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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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How Can Drug Interaction Between Methotrexate, Prednisone And Colchicine Be Prevented?

I’m on methotrexate for RA and have been experiencing what is believed to be gout attacks on the side of my right foot. I’m scheduled for ultrasound imaging on this foot on the 22nd of this month since it’s an unusual spot. To get me to my next appointment, my doctor put me on prednisone, which took care of the flare ups. But as soon as the pack was finished, I would have another flare up. So now I have a 5 mg prednisone prescription in which I was taking 4 pills for 2 days, 3 for 2 days, 2 for 2 days and then 1 5mg. As soon as I got down to 5 mg, I’m having another flare up, this time in my big toe on my left foot. I have the 5 mg prescription of prednisone, I have another “pack” of prednisone and I have colchicine. To avoid interactions, what should I do? I’m nervous self medicating with prednisone and not sure about potential interactions given the methotraxate, prednisone, colchicine and indomethacin. Thank you, Kevin
Thu, 30 Aug 2018
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Internal Medicine Specialist,  's  Response
Hi,

The general recommendation for flare prophylaxis of gout is to use Colchicine, with dose adjustments as needed for renal impairment, or intolerance, for first few weeks. Drug interactions are not well documented.

NSAIDs like Indomethacin are also used for prophylaxis but there are few studies that support their use; hence not recommended.

Methotrexate can be used with low maintenance doses of Prednisone.

Treating physician remains the best judge in individual case.

Hope I have answered your query. Let me know if I can assist you further.

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How Can Drug Interaction Between Methotrexate, Prednisone And Colchicine Be Prevented?

Hi, The general recommendation for flare prophylaxis of gout is to use Colchicine, with dose adjustments as needed for renal impairment, or intolerance, for first few weeks. Drug interactions are not well documented. NSAIDs like Indomethacin are also used for prophylaxis but there are few studies that support their use; hence not recommended. Methotrexate can be used with low maintenance doses of Prednisone. Treating physician remains the best judge in individual case. Hope I have answered your query. Let me know if I can assist you further.