What is the dose of colchicine (Colcrys) for treatment?

From the Guidelines

The recommended dose of colchicine for acute gout is 1.2 mg at the first sign of a flare, followed by 0.6 mg one hour later, as this low-dose regimen is as effective as higher doses in reducing pain and is associated with fewer gastrointestinal adverse effects. This recommendation is based on moderate-quality evidence from the American College of Physicians (ACP) clinical practice guideline 1. The ACP strongly recommends using low-dose colchicine to treat acute gout, with a grade of strong recommendation and moderate-quality evidence.

Some key points to consider when dosing colchicine include:

• The initial dose of 1.2 mg, followed by 0.6 mg one hour later, is the recommended regimen for acute gout flares 1.
• For gout prophylaxis, the standard dose is 0.6 mg once or twice daily.
• Dose adjustments are necessary for patients with renal or hepatic impairment, with reduced doses of 0.3 mg daily to every other day in severe cases 1.
• Elderly patients may also require lower doses due to decreased clearance.
• Common side effects of colchicine include gastrointestinal symptoms like diarrhea, nausea, and abdominal pain, which often serve as indicators to reduce or temporarily stop the medication 1.
• Drug interactions, particularly with CYP3A4 inhibitors and P-glycoprotein inhibitors, can significantly increase colchicine levels and toxicity risk, requiring dose adjustments 1.

It is essential to note that the evidence supporting the use of low-dose colchicine comes from moderate-quality studies, and the ACP recommends discussing benefits, harms, costs, and individual preferences with patients before initiating urate-lowering therapy, including concomitant prophylaxis, in patients with recurrent gout attacks 1.

From the FDA Drug Label

The recommended dosage of Colchicine Tablets, USP depends on the patient's age, renal function, hepatic function and use of coadministered drugs The recommended dosage of Colchicine Tablets, USP for prophylaxis of gout flares for adults and adolescents older than 16 years of age is 0.6 mg once or twice daily. The maximum recommended dose for prophylaxis of gout flares is 1.2 mg/day. The recommended dose of Colchicine Tablets, USP for treatment of a gout flare is 1.2 mg (two tablets) at the first sign of the flare followed by 0.6 mg (one tablet) one hour later. The recommended dosage of Colchicine Tablets, USP for FMF in adults is 1.2 to 2.4 mg daily.

The dose of colchicine is as follows:

• Prophylaxis of gout flares: 0.6 mg once or twice daily, with a maximum dose of 1.2 mg/day.
• Treatment of gout flares: 1.2 mg at the first sign of the flare, followed by 0.6 mg one hour later.
• FMF in adults: 1.2 to 2.4 mg daily. 2

From the Research

Dose of Colchicine

• The recommended dosage of colchicine for the treatment of acute gout flares is 1.2 mg at the first sign of the flare, followed by 0.6 mg in 1 hour 3.
• A low-dose colchicine regimen of 1.8 mg over 1 hour is effective in reducing pain and is well tolerated in patients with acute gout 4.
• High-dose colchicine may improve symptoms, but with increased risk of harms, while low-dose colchicine may be an effective treatment for acute gout with little or no increased risk of adverse events 5, 6.
• The incidence of adverse events is greater in those who receive high-dose colchicine versus placebo, with a number needed to treat to harm (NNTH) of 2 5.

Comparison of High-Dose and Low-Dose Colchicine

• Low-quality evidence suggests that high-dose colchicine may increase the number of adverse events compared to placebo, while low-quality evidence indicates that the number of adverse events may be similar with low-dose colchicine and NSAIDs 6.
• There may be little or no difference in benefit in terms of treatment success at 32 to 36 hours between high-dose and low-dose colchicine, but more adverse events are associated with the higher dose 5, 6.

Mechanism of Action of Colchicine

• Colchicine modulates multiple pro- and antiinflammatory pathways associated with gouty arthritis, including preventing microtubule assembly and disrupting inflammasome activation, microtubule-based inflammatory cell chemotaxis, generation of leukotrienes and cytokines, and phagocytosis 7.
• The multimodal mechanism of action of colchicine suggests potential efficacy of colchicine in other comorbid conditions associated with gout, such as osteoarthritis and cardiovascular disease 7.