Let’s begin with a
patient case. An elderly patient is
being treated with acetaminophen 650 mg po q6hr prn osteoarthritis pain of the
hands. She takes all four doses on most
days and does not feel this relieves her symptoms adequately. She has multiple comorbidities and is looking
for some therapy with improved efficacy.
She wants to know if Capzasin® over-the-counter would be a good choice.
HughesMedicine - Pharmacotherapy Pearls from the Internal Medicine Clinical Pharmacist
Sunday, June 23, 2013
Sunday, June 9, 2013
Dosing colchicine in acute gouty arthritis
Let’s start with a
patient case. An elderly patient with
multiple comorbidities is being treated in the hospital for heart failure when
he develops an acute gouty attack. His past
medical history, among other things, includes CKD (Stage 4). Should colchicine be used in this patient and
if so, what dose would be indicated?
The American College of
Rheumatology guidelines for the treatment of acute gout consider colchicine,
NSAIDs, and corticosteroids all first
line monotherapy (Evidence A) for moderate severity pain in 1-2
joints. A combination of these is
appropriate to consider in severe pain (Evidence C). Since all have the same grade evidence for
first line therapy, agent selection should be based on prior response,
comorbidities, and patient preference while also considering each agent’s drug
interactions.
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