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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.
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.
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.
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!
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.
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!
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.
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.
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.
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!)
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.
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.
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.
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.
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.
…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 :).
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.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
Wes,
First thought: take Aleve (naproxyn,) up to 800 mg./day, until a week after you are through with the Z-Pak. And then begin the colchicine if you need it.
A severe interaction between the macrolide and the colchicine is NOT worth the risk.
But another little dirty thought: the DANGER of the macrolide is that it prevents the liver from destroying the colchine so maybe a LITTLE colchicine will give a lot more relief than expected. THis is of course an IFFY proposition because it is hard to draw that line between just right and too much. But too much colchicine has a pretty good signature: murderous diarrhea.
If I were dosing myself, I think I would take up to 4 colchicine and see what happens. If no relief then I'd do the naproxyn.
How is your condition progressing that requires the Z-Pak?
I really think taking HALF a Z-pak is a terrible idea. Once started it should be finished to avoid a super rebound infection.
What is your basic treatment for tophaceous gout? Allopurinol, probenecid or BOTH?
I had actually taken my last Zpack pil today. I talked to the pharmacist, and he said he was aware of some crosses, but the zithromax had been alright with all his customers. So, I took my chances. 2 hrs ago (.6) and some swelling is gone. Can't type much, as my right hand looks like a balloon. I'm going to take two more and try to make it through the night. I think it actually worked better than the narcotics I still have. You know, the narcotics work great at first at making you not feel the pain. But, after awhile, they dryyou out and cause over use and extra swelling. The key for me is getting off the pain and pred, and most of all, patience. I always knew in the back of my mind what was going on, but it was too easy to take the pain meds and pred. I am paying for it now as I have some severe difformities. Especially one elbow. I'm going to suffer for months, but I've made up my mind to fight. Now, for some more water.
lGood choice Wes.
My personal experience has been horrific interactions between clarithromycin and Lipitor…never again. But I have taken several Z-packs over the last years for terrible bacterial bronchitis and there was no interference with the Lipitor. Maybe the same could be said for azithromycin-colchicine as your pharmacist implied.
So perhaps azithromycin isn't as coactive as some of the other macrrolides. Personally, I think it is a wonder drug.
And of course for gout pain, I don't think ANYTHING approaches colchicine for effectiveness. I think those who don't see great results with colchicine are usually just taking too little.
Is it ever a good idea to take colchicine when you are taking Z-Pak, or any other antibiotic?
If your immune system is fighting an infection, why compromise it with colchicine. I agree that, in most case, colchicine is absolutely the best first line attack against gout pain, but at times of infection, personally, I’d go straight to anti-inflammatories / analgesics.
See more information about azithromycin in the prescribing information for Colcrys within the colchicine guidelines.
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