Colchicine + Z- Pack = BAD??? HELP

Gout Support Home Page Forums Please Help My Gout! Gout Treatment Colchicine + Z- Pack = BAD??? HELP

This topic contains 21 replies, has 7 voices, and was last updated by Profile photo of KeithTaylor KeithTaylor 1 year, 9 months ago.

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  • #3001 Reply
    Profile photo of cjeezy
    cjeezy
    Participant

    I started a prescribed Z-pack yesterday for a bout of bronchitis I'm trying to get over.  Well unfortunately I hd some twinges this morning so  I took 2 colchicine when I woke up and then another 1 every hour for the next 4 hours or so.  Long story short is I got really dizzy, couldn't think straight, had trouble breathing and felt the worst I've ever felt in my life. I'm sure anxiety symptoms were there too.  I called the pharmacist and she said that those to drugs shouldn't be mixed and for me to stop theColchicine immediately?  WTF? I had to leave work to lay down.  I havent taken Colchicine in over 4 hrs now and feel a little better. but I know the drug could have delayed effects.  How long until this stuff is outta me.  This is awful, plus I still have gout pain.  I left a message with my Dr, but havent heard back yet.

    #5804 Reply
    Profile photo of trev
    trev
    Participant

    Colchicine is not a drug to mess with- in my  exp. when co- admiinistered with other drugs.

    My last adventure on this was with statins and it took a couple of days for my system to reset, and that was on 6 x 0.5 mg Colch. over a day.

    The only antibiotic I usually take is incompatible with Colch also. (Erythromicin]

    I did feel pretty weird and the fact that medics don't actualy have much, if any,personal experience of what side effects can come about, makes it worse!

    If you're still at work, I would consider a few days rest to get your system steady-Likewise, any exercise regime.

    We're not  machines- and drugs , apart from the pain and worry about the illness, take toll on our metabolism at the best of times- which we don't always allow for.

    #5808 Reply
    Profile photo of zip2play
    zip2play
    Participant

    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.Cool)

    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.

    #5814 Reply
    Profile photo of cjeezy
    cjeezy
    Participant

    That was probably one of the worst days Ive had in a very long time! Dr never called me back yesterday.  This morning they left me a message saying to stop taking the Z pack and that they called me in another antibiotic called Keflex (or something like that).  Any ideas? How long does Colchicine stay in my system?  This is probably the worst situation for me now.  I cant breath and my foot is getting worse!

    #5817 Reply
    Profile photo of zip2play
    zip2play
    Participant

    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.

    #5819 Reply
    Profile photo of cjeezy
    cjeezy
    Participant

    Hi Zip,

    I took 6 or 7 .6mg Colchicine’s and 2 250mg of the Z pack the night b4. It just really pisses me off that the Dr didn’t see that the 2 could have a bad interaction. Luckily the 400mg of Alleve I took today is helping to somewhat keep my gout pain at bay. I started 300mg of AP today too. Next week Ill post me UA levels. Ill tell u, in the past month I have felt just horrible. I hope all this passes soon!

    #5821 Reply
    Profile photo of Utubelite
    Utubelite
    Participant

    Hi cjeezy,

    I hope you should be out of this drug interaction mode soon.

    I have couple of friends who have Gout experience and they rely on Aleeve. They actually talk so high about Aleeve and have never taken a Colchicine( one of them heard this name from me for the first time).

    I have no experience but Aleeve may workout as an alternative to Colchicine and help you till you can resume Colchicine. 

    #5826 Reply
    Profile photo of zip2play
    zip2play
    Participant

    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.

    #5827 Reply
    Profile photo of cjeezy
    cjeezy
    Participant

    No statins for me…luckily. I guess it will be a while b4 I can start Colchicine again. Should I have any worries about these two drugs still interacting in my system? I feel much better today, but as you said (also my pharmacist) these drugs have an extremely long half life.

    #5829 Reply
    Profile photo of zip2play
    zip2play
    Participant

    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!)

    #5833 Reply
    Profile photo of cjeezy
    cjeezy
    Participant

    I woke up at 5am last night to take my new antibiotic and my foot still hurt pretty bad. I hobbled to the medicine cabinet and took 400mg more of Alleve. I also checked my UA level and it turned out to be 4.2. Now that I’m moving around this afternoon, it seems to hurt a little more than yesterday (but at least I can somewhat walk on it). I hope it doesn’t get worse before it gets better. When would be a safe time that I could restart Colchicine? The last dose I took was at 10am on Thursday.

    #5834 Reply
    Profile photo of zip2play
    zip2play
    Participant

    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.

    #5835 Reply
    Profile photo of cjeezy
    cjeezy
    Participant

    Hi Zip,

    I stopped taking the Z pack (as recommended by my Dr). I only took that first 500mg. Yesterday I started the 10 day Rx of Keflex. Also, I’m hoping that the 4.2 was accurate for me last night. I’m thinking it was because I’ve started 300mg of AP whereas 200mg got my UA to around 5.

    As far as my chest, I’ve had breathing troubles since I stopped smoking about a month ago (the irony!). Finally last week Dr diagnosed me with Bronchitis and gave me Advair and the antibiotic. At least now I can inhale enough to try and cough everthing up. I think everything in my chest was impacted or something because it took damn near 3 weeks b4 I even developed a cough!

    My plan is to take 200mg-800mg of Alleve as needed everyday. Hopefully the pain in my foot now is from crystals dissolving and with my low UA it will dissolve quickly. I just want to get back to my normal life as much as possible. Hopefully I’m making progress.

    #5842 Reply
    Profile photo of cjeezy
    cjeezy
    Participant

    Kind of a random question, but is it possible that the Z-pack somehow triggered my gout flare up?  I'm only asking because up until that flare up (as shown in a previous post), my UA levels were consistently below 6.  Then one night, I take 500mg of the Z-pack for the first time, go to bed and bam another attack that same night…even though I had no soreness or warning signs whatsoever.

    Just a thought. I'll be curious as to what my UA levels will be on 300mg of AP.  Just ordered 50 more test strips.  I'll post results next week. 

    #5846 Reply

    Sorry I'm late to this topic. I hope you are OK now, cjeezy.

    This one has me a bit confused. When the Biaxin warning was issued about not taking that macrolide antibiotic if you were taking colchicine, the warning was based (at least partly) on “Fatal Interaction between Clarithromycin and Colchicine in Patients with Renal Insufficiency: A Retrospective Study”. In that study, the authors state:

    “If a macrolide must be prescribed with colchicine, azithromycin should be considered, because it is mainly excreted unchanged in bile and has no effect on cytochrome P450 metabolism and the P-glycoprotein transporter system.”

    Clearly, this is NOT the case.

    Anything that affects the liver is a risk. Whilst checking my references for this, I found a study earlier this year about potential problems with grapefruit juice -

    The data suggest that GFJ may augment colchicine oral bioavailability. Due to colchicine narrow therapeutic-index and severely toxic side-effects, awareness of this interaction is prudent.

    Though I'm not sure how much credence one should give to someone who abbreviates Grapefruit Juice to GFJ.

    Note: Pomegranate Juice (PGJ?) and some other fruits will probably have similar effects.

    #5847 Reply
    Profile photo of cjeezy
    cjeezy
    Participant

    …has no effect on cytochrome P450 metabolism and the P-glycoprotein transporter system.”


    I guess this is where the confusion comes in, as the print out my pharmacist gave me states the opposite.  Oh well, I'm feeling better these past couple days at least :). 

    #5853 Reply
    Profile photo of zip2play
    zip2play
    Participant

    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.
    #6206 Reply
    Profile photo of roosterwes
    roosterwes
    Participant

    GoutPal said:

    Sorry I'm late to this topic. I hope you are OK now, cjeezy.

    This one has me a bit confused. When the Biaxin warning was issued about not taking that macrolide antibiotic if you were taking colchicine, the warning was based (at least partly) on “Fatal Interaction between Clarithromycin and Colchicine in Patients with Renal Insufficiency: A Retrospective Study”. In that study, the authors state:

    “If a macrolide must be prescribed with colchicine, azithromycin should be considered, because it is mainly excreted unchanged in bile and has no effect on cytochrome P450 metabolism and the P-glycoprotein transporter system.”

    Clearly, this is NOT the case.

    Anything that affects the liver is a risk. Whilst checking my references for this, I found a study earlier this year about potential problems with grapefruit juice -

    The data suggest that GFJ may augment colchicine oral bioavailability. Due to colchicine narrow therapeutic-index and severely toxic side-effects, awareness of this interaction is prudent.

    Though I'm not sure how much credence one should give to someone who abbreviates Grapefruit Juice to GFJ.

    Note: Pomegranate Juice (PGJ?) and some other fruits will probably have similar effects.


    There is no doubt in my mind that Z Pacs cause flare up.  I think it is documented somewhere, but not sure.  It certainly does mine.  I happened to be reading on this wonderful website while being on a Zpac.  Also, my wife just happens to walk in the door with the colchicine I was prescribed today for severe tophacious gout.  I am also hurting and haven't taken colchicine in years.  What to do?  HELP  

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