Gout Medications (Colchicine, Allopurinol)
Common brand names: Zyloprim, Aloprim, Colcrys, Mitigare, Uloric
Three nutrients listed against this medication. The most severe is marked critical.
At a glance
One of the three is marked well documented. The other two carry their own evidence levels.
At a glance
- Vitamin B12Critical · Well documented
- MagnesiumModerate · Traditionally cited, limited evidence
- Vitamin CMild · Traditionally cited, limited evidence
Color shows how serious each listed effect is. The label beside it shows how strong the evidence is. The cards below explain each one and show its evidence.
Nutrients it can lower
Mechanism, Colchicine binds to microtubules in intestinal cells, directly blocking intrinsic factor-B12 complex absorption in the terminal ileum. Dose-dependent structural blockade of B12 absorption.
Common signs, Peripheral neuropathy, cognitive decline, megaloblastic anemia, fatigue, depression
Webb et al. (N Engl J Med, 1968; PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 5677718): colchicine causes reversible vitamin B12 malabsorption via an ileal effect (applies to the colchicine component).
Methylcobalamin 1,000–2,000 mcg sublingual daily is a range in common use, not from a trial cited on this row. Webb describes reversible B12 malabsorption through an ileal effect, not an intrinsic-factor effect, and tested no sublingual dose.
Mechanism, Hyperuricemia is independently associated with magnesium deficiency, low magnesium promotes uric acid retention. Colchicine-induced diarrhea increases magnesium losses.
Common signs, Worsening uric acid retention, cardiovascular risk, muscle cramps from diarrhea
Low magnesium is associated with higher uric acid. Zhang and Qiu (Nutrients, 2018; PMID 29498657) is a cross-sectional analysis of dietary magnesium intake in 26,796 NHANES participants: it studied no drug and establishes no depletion. The association also runs the reverse of a drug-caused depletion, so this row is retained as a monitoring note only.
Magnesium 300–400 mg daily is a range in common use, not from a trial cited on this row. The cited paper is a cross-sectional study of dietary magnesium and hyperuricemia in which no drug was studied.
Mechanism, Vitamin C is a uricosuric agent that increases urinary uric acid excretion. Gout patients are often Vitamin C insufficient, worsening the condition these drugs treat.
Common signs, No vitamin C deficiency has been demonstrated on allopurinol or colchicine. The cited association concerns gout risk, not vitamin C status.
Choi et al. (Arch Intern Med, 2009; PMID 19273781): higher vitamin C intake was associated with lower incident gout across 46,994 men followed 20 years. That is an effect of vitamin C on uric acid, not evidence that allopurinol or colchicine deplete vitamin C. This row is therefore retained as a monitoring note only, not as a depletion claim.
No trial has tested vitamin C repletion during allopurinol or colchicine therapy. The cited cohort measured dietary and supplemental intake, not a repletion protocol.
For your next appointment
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Disclosure
These statements have not been evaluated by the Food and Drug Administration. Any grade on this page describes the strength of published human trial evidence in the populations studied. It is not a recommendation for any individual and is not medical advice. Starting, stopping or changing any supplement or medication is a decision for your physician.
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