Allopurinol vs colchicine for gout: compared
Allopurinol and colchicine are not alternatives so much as partners. Allopurinol lowers uric acid over months to prevent gout attacks and joint damage; colchicine treats a flare and prevents flares in the early months of allopurinol.
Updated October 4, 2026
At a glance
- Role
- Allopurinol
- Long-term: lowers uric acid
- Colchicine
- Treats flares; prevents flares when starting allopurinol
- How quickly it helps
- Allopurinol
- Months
- Colchicine
- Hours, when started early in a flare
- Main cautions
- Allopurinol
- Rare severe rash; interactions with azathioprine
- Colchicine
- Toxic with some common drugs; diarrhea
- Taken during a flare
- Allopurinol
- Continue it; do not stop
- Colchicine
- Yes, at the first sign
- Generic
- Allopurinol
- Yes
- Colchicine
- Yes
Allopurinol Zyloprim | Colchicine Colcrys, Mitigare | |
|---|---|---|
| Role | Long-term: lowers uric acid | Treats flares; prevents flares when starting allopurinol |
| How quickly it helps | Months | Hours, when started early in a flare |
| Main cautions | Rare severe rash; interactions with azathioprine | Toxic with some common drugs; diarrhea |
| Taken during a flare | Continue it; do not stop | Yes, at the first sign |
| Generic | Yes | Yes |
How they work together
Gout flares happen when uric acid crystals form in a joint. Allopurinol lowers the body’s uric acid so crystals dissolve over time, which prevents flares, but in the first months the shifting crystals can trigger more attacks. Low-dose colchicine taken daily during those months prevents them, and colchicine at the first sign of a flare cuts it short.
Allopurinol
Allopurinol is started low and increased until a target uric acid level is reached, then taken for the long term. Keep taking it during a flare. Stop and seek care for any rash, which can rarely be the start of a severe skin reaction; people of some Asian ancestries may be tested for a gene that raises this risk. It interacts dangerously with azathioprine and mercaptopurine.
Colchicine
For a flare, colchicine works best started within hours, at the dose prescribed; taking more does not work better and can be toxic. Clarithromycin, ketoconazole, ritonavir, cyclosporine and grapefruit juice can raise its levels dangerously, and doses are lowered in kidney or liver disease. Diarrhea is often the first sign of too much.
Other measures
Limiting alcohol, especially beer, sugary drinks and large amounts of red meat and shellfish can help, alongside staying hydrated. Anti-inflammatories or steroids are other options for treating flares.
Cost
Allopurinol is an inexpensive generic. Colchicine generics are available, though prices vary by product, so compare quotes.
Questions for your prescriber
- What uric acid level are we aiming for?
- How long should I take colchicine for flare prevention?
- Do any of my medicines interact with colchicine?
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Sources
Written by the Script Unlock editorial team from the sources above. It is general information, not advice for you or your pet; your prescriber decides which medicine is right.
Script Unlock is a marketplace that lets licensed pharmacies quote a cash price on your prescription. It does not prescribe, dispense or sell medication, does not process patient payments, and does not give medical advice. Always follow the instructions of your prescriber and pharmacist and read the medication guide supplied with your medicine.