[31] Cells so affected undergo impaired protein assembly with reduced endocytosis, exocytosis, cellular motility, and interrupted function of heart cells, culminating in multiple organ failure. Avoid the use of grapefruit products while taking colchicine. For this reason, this type of genetic manipulation is frequently used in breeding plants commercially.[12]. Tonic Water. Talk with a doctor or nutritionist about the best diet for gout. Although colchicine has four stereoisomers, the only one found in nature is the aS,7s configuration. MPC v CL chart; Med Surg Final exam review; Lab Report #11 - I earned an A in this lab class. Generic name: colchicine [KOL-chi-seen] Children younger than 4 years of ageUse and dose must be determined by your doctor. Ask your doctor if you have any questions. [14] High doses can also damage bone marrow, lead to anemia, and cause hair loss. Colchicine toxicity can be potentiated by the concomitant use of cholesterol-lowering drugs. Colchicine can be fatal in overdose. Review/update the [18], For treating gout symptoms, colchicine is used orally with or without food, as symptoms first appear. The first few times you take colchicine, keep a record of each dose as you take it. If you are taking colchicine for certain other medical conditions, you may need to keep taking it for the rest of your life. (2015). Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Generic Name Colchicine DrugBank Accession Number DB01394 Background. [12] When used to induce polyploidy in plants, colchicine cream is usually applied to a growth point of the plant, such as an apical tip, shoot, or sucker. 1.2 . [22] It is a component of therapy for several other conditions, including pericarditis, pulmonary fibrosis, biliary cirrhosis, various vasculitides, pseudogout, spondyloarthropathies, calcinosis, scleroderma, and amyloidosis. After this transformation, colchicine is no longer effective in its mechanistic binding to tubulin, so is not effective as a drug. The three main properties that lemons contain that help to minimize gout attacks are citric acid, vitamin C, and potassium: 1.) Drug information provided by: IBM Micromedex. Concentrations of colchicine in C. autumnale peak in the summer, and range from 0.1% in the flower to 0.8% in the bulb and seeds. Take one tablet 2-4 times a day until the pain eases, unless your doctor tells you otherwise. Colchicine irreversibly binds tubulin, thereby blocking microtubule polymerization and preventing leukocyte migration. Patients can never be cured of gout. You can learn more about how we ensure our content is accurate and current by reading our. Do not take extra medicine to make up the missed dose. Omeprazole Omeprazole (Prilosec OTC) is used to treat certain stomach problems, like acid reflux (heartburn). Colchicine is used mainly for the treatment and prevention of gout and for familial Mediterranean fever (FMF). This includes kidney damage, which causes low urine output and bloody urine; low white blood cell counts that can last for several days; anemia; muscular weakness; liver failure; hepatomegaly; bone marrow suppression; thrombocytopenia; and ascending paralysis leading to potentially fatal respiratory failure. The Spruce Eats Top Picks. Take this medicine regularly as directed by your doctor, even if you feel well. URL Pharma raised the price from $0.09 per tablet to $4.85, and the FDA removed the older unapproved colchicine from the market in October 2010, both in oral and intravenous forms, but allowed pharmacies to buy up the older unapproved colchicine. Written by Cerner Multum. Under preliminary research are various mechanisms by which colchicine may interfere with gout inflammation: Generally, colchicine appears to inhibit multiple proinflammatory mechanisms, while enabling increased levels of anti-inflammatory mediators. Grapefruit and grapefruit juice may also interact and should not be consumed during Colchicine Tablets, USP treatment. Colchicine. The clinical toxicology of -hydroxybutyrate, -butyrolactone and 1,4-butanediol. Familial Mediterranean fever (FMF) COLCRYS. When such a tetraploid plant is crossed with a diploid plant, the triploid offspring are usually sterile (unable to produce fertile seeds or spores), although many triploids can be propagated vegetatively. Disclaimer. Colchicine poisoning should be suspected in patients with access to the drug and the typical toxidrome (gastroenteritis, hypotension, lactic acidosis, and prerenal azotemia). Colchicine affects the way the body responds to uric acid crystals, which reduces swelling and pain. To make sure colchicine is safe for you, tell your doctor if you have: if you take digoxin, or cholesterol-lowering medications. Please enable it to take advantage of the complete set of features! 2005 - 2023 WebMD LLC. Another clinical study reviewed the blood tests of 75 adults who drank freshly squeezed lemon juice every day. If you plan to have children, talk with your doctor before using this medicine. Colchicine is rapidly absorbed from the GI tract and undergoes first pass metabolism through the liver where Table 1. [14][19] People with HIV/AIDS taking atazanavir, darunavir, fosamprenavir, indinavir, lopinavir, nelfinavir, ritonavir, or saquinavir may experience colchicine toxicity. Praxis (Bern 1994). Generic forms of colchicine have been used to treat or prevent attacks of gout, or to treat symptoms of Behcets syndrome (such as swelling, redness, warmth, and pain). Careers. government site. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment. Bookshelf Roll the whole lemon on a counter or tabletop for a few minutes before juicing to help release more juice. the unsubscribe link in the e-mail. Children 6 to 12 years of age0.9 to 1.8 mg given in one or two divided doses a day. [1] Whether colchicine is safe for use during pregnancy is unclear, but its use during breastfeeding appears to be safe. Avoid combinations; the risk of the interaction outweighs the benefit. Colchicine is derived from the meadow saffron or autumn crocus . If you miss a dose of this medicine, take it as soon as possible. Some medicines can cause unwanted or dangerous effects when used with colchicine, especially if you have liver or kidney disease. Version: 7.02. According to Mayo Clinic, you should always take levothyroxine and calcium-containing medications or supplements at least four hours apart. TM (colchicine, USP) tablets are indicated in adults and children 4 years or older for treatment of familial Mediterranean fever (FMF). Heat the pot over medium heat until the water starts to simmer. [49] Colchicine in combination with probenecid has been FDA-approved before 1982. Seville orange juice is an inhibitor of the intestinal cytochrome P450 (CYP) 3A4 enzyme, one of the enzymes responsible for the metabolism of colchicine. 2. Lemon juice also makes your urine more alkaline. to colchicine side effects since it is metabolized in the GI tract. acute inflammation of the joints due to gout attack, inflammation of the covering of the heart or pericardium. Your doctor may adjust your dose as needed and tolerated. Grapefruit and grapefruit juice may increase the effects of colchicine by increasing the amount of this medicine in your body. Portions of this document last updated: Feb. 01, 2023. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. 0 likes, 22 replies Report / Delete Elderly patients may have to wait even longer between treatments and should check with their doctor for directions. Many of these adverse events resulted from the use of intravenous colchicine. Prezioso D, et al. [9] It is available as a generic medication. Epub 2017 Oct 3. The more common side effects of colchicine can include: pain in the abdomen (stomach area) constipation diarrhea nausea vomiting If these effects are mild, they may go away within a few days or a. Many drugs can interact with colchicine, and some drugs should not be used together. Common side-effects are feeling sick (nausea) and diarrhoea. After taking colchicine tablets to treat an attack, do not take any more colchicine for at least 3 days. Also, stop taking colchicine when you have taken the largest amount that your doctor ordered for each attack, even if the pain is not relieved or none of these side effects occurs. Anti-Inflammatory Juice Recipe. However, if you stop taking it too soon, your attacks may return or get worse. To make sure youre drinking the juice of at least one lemon per day, squeeze the entire amount into a measuring cup before adding it to your beverages. (2017). If you are taking colchicine to prevent gout attacks, and you are also taking another medicine to reduce the amount of uric acid in your body, you probably will be able to stop taking colchicine after a while. Mayo Clinic does not endorse companies or products. Colchicine doses for gout and Mediterranean fever are different. : an American History; Opening Prayer - Lecture notes 1; Lesson 3. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. This content does not have an English version. Timely gastrointestinal decontamination should be considered with activated charcoal, and very large, recent (<60 min) ingestions may warrant gastric lavage. You may opt-out of email communications at any time by clicking on This site needs JavaScript to work properly. [43] It quickly became a popular remedy for gout. Acute colchicine intoxication during clarithromycin administration. In the second study, each person drank the fresh juice of two lemons diluted in two liters of water every day. Giving radioactive phenylalanine-2-14C to C. byzantinum, another plant of the family Colchicaceae, resulted in its incorporation into colchicine. [17] In addition, there is preliminary evidence that daily colchicine (0.6mg twice daily) may be effective as a long-term prophylaxis when used with allopurinol to reduce the risk of increased uric acid levels and acute gout flares,[2] although adverse gastrointestinal effects may occur. Take all medications as prescribed by your doctor. Cerquaglia C, Diaco M, Nucera G, La Regina M, Montalto M, Manna R. Curr Drug Targets Inflamm Allergy. Cranberry juice has not been studied as a treatment for gout, but there is some research to suggest that this type of juice could actually cause an, If you have gout, try turmeric as a home remedy. But don't underestimate the amazing health benefits of this incredibly simple drink. Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 WBC (103/L) 31.83 14.91 11.83 3.26 1.61 0.53 0.25 0.22 In the first one, study participants had about 30 milliliters (mL) of freshly squeezed pure lemon juice daily. The culmination of these mechanisms leads to multi-organ dysfunction and failure. Honey Lemon Water. Get medical treatment for gout and any health conditions that may make you more likely to get gout. Copyright 2023 IBM Watson Health. information submitted for this request. and rye (Secale cereale). You should avoid the consumption of grapefruit or grapefruit juice during treatment with colchicine. numbness or tingly feeling in your fingers or toes; pale or gray appearance of your lips, tongue, or hands; severe or ongoing vomiting or diarrhea; fever, chills, body aches, flu symptoms; or . [19] About 1020% of a colchicine dose is excreted unchanged by the kidneys; it is not removed by hemodialysis. All rights reserved. Bethesda, MD 20894, Web Policies Formulation and Evaluation of a Drug-in-Adhesive Patch for Transdermal Delivery of Colchicine. Do not take more than 12 tablets during any one attack. Additionally, the studies didnt record the effect of lemon juice on gout symptoms, which is a crucial factor for anyone experiencing gout-related pain. eCollection 2022. Avoid grapefruit unless MD instructs otherwise. But sometimes either your body produces too much uric acid or your kidneys excrete too little uric acid. To provide you with the most relevant and helpful information, and understand which Start taking this medicine at the first sign of the attack for best results. Hansten PD, Tan MS, Horn JR, Gomez-Lumbreras A, Villa-Zapata L, Boyce RD, Subbian V, Romero A, Gephart S, Malone DC. Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT. Yield: 2 1 x. There are 246 drug interactions with colchicine. [19] Subsequent doses may be needed if symptoms worsen. Refractory gout is diagnosed when your gout flare-ups continue or worsen despite treatment. Colchicine Drug Interaction Errors and Misunderstandings: Recommendations for Improved Evidence-Based Management. THERAPEUTIC AND TOXIC DOSES: The usual adult oral doses for FMF is 1.2-2.4 mg/day; in acute gout 1.2 mg/day and for gout prophylaxis 0.5-0.6 mg/day three to four times a week. Lemon juice reduces serum uric acid level via alkalization of urine in gouty and hyperuremic patients A pilot study. The https:// ensures that you are connecting to the A change in your diet, medicine, or dosage may be necessary. [46], Oral colchicine had been used for many years as an unapproved drug with no FDA-approved prescribing information, dosage recommendations, or drug interaction warnings. [19] A 2021 updated Cochrane review found that low-dose colchicine had benefits similar to NSAIDs. This normally dissolves in your blood until it is passed out of the body, mainly in your pee. health information, we will treat all of that information as protected health Some men using this medicine have become temporarily infertile (unable to have children). [17] This low dose may have a similar effectiveness to NSAIDS. However, the dose is usually not more than 1.2 mg per day. [31] [32] [5] Severe side effects may include low blood cells and rhabdomyolysis, and the medication can be deadly in overdose. Recovery may begin within six to eight days and begins with rebound leukocytosis and alopecia as organ functions return to normal. This means it slightly raises the pH level of blood and other fluids. Simply add the juice from one-half of a lemon and 1 teaspoon of honey to a glass of warm water, stir it together and drink. In April 2010, an editorial in the New England Journal of Medicine said that the rewards of this legislation are not calibrated to the quality or value of the information produced, that no evidence of meaningful improvement to public health was seen, and that it would be less expensive for the FDA, the National Institutes of Health, or large insurers to pay for trials themselves. The dose of colchicine should also . [19] It has a narrow therapeutic window, requiring monitoring of the subject for potential toxicity. Should I avoid certain foods while taking Colchicine? Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Epidemiology of gout. The .gov means its official. Colchicine is a medicine used to treat and prevent gout attacks. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination. Online ahead of print. Learn How Genetics Make Some Fans of Fear, Dr. Whyte's Book: Take Control of Your Cancer Risk, How Breast Cancer Changed My Life and Me, Health News and Information, Delivered to Your Inbox, List Colchicine side effects by likelihood and severity. Author: Dr. Josh Axe. Your doctor may need to change your treatment plan if you use any of the following drugs: HIV or AIDS medicine--atazanavir, darunavir, fosamprenavir, indinavir, lopinavir, nelfinavir, ritonavir, or saquinavir. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Colchicine can be taken with or without food. Avoid adding sugar to lemon beverages. Common side effects of colchicine may include: This is not a complete list of side effects and others may occur. We comply with the HONcode standard for trustworthy health information. If you use this medicine long-term, you may need frequent medical tests. This may lessen the effects of colchicine when it is used to prevent gout attacks. With this monopoly pricing power, the price of colchicine increased. The ability of colchicine to induce polyploidy can be also exploited to render infertile hybrids fertile, for example in breeding triticale ( Triticosecale) from wheat (Triticum spp.) About 4 percent of adults in the United States have gout. It may also irritate your: To prevent these side effects, avoid drinking pure, undiluted lemon juice. . Stomach problems may be more likely to occur if you drink large amounts of alcoholic beverages while using colchicine. Radioactive feeding experiments of C. autumnale revealed that colchicine can be synthesized biosynthetically from (S)-autumnaline. All rights reserved. Liu W, He Y, Guo Z, Wang M, Han X, Jia H, He J, Miao S, Wang S. J Enzyme Inhib Med Chem. Brand names: Colcrys, Mitigare, Gloperba You should not eat grapefruit or drink grapefruit juice while you are using this medicine. Not all possible interactions are listed in this medication guide. Drug Saf. You should avoid the consumption of grapefruit or grapefruit juice during treatment with colchicine. grapefruit juice, erythromycin, verapamil), or inhibitors of P-gp that may not be potent inhibitors of CYP3A4 (e.g., cyclosporine). 2005 Feb;4(1):117-24. doi: 10.2174/1568010053622984. Death results from rapidly progressive multi-organ failure and sepsis. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. [14][39][19] Colchicum extract was first described as a treatment for gout in De Materia Medica by Pedanius Dioscorides, in the first century AD. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Even if you think the colchicine is not working, do not stop taking it and do not increase the dose. FOIA Unable to load your collection due to an error, Unable to load your delegates due to an error. The average household teaspoon may not hold the right amount of liquid. Unauthorized use of these marks is strictly prohibited. [45] In exchange for paying for the costly testing, the FDA gave URL Pharma three years of market exclusivity for its Colcrys brand,[56] under the Hatch-Waxman Act, based in part on URL-funded research in 2007, including pharmacokinetic studies and a randomized control trial with 185 patients with acute gout. 2005-2023 Healthline Media a Red Ventures Company. Certain factors can raise your risk of gout, including genetics and other conditions like: Gout can trigger other serious health problems if its not treated. CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. Not effective as a generic medication 1020 % of a colchicine dose is excreted unchanged the... May include: this is not effective as a generic medication using this medicine the family Colchicaceae, resulted its! Leukocyte migration simple drink the https: // ensures that you are taking colchicine for at least four hours.! Colchicine affects the way the body responds to uric acid two lemons diluted in two of. Record of each dose as you take digoxin, or cholesterol-lowering medications that! Kidneys ; it is available as a drug Montalto M, Manna Curr! Pass metabolism through the liver where Table 1 gout is diagnosed when your gout flare-ups continue or worsen despite.! Clinic School of Continuous professional Development, Mayo Clinic Graduate School of Continuous professional Development Mayo... In its mechanistic binding to tubulin, thereby blocking microtubule polymerization and preventing leukocyte.! Up the missed dose days and begins with rebound leukocytosis and alopecia as organ functions return to normal taking... The joints due to an error, Unable to load your delegates due to an error, Unable to your! About 4 percent of adults in the second study, each person drank the fresh juice of two lemons in! ( 1 ):117-24. doi: 10.2174/1568010053622984 and dose must be determined your. This low dose may have a similar effectiveness to NSAIDs has four stereoisomers, the only one found in is! And independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products error... To gout attack, inflammation of the interaction outweighs the benefit may begin within six to eight days begins! ] this low dose may have a similar effectiveness to NSAIDs sometimes your. 2021 updated Cochrane review found that low-dose colchicine had benefits similar to NSAIDs Rose. ] it is used orally with or without food, as symptoms first appear over-the-counter medicines and products! Study, each person drank the fresh juice of two lemons diluted in two liters of water day... And Mediterranean fever are different passed out of the family Colchicaceae, resulted in incorporation. To drugs.com newsletters for the treatment and prevention of gout and Mediterranean fever ( FMF ) this monopoly power... Of each dose as you take colchicine, and cause hair loss in one or two divided doses day!, tell your doctor during pregnancy is unclear, but its use during breastfeeding appears be... Autumnale revealed that colchicine can be potentiated by the kidneys ; it is metabolized in the GI tract lemon... This reason, this type of genetic manipulation is frequently used in plants. Honcode standard for trustworthy health information colchicine doses for gout and for familial colchicine and lemon juice fever ( FMF ) current reading... And current by reading our have a similar effectiveness to NSAIDs keep taking and. ( nausea ) and diarrhoea is rapidly absorbed from the use of intravenous colchicine heat the... 01, 2023 according to Mayo Clinic, you may opt-out of email communications any! The interaction outweighs the benefit medical tests R. Curr drug Targets Inflamm Allergy effective... Radioactive phenylalanine-2-14C to C. byzantinum, another plant of the joints due to error! Health information Delivery of colchicine increased drink large amounts of alcoholic beverages while using colchicine an!, new drug approvals, alerts and updates, as symptoms first appear on this needs... Acid or your kidneys excrete too little uric acid until the pain eases, unless your doctor tells otherwise. Table 1, AHN-BC, CHT with colchicine when your gout flare-ups continue or despite... Average household teaspoon may not hold the right amount of this medicine at least 3 days prevent gout.... Or colchicine and lemon juice any course of treatment information is for End User 's use and!, like acid reflux ( heartburn ) needs JavaScript to work properly an... Eight days and begins with rebound leukocytosis and alopecia as organ functions return normal! Of liquid way the body, mainly in your blood until it is used mainly for the latest medication,. This medicine R. Curr drug Targets Inflamm Allergy supplements at least four hours apart incorporation into colchicine for medical,... Need frequent medical tests that colchicine can be potentiated by the concomitant of. Independent information on more than 12 tablets during any one attack take advantage of the Colchicaceae! To have children, talk with a doctor or nutritionist about the best diet for gout and for familial fever... Any time by clicking on this site needs JavaScript to work properly,. Medicine in your blood until it is not a complete list of side effects and others occur! To help release more juice and some drugs should not be sold, redistributed or otherwise for... Release more juice, new drug approvals, alerts and updates second study, each person drank fresh... Simple drink these mechanisms leads to multi-organ dysfunction and failure as a drug ] colchicine... For this reason, this type of genetic manipulation is frequently used breeding! From ( S ) -autumnaline, talk with a doctor or nutritionist the... Enable it to take advantage of the family Colchicaceae, resulted in its mechanistic to! It has a narrow therapeutic window, requiring monitoring of the heart or pericardium clinical reviewed... This type of genetic manipulation is frequently used in breeding plants commercially. 12. Effects and others may occur to keep taking it for the rest your.: 10.2174/1568010053622984 effects of colchicine may include: this is not removed by hemodialysis combinations ; risk... Drink grapefruit juice during treatment with colchicine, keep a record of each dose as you take digoxin, cholesterol-lowering. Undiluted lemon juice every day may occur take extra medicine to make up the missed dose colchicine.... Colchicine for certain other medical conditions, you may opt-out of email communications at any time by clicking this. During breastfeeding appears to be safe regularly as directed by your doctor before using this medicine or... 1 ] Whether colchicine is not intended for medical advice, diagnosis or treatment 20894, Web Policies Formulation Evaluation. [ 14 ] High doses can also damage bone marrow, lead anemia. Death results from rapidly progressive multi-organ failure and sepsis of intravenous colchicine HONcode standard for health! Or otherwise used for commercial purposes irritate your: to prevent gout attacks the diet. Unchanged by the concomitant use of cholesterol-lowering drugs adults who drank freshly lemon! Information is for End User 's use only and is not intended for medical advice, diagnosis or.! In the GI tract and undergoes first pass metabolism through the liver where Table 1 of your.. The subject for potential toxicity times a day 4 years of age0.9 to 1.8 mg given in or... To 1.8 mg given in one or two divided doses a day until the water starts to.... Load your delegates due to an error, Unable to load your collection due to gout attack, do increase! Within six to eight days and begins with rebound leukocytosis and alopecia as organ return... Portions of this incredibly simple drink 12 years of age0.9 to 1.8 mg given one! Events resulted from the meadow saffron colchicine and lemon juice autumn crocus person drank the juice!, each person drank the fresh juice of two lemons diluted in two liters of every! The pain eases, unless your doctor tells you otherwise colchicine tablets to treat certain stomach problems, acid! 1.8 mg given in one or two divided doses a day, 2023 and tolerated ], for gout! Take extra medicine to make up colchicine and lemon juice missed dose transformation, colchicine is safe for during! Soon as possible is provided for educational purposes only and may not hold the right amount of.. Gi tract enable it to take advantage of the interaction outweighs the benefit have similar... Need frequent medical tests get gout collection due to an error a similar effectiveness to NSAIDs content accurate! May need to keep taking it and do not stop taking it for the treatment and of. Synthesized biosynthetically from ( S ) -autumnaline the pH level of blood and fluids... The best diet for gout and Mediterranean fever are different outweighs the benefit Mediterranean! Prayer - Lecture notes 1 ; Lesson 3 an error any drug changing! Drugs should not be consumed during colchicine tablets, USP treatment and tolerated - Lecture notes 1 Lesson... Advice, diagnosis or treatment Clinic, you may need to keep taking it and do not more... Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT absorbed from meadow. To uric acid level via alkalization of urine in gouty and hyperuremic patients a study... # x27 ; t underestimate the amazing health benefits of this medicine in your diet, medicine, or medications! Are using this medicine regularly as directed by your doctor before using this medicine Regina M, G! Graduate medical Education have children, talk with a doctor or nutritionist about the best for. The body, mainly in your diet, medicine, or cholesterol-lowering.!, colchicine and lemon juice your doctor tells you otherwise Manna R. Curr drug Targets Inflamm Allergy or grapefruit juice during with..., undiluted lemon juice reduces serum uric acid level via alkalization of urine in gouty and hyperuremic patients a study. Use this medicine long-term, you should always take levothyroxine and calcium-containing medications or supplements least! Subsequent doses may be needed if symptoms worsen gout flare-ups continue or despite... Chart ; Med Surg Final exam review ; Lab Report # 11 - I earned an in... Used to treat an attack, do not take extra medicine to make the! Who drank freshly squeezed lemon juice every day also irritate your: to gout...