From the Guidelines
Colchicine is recommended for the treatment of acute gout, with a typical dosing regimen of 1.2 mg followed by 0.6 mg one hour later, then 0.6 mg once or twice daily until the attack subsides, as it has been shown to reduce pain and inflammation associated with gout attacks. This recommendation is based on moderate-quality evidence from recent studies, including a clinical practice guideline from the American College of Physicians 1. The guideline suggests that lower doses of colchicine are as effective as higher doses at reducing pain and are associated with fewer gastrointestinal adverse effects.
Key Points to Consider
- Colchicine is a prescription medication that should only be taken under the guidance of a healthcare provider due to its potential for serious side effects and drug interactions.
- The medication works by reducing inflammation in the body, particularly by interfering with the function of white blood cells involved in the inflammatory process.
- Common side effects include gastrointestinal upset, such as nausea, vomiting, and diarrhea, and it is essential to follow dosing instructions carefully to avoid toxicity.
- Patients with kidney or liver problems may need dose adjustments, and it is crucial to inform the doctor of all medications being taken to avoid potential interactions.
Evidence-Based Recommendations
- The American College of Physicians recommends using low-dose colchicine when treating acute gout, with a strong recommendation based on moderate-quality evidence 1.
- The guideline also suggests that corticosteroids should be considered as first-line therapy in patients without contraindications, as they are generally safer and a low-cost treatment option 1.
- NSAIDs, such as indomethacin, naproxen, and ibuprofen, can also be used to treat acute gout, but their use should be cautious in patients with renal disease, heart failure, or cirrhosis 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.1 Gout Flares Colchicine Tablets, USP are indicated for prophylaxis and the treatment of acute gout flares. Prophylaxis of Gout Flares: Colchicine Tablets, USP are indicated for prophylaxis of gout flares. Treatment of Gout Flares: Colchicine Tablets, USP are indicated for treatment of acute gout flares when taken at the first sign of a flare.
Colchicine is indicated for:
- Prophylaxis of gout flares
- Treatment of acute gout flares The recommended dosage of Colchicine for prophylaxis of gout flares is 0.6 mg once or twice daily and 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 2, 2, 2.
From the Research
Efficacy of Colchicine for Gout
- Colchicine is an effective treatment for reducing pain and clinical symptoms in patients experiencing acute attacks of gout 3, 4, 5, 6
- Low-dose colchicine (1.8 mg over 1 hour) is effective in reducing pain and is well tolerated in patients with acute gout 4, 5, 6
- High-dose colchicine may improve symptoms, but with increased risk of harms 4, 5
Comparison to Other Treatments
- Colchicine may be used as a second-line therapy when NSAIDs or corticosteroids are contraindicated or ineffective 3
- Low-dose colchicine may have similar benefits to NSAIDs in terms of treatment success and pain reduction 5
- There is no evidence comparing colchicine to glucocorticoids (by any route) 4, 5
Safety and Tolerability
- Colchicine has a narrow therapeutic-toxicity window and important variability in tolerance between subjects 6
- Gastrointestinal adverse events (diarrhea, vomiting, nausea) are common with colchicine, especially at high doses 3, 4, 5
- Low-dose colchicine may have a lower risk of adverse events compared to high-dose colchicine 4, 5