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Has anybody had any experience using Uloric to treat high uric acid production gout in patients allergic to Allopurinol? I cannot find any reference to possible cross-sensitivity.

Leslie,
Uloric works well but is very expensive (especially in comparison to allopurinol which is dirt cheap). Although it is another xanthine oxidase inhibitor, its chemical structure is very different from allopurinol. I can find nothing to indicate that there is cross-sensitivity. As you may know, the PI does NOT say that it should be used with caution in those allergic to allopurinol.

Been meaning to mention your new avatar. Is that a mule or a donkey? Either way, a compliment is in order. If it is the former, I like your mule. If it is the latter, I like your new [censored].

Leave it to Jon, HA HA! He's back in full form!

I have used Uloric in a patient with tophaceous gout who could not tolerate allopurinol with no problem.

HAHAHA! It is a grumpy [censored], Jon. Thought it was pretty introspective of me.

Man, you need to have vacations more often so you can do all my research for me! I knew that the PI does not mention anything about cross-sensitivity but wondered if anybody had any anecdotal experience. This patient is allergic to allopurinol and NSAIDS. Her insurance wanted to charge her 400/month for colchicine!! Anyway, thanks for the help. HEEHAWW!

Leslie,
This from UpToDate....

The cost of prophylactic use of colchicine?may be an issue for many patients and their clinicians. In the United States, only one manufacturer's brand is approved for use, and the cost of the FDA approved product is reportedly 4.30 US dollars per tablet [88]. The manufacturer offers a program to defray the cost for eligible patients [89]. Resources for patients who need assistance paying for colchicine or other medications are reviewed separately. (See "Patient information: Reducing the costs of medicines (Beyond the Basics)", section on 'Help paying for your medicine'.)

Yes, Leslie, my enforced time off is a factor and I would be happy to be your part-time research assistant. In addition, I have gout which after a long period of denial and stubborness on my own part was diagnosed and successfully treated by my wife some years ago. So I have a personal interest in all of this...
As David points out, colchicine recently went from being a super cheap drug to a super expensive one. There are ways to get it cheaper but the paperwork can be a pain in the butt.
Speaking as a gout sufferer and as a gastroenterologist, I am often surprised by the reluctance of many docs to prescribe allopurinol (or Uloric, for that matter). I assume this reluctance is due to potential hepatotoxicity which in fact is relatively uncommon, and is easy to spot with blood work. Colchicine (even when cheap) is much better for an attack than it is for prevention, so why not put the patient on allopurinol, prevent the attacks, and obviate the need for colchicine?
Personally (since Leslie likes anecdotes) once I got my uric acid level down with allopurinol, I have had no need for colchicine.

A few months ago, I started Uloric on a lady who developed a fixed drug eruption shortly after starting allopurinol. She has been fine on the Uloric. Both worked really well for lowering the uric acid level. My main fear about allopurinol is the potential for Stevens Johnson syndrome, which I have seen in a patient (due to another cause) and I don't ever want to see again! I know a lot of other things can cause it, too, though. I have also seen bone marrow suppression from allopurinol twice, but caught it because I watch for it.

Someone please educate me but how did colchicine go from pennies to 4.30 a pill in the past year. I use to use it all the time, now no one can afford it. As I understand the DEA looked into how it was being prescribed, which had never been formally studied as how it was traditionally prescribed, then studied, and soon Colcrys became available--but now I can't get any of my limited incomed patients to afford it--jimmie

FDA not DEA--oops!!! jimmie

You are close Jimmie; not so much how it was prescribed as how it was made by the generic manufacturers. Here us a summary of the issue. I think the jury is still out on whether or not gout sufferers are getting screwed (and if the Colcrys makers are taking advantage).

A relevant quote: "In a ?Colcrys Myths and Facts? resource on its website, the company also notes that ?uninsured and Medicare Part D patients with household incomes of up to three times the federal poverty level (up to $66,000 per year for a family of four) can receive Colcrys free of charge. Uninsured and Medicare Part D patients with household incomes between three to four times the federal poverty level (up to $88,000 per year for a family of four) can receive Colcrys for $5 a month."

The problem is how difficult it is to actually implement the free medication programs. Most of the companies providing "free" medication make the patient submit extensive paperwork including tax returns and form signed by their physician, as well as proof that no one else covers the meds. How do you prove that you don't have drug coverage?

In a practical sense this would make it impossible to get colchicine promptly. But of course, a skeptic would say this is exactly what Big Pharma wants, good publicity with no commitment.

Jon,
thank you that link is very informative--the whole deal just doesn't seem right-I smell a rat.

John,
We (unfortunately) have a fair amount of experience with these programs, often for our inflammatory bowel disease and hepatitis C patients, as well as some run-of-the-mill proton pump inhibitor users. Just as you might expect, some companies make the process pretty easy and some make it such a pain that we never want to do it again. The Colcrys one is not bad. In general, if the patient has $0 income and can check the box "My income is 0 so I can't prove my income", then things move pretty fast.
Believe me, I am no apologist for Big Pharma.

I am thinking of the well-publicized $4/mo Lipitor program. They distributed dozen of applications to my office, but only a tiny percent of patients qualify for the discount. And no one on Medicare. Thanks Pfizer!

My other favorite gripe is about quinine. Yes, I know there were a few bad reactions... But the "approved" medications for leg cramps are no more benign, and don't seem to work. Plus, how many gin and tonic drinkers supper problems from the tonic portion? It is still available in Canada, last I checked. How about colchicine?

I researched the quinine issue a bit: there were reported 400 cases of sudden death in patients taking quinine, get this, over forty years, forty,
No stats, just anecdotal "data". The only science is prolongation of QT interval.
After listening to an ophthalmologist turned legistive assistant (i know, what??!?!?!) I suspect there was a legislator or a regulator who had a relative/loved one suffer sudden death while on quinine.
Colcrys was an opportunity a company seized when the FDA decided to "un-grandfather" colchicine. Thanks again to our great bureuacracy (hey! Anyone ever notice the bureaucracy is bureau +crazy -- just change the z to c . . . Sorry for the digression there).
Makes you want to consider have patients order certain meds from Canada!
So, what if the FDA decides to un-grandfather aspirin?

Just a comment on our society in the U.S. in relation to medications:
since every human being in the history of Earth dies eventually (excluding Jesus Christ), it would be quite simple to associate every medication ever invented as being involved in "sudden death." The real problem in our litigenous society is slowing the massive pendulum from swinging in its current direction. There is an over-cautious mentality, and a sense that all of our drugs must be deemed "safe."

We need to get over this pipe-dream, and everyone (especially the F-ing lawyers and the patients who hire them) needs to accept the fact that NO DRUG IS SAFE. Before too long, we won't have any drugs for anything. And it gets increasingly frustrating for my patients who are WILLING to accept the inherent risk of taking a certain drug only to find that it's no longer available in the U.S. Vioxx was an awesome drug for muscular and skeletal pain, dysmenorrhea, and arthritis. Too bad I still have patients who have never found an NSAID that worked as well as that one, including myself personally.

Spot on, Adam. But it is not just medication. It is everything. Our culture wants EVERYTHING to be risk free. The end result is that many things have devolved to a vanilla pudding like state where real innovation and advancement is no longer possible.

I would be much more tolerant of the risk-averse if we could a develop a simple check box that would say "I have checked the out to my satisfaction, and I still want to do it." Then I could sign my kid up for a chemistry class where they actually handle strong acids and bases, You could take Vioxx, and my elderly guy with severe cramps could use quinine.

Ya, I wish we had that check box for most things here in the states.

What a great thread! It is a sad state when all a doctor can think of any more is how many years left until retirement! I still have patients screaming for quinine. I tell them to do just what Roger said...drink some tonic and lemon before bed.

Sharon, thanks for the first-hand experience. My patient had a severe fixed-drug reaction to allopurinol as well. I think I will see how much they want to charge her for the Uloric.