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Gout Management

Bryan Hayes, PharmD and Mike Weinstock, MD
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Bryan and Mike discuss the pathophysiology of gout, what chronic gout medications patients might be taking, and acute pain management strategies with a focus on NSAIDS, glucocorticoids, and colchicine. They also present a pathway for when to refer the patient for outpatient follow up and possible preventative therapy.

 

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Tulja P. -

I work in an urgent care setting, most of my patients do not have a PCP and come in for recurrent gout flare ups asking specifically for colchicine. I usually do not have any previous labs or medical history for these patients in the system.

My question is regarding colchicine use:
1. Are there any relative contraindications to use of colchicine?
2. I was taught to monitor kidney and liver functions tests on patients using colchicine. Any suggestions on how often these tests should be ordered on patients having recurrent gout and taking colchicine? Do you recommend getting baseline labs before starting a patient on colchicine?

Mike W., MD -

From Bryan Hayes:
1) Colchicine is tricky because it's clearance is dependent on kidney and liver function AND it has some significant drug interactions. Its metabolism is inhibited by P-glycoprotein inhibitors or strong CYP3A4 inhibitors (eg, grapefruit juice, ketoconazole, verapamil). So, the absolute contraindication would be in the setting of renal or liver impairment PLUS concomitant inhibitors. The relative contraindication would be any conditions affecting one of those (eg, older adult with dehydration leading to AKI).
2) If you are able, a baseline set of kidney and liver function tests would be great. Primary care can follow up with 6-month or 12-month monitoring, or if an acute change is suspected.
--
Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP
Assistant Professor of Emergency Medicine, Harvard Medical School
Attending Pharmacist, EM & Toxicology, MGH
President, American Board of Applied Toxicology (ABAT)
Twitter: @PharmERToxGuy
PharmERToxGuy.com

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Difficult patient vs. personality disorder? Full episode audio for MD edition 187:27 min - 88 MB - M4AHippo Urgent Care RAP - May 2019 Written Summary 572 KB - PDF

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