From the Guidelines
Colchicine is a recommended treatment for acute gout, with a suggested initial dose of 1.2 mg followed by 0.6 mg after 1 hour, as it reduces pain and has fewer gastrointestinal adverse effects compared to higher doses. This recommendation is based on high-quality evidence from a study published in the Annals of Internal Medicine in 2017 1. The study found that lower doses of colchicine are as effective as higher doses for reducing pain in patients with acute gout, and are associated with fewer gastrointestinal adverse effects, such as diarrhea.
Key Points to Consider
- Colchicine is effective in reducing pain in patients with acute gout, as shown by high-quality evidence from several randomized controlled trials 1.
- The recommended dose of colchicine for acute gout is 1.2 mg initially, followed by 0.6 mg after 1 hour, as this dose is associated with fewer gastrointestinal adverse effects compared to higher doses 1.
- Common side effects of colchicine include gastrointestinal upset, particularly diarrhea, nausea, vomiting, cramps, and pain, as well as headache and fatigue 1.
- Colchicine should be used cautiously in patients with kidney or liver disease, as dosage adjustments may be necessary, and is contraindicated in patients with severe renal impairment who are also taking P-glycoprotein or strong CYP3A4 inhibitors.
Important Considerations for Treatment
- Start treatment with colchicine within 12-24 hours of symptom onset for best results.
- Continue the medication until the attack resolves, usually within 7-10 days.
- For prevention, long-term daily use may be recommended, especially for patients with frequent gout attacks.
- Be aware of potential interactions with other medications, and inform your healthcare provider about all drugs you're taking.
From the FDA Drug Label
The evidence for the efficacy of colchicine in patients with chronic gout is derived from the published literature. Two randomized clinical trials assessed the efficacy of colchicine 0.6 mg twice a day for the prophylaxis of gout flares in patients with gout initiating treatment with urate-lowering therapy. In both trials, treatment with colchicine decreased the frequency of gout flares. The efficacy of a low-dosage regimen of oral colchicine (total dose 1.8 mg over one hour) for treatment of gout flares was assessed in a multicenter, randomized, double-blind, placebo-controlled, parallel group, one week, dose-comparison study.
Colchicine is effective for gout.
- The recommended dosage of colchicine for prophylaxis of gout flares is 0.6 mg once or twice daily, with a maximum dose of 1.2 mg/day.
- The recommended dose for treatment of a gout flare is 1.2 mg at the first sign of the flare, followed by 0.6 mg one hour later, with a maximum dose of 1.8 mg over a one hour period 2.
- Dose adjustments are necessary when coadministering colchicine with certain interacting drugs, such as strong CYP3A4 or P-gp inhibitors 2.
From the Research
Colchicine for Gout
- Colchicine is approved in the US for the treatment of acute gout flares in adult patients and the prophylaxis of gout flares in patients aged >16 years 3
- The principal mechanism of action of colchicine in gout is thought to be inhibition of cytoskeletal microtubule polymerization, an important process in neutrophil functioning 3
- Studies have shown that colchicine is effective in reducing pain and clinical symptoms in patients with acute gout, with a number needed to treat (NNT) of 3 for pain and 2 for clinical symptoms 4
- Low-dose colchicine (1.8 mg over 1 hour) has been shown to be effective in reducing pain and is well tolerated in patients with acute gout, with a NNT of 5 5, 6
- High-dose colchicine has been shown to be effective in reducing pain, but is associated with a higher risk of adverse events, such as diarrhea, vomiting, and nausea 4, 6
- Low-quality evidence suggests that low-dose colchicine may be an effective treatment for acute gout, with similar benefits to non-steroidal anti-inflammatory drugs (NSAIDs) and a similar number of adverse events 7
- There is a need for further trials comparing colchicine to other treatments, such as glucocorticoids, and in populations with comorbidities 6, 7
Adverse Events
- The most common adverse events associated with colchicine are gastrointestinal, including diarrhea, vomiting, and nausea 3, 4, 6
- High-dose colchicine is associated with a higher risk of adverse events, with a number needed to harm (NNH) of 2 4, 6
- Low-dose colchicine has been shown to have a similar number of adverse events to placebo, with a NNH of 2 to 5 5, 6