Colchicine and Simvastatin

[fortunate]

Does anyone take Colchicine and Atorvastatin? I take Colcicine 500 micrograms twice daily. I have just been prescribed Atorvastatin for high Cholesterol but was warned by my pharmacist that there was a dangerous drug interaction between these two medications. My Dr says the risk is low but I've read several reports that the risk is not worth taking. I would really appreciate your advice.

[jzeis]

Hi fortunate,

I've been taking colchicine for at least 20 years. Last year, my PCP put me on simvastatin because of my high cholesterol. I take one tablet of colchicine (0.6 mg) in the morning, and my simvastatin (only 10 mg) before I go to bed.

I've had BD since 1979, although it wasn't diagnosed until 1996. My flares aren't as serious, or happen as often, now that I've gone through menopause.

When I start to flare, though, sometimes I take one colchicine in the morning and another before I go to bed -- that's usually enough to keep things in check. Last year, I took a second colchicine at night at the same time as I took my simvastatin. I couldn't believe how much pain I was in the next morning -- the muscles in my upper thighs were screaming, it was hard to walk, and it was pain like I'd never felt before. I spoke with my PCP, and she said she hadn't been worried about prescribing both drugs at the same time because my dose of each was so low. The interaction of the two can sometimes cause rhabdomyolysis (you can read more about it here: medlineplus.gov/ency/articl.... I stopped taking both drugs for about 3 days, until my muscles felt normal again.

Since I'd had such an extreme reaction taking both at the same time, my PCP suggested I stop simvastatin during flares and just continue with my colchicine. That's worked for me so far, and the problem hasn't happened again.

The bottom line is that colchicine is the only BD drug I've taken consistently because it works so well for me. And simvastatin helped drop my cholesterol levels to normal for the first time in years -- my total cholesterol had been close to 300 by the time I started taking it.

I don't know if this helps. It's really a decision that each person needs to make with their own doctor, depending on the dose you take of each drug. I can definitely understand if someone doesn't want to take the risk, though.

All the best,

Joanne Z.

[fortunate in reply to jzeis]

Thank you so much for this advice Joanne. The warnings I've seen about taking Atorvastatin and Colchicine do mention the possibility of getting Rhabdomyelisis so you are spot on there. I'm glad your solution of not taking the two together when you have a flare seems to be working for you. My problem is that I've had to start taking Colchicine all the time as my Behcet's has got worse lately and I was having flares of mouth ulcers more frequently. I used to just take Colchicine when I was in a flare. My Dr has left the decision up to me whether to take the statins or not and this does pose a bit of a dilemma as I would like to get my Cholesterol down to more normal levels. Mine is 6.5. As I live in Scotland, we use a different number system for measuring Cholesterol.

Joanna, I'm assuming that you wrote the book about Behcet's. I thought it was an excellent and well researched book which is invaluable for all Behcet's patients. I'm so honoured that you took the time to reply to me. I used to run a support group for BD sufferers in Scotland so know how varied and unpredictable the illness can be. Because our numbers are so small we don't have centres of excellence like they do in England so support is often patchy.

Thank you once again for your advice. I'll let you know of the decision I finally make.

[jzeis in reply to fortunate]

Hi,

You're in a tough spot for making a decision. I'm not sure what I'd do in your case, except stay in close touch with your doctor if you decide to keep using Atorvastatin

I looked up cholesterol levels on a converter, and my total level was about 7.7 before I started taking simvastatin, so it's worked incredibly well for me.

About my book -- do you have the Essential Guide to Behcet's, or do you have the most recent book? (Behcet's Disease: MyModernHealth FAQs) Either way, thanks so much -- I'm glad it's been helpful for you!

And yes, please let me know what you decide to do.

All the best,

Joanne Z.

[fortunate in reply to jzeis]

Hi Joanne

I asked for advice from my rheumatologist about the risks involved regarding taking Atorvastatin and Colchicine together. She sent me a letter, which she ccd my GP into, stating that there was indeed a risk of severe muscle problems when taking the two medications. She advised me to stop taking the Colchicine for the time being and to start on the statins as I am in a high risk category for heart disease as I also have high blood pressure. I think I will do what you do Joanne and just take the Colchicine when I have a flare and stop taking the statin until it passes. I used to just take Colchicine for a flare in the past, but as they were occurring more frequently my Rhuematologist suggested I take them all the time. I always felt quite fortunate that I only got mouth, throat and genital ulcers and did not have any joint or eye involvement like so many of the others that were in my support group. I thought things would perhaps settle down when I got older, which is sometimes the case, but instead things got worse. I am nearly 66 now and have had Behcet's since my late twenties but it wasn't diagnosed until about twenty years ago.

Thank you again for your sound advice and I'll let you know if this solution works for me.

All the best

Catherine

[jzeis in reply to fortunate]

Thanks Catherine -- let me know how things work out for you

Joanne

[rooser1]

I am curious to why 0.5 and not 0.6 of colcrys? Also to be a pushy know it all- have you considered dietary change to avoid the simvastatin? Im not talking about avoiding some foods- Im actually recommending a complete overhaul- the Keto diet. Ive been doing high fat, high protein, low carb for a long time now and its managing my BD wonderfully (i am on half a dose of colcrys as well and have been ulcer free since the diet).

It has MANY reports of correcting cholesterol and HBP, as well as managin inflammation in the body.

Do a quick google search and see what you think.

Stay well!

[jzeis in reply to rooser1]

Hi rooser1

Fortunate lives in the UK, and I'm pretty sure standard colchicine dosing there is 500 mcg/tablet.

About the Keto diet -- I spent a few days out of town with friends, and one of them was on the Keto diet. I got to see what she prepared and ate every day, and it was hard to watch. (I'm one of those people who feels terrible after I eat high-fat foods, and I usually have bad diarrhea.)

But I decided to educate myself, so I hunted around online until I found a PDF review that links to over 80 medical journal articles and summaries, looking at how effective (or not) the Keto diet is. For anyone who's interested, you can download it here: thepaleomomcom-xt0mxgicgroc...

Hope that helps -- and I'm glad you found something that works well for you, rooser1!

Joanne Z.

[fortunate in reply to rooser1]

Hi Rooser1

Joanne is right, the standard dosage of Colchicine is 0.5 mgs in Scotland I'm sure it was 0.6 mgs several years ago and don't know why it changed Colchicine has been available much longer in the UK than in the USA and is used quite extensively for gout

Regarding the Keto diet, I'm amazed that such a high fat diet can reduce cholesterol and high blood pressure. It seems a bit counter intuitive but you are testament that it works I tried the Atkins diet a number of years ago but really missed not being able to eat a variety of foods and got fed up with scrambled eggs I'm not massively overweight but could do with losing about seven pounds I have just been trying to cut out as much sugar as possible, as it now seems to be recognised that it is more dangerous than too much fat I have had high blood pressure since I was 20 even although I wasn't overweight and no obvious cause was ever found I also had pre-eclampsia in pregnancy and often wonder if there is a link to Behcet's as it is a vasculitis

Thanks for your inreresting advice regarding the diet I may try and eat more protein than carbohydrate as that generally works for me I love oily fish like Salmon and Trout just need to cut out the fresh cream Meringues, which I adore!

All the best

Catherine

[Matilda53]

I've been on both for years... the station drug is primarily to off-set the side effects of the prednisone I take. No problems.... but keep in mind that the colchicine can cause diarrhea

[fortunate in reply to Matilda53]

Hi Matilda

Thank you for your response. I am sure ther must be many more people like yourself who need to take both drugs and do not have any side effects. Everyone is different in how they may react to different drugs. I tend to be quite sensitive to some drugs so would be a bit wary of taking the two together.

Keep well and I hope the medications keep working for you.

All the best

Catherine

[g0rok]

Both colchicine and statin therapy may be associated with myopathy, which usually occurs after several months of therapy. The concomitant use, however, of colchicine and statin has been associated with the rapid onset of muscle weakness. Patients receiving combination therapy with colchicine and simvastatin, particularly in the presence of renal insufficiency, should be monitored for the development of myopathy, including rhabdomyolysis.

journals.lww.com/jclinrheum...