consequences.
)Coincidentally all three are contraindicated with statins and I had a DOOZY of a reaction between Lipitor and clarithromycin after ear surgery…leg pain so bad I bent down to get something and wound up on the floor unable to muster the strength in my legs to get up. Scared the Schitte out of me. I can get away with the Z-pak and even erythromycin but I will NEVER take clarithromycin again.
Remember cjeezy, Azithromycin has an EXTREMELY long half life…that's why you need take only 3 (or 6 of the older variety.) So be sure to wait til several days AFTER your last pill before taking another colchine. Yes, you are caught between a rock and a hard place…maybe give Aleve a try.
One would have thought that at the time they took the trouble to aspirate joint fluid they'd have taken a vial of blood for a uric acid test. It defies logic they did one without the other.
Treatment of choice is colchicne and allopurinol but you need an Rx for them, so why not call your dictor and ask him to call in a prescription for colchicne.
Second choice, but far behind, is probably indomethacin, again Rx. If you are in the U.S. you can buy a bottle of naproxyn without Rx and give it a try. Do NOT take aspirin
I guess you can try some of the old nostums if desperate: cherries, a couple tespoons of baking soda each day, black bean broth. .
Sure, the two ingredients are allopurinol and colchicine…easy peasy!
As for THE BOOK, there are a jillion of them spouting nonsense…most require daily cherries and abstinence from sweetbreads, say WHAT?
Everything else on the market is a combination of colchicine and probenecid, so that's what you've probably been taking.
There has long been a product on the market called Colbenemid, a large pill that combined probenecid and cochicine. I think your cousin is confused.
Along with pagey, I too think that once we have had gout attacks in our feet they are not quite the same feet as before…some permanent damage is probably likely. My right bunion joint is larger and slightly more pointy than the left and my right was where I had the attack of DEATH!
But then haven't people allways complained of BUNIONS?
Who's to know for sure?
The horrible but true fact is that IF you have gout, medications work and a life of “good living” doesn't.
Gout is a killer and before there was decent treatment (circa 1950) every shaman, witch doctor, herbologist, accupunturist, chiropractor, and “new ager” had a fake cure that separated us from our money but not our pain.
Check you uric acid and if high, control it..
Very similar rationale pertains to diabetes before insulin…lotsa “cures” that left the dead in heaps during their teen years. Same for syphilis before penicillin, except death took longer and involved dementia.
There has NEVER been a disease where someone wasn't selling a “cure”…arthritis with copper bracelets, sitting in radium caves, eating one of a thousand “nutritional” aids.
When the REAL cure emerges there are still the shamans who depend for their living on the nonsense cure.
You probably CAN take the 300 mg now because of that long half life of oxypurinol you won't have the full effects of the change for a week or more.
I guess if the obscene FDA ban on generic colchicine comes to bear on us, we (in the U.S. at least) will be counting on allopurinol more because we cannot risk an acute attack and dosing with $5.00 Colcrys tablets. I for one have has only ONE 9 day attack of EXCRUCIATING, CRIPPLING podagra and it was so AWFUL that I don't think I could bear another, especially if a gun was handy. If colchicine becomes unavailable to me I will go to 400 mg. allopurinol to keep my numbers below 5.0 to do all I can to insure no attack..
I HAVE been walking around with my numbers in the mid 6's probably for some time (what with my lowering to 200 mg.) and I haven't been hit with anything but the occasional morning twinges. Maybe I got away with it and you didn't becasue I have been on 2 decades of allopurinol and maybe I have fewer active exposed deposits? Does that sound reasonable?
In any case, I think a small amount of colchicine will resolve your newbie!
youtube,
Have you ever tried colchicine? In many cases it is diagnostic in that if it helps a lot the pain is gout; if it doesn't do much, it is NOT gout. This isn't infallible but it is GOOD evidence.
For non-gout aches and pains I STRONGLY recommend Alleve (or the cheaper generic naproxen.) In my experience it has no peers among the NSAIDS and we in the U.S. are lucky that it does not require an Rx. Pop 2 (200 mg. each) of them and you might be amazed.
(I wrote to Bayer and they told me their research also showed it to be good for gout pain without affecting serum uric acid…but I haven't used it for gout, I don't THINK. It works wonders on my knee and shoulder pain.)
trev,
Sorry you whacked your little toe last night, I have a tendency to do the same thing. My last was into a dumbbell left on the floor and, yes it's true, we CAN actually see stars.
