What is the dose and frequency of Colchicine (colchicine) for acute gout flare-up?

From the Guidelines

Colchicine should be prescribed at a low dose of 1.2 mg initially, followed by 0.6 mg one hour later, for a total of 1.8 mg on the first day, to treat acute gout flare-ups, as this regimen is as effective as higher doses but with fewer gastrointestinal adverse effects. This recommendation is based on moderate-quality evidence from the American College of Physicians (ACP) guideline on the management of acute and recurrent gout 1, 2. The ACP strongly recommends using low-dose colchicine to treat acute gout, with the goal of reducing pain and minimizing adverse effects.

Some key points to consider when prescribing colchicine for gout flare-ups include:

• Starting the medication within the first 12-24 hours of a flare for maximum effectiveness
• Using a reduced dose in patients with kidney disease, liver impairment, or those taking certain interacting medications, such as 0.6 mg initially with no follow-up dose, then 0.3 mg daily for maintenance
• Monitoring for common side effects, including diarrhea, nausea, and abdominal pain, and temporarily stopping the medication if these occur
• Encouraging patients to rest the affected joint, apply ice, and maintain adequate hydration during a gout flare

It's also important to note that colchicine is contraindicated in patients with renal or hepatic impairment who are using potent cytochrome P450 3A4 inhibitors or P-glycoprotein inhibitors 1, 2. By following these guidelines and using low-dose colchicine, clinicians can effectively manage acute gout flare-ups while minimizing adverse effects and improving patient outcomes.

From the FDA Drug Label

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. Higher doses have not been found to be more effective. The maximum recommended dose for treatment of gout flares is 1.8 mg over a one hour period.

The dose and frequency of colchicine for a gout flare up is:

• 1.2 mg at the first sign of the flare
• 0.6 mg one hour later
• Maximum dose: 1.8 mg over one hour period 3 4 5

From the Research

Colchicine Dosage for Gout Flare Ups

• The standard dosage of colchicine for gout flares is not explicitly stated in the provided studies, but a study from 2021 6 compared the efficacy of low-dose (0.6 mg/day) versus regular-dose (1.2 mg/day) colchicine in preventing gout flares in patients initiated on urate-lowering therapies.
• The study found that low-dose colchicine was associated with a lower rate of adverse events compared to regular-dose colchicine, with no significant difference in the rate of gout flares between the two groups.
• Another study from 2024 7 used colchicine 0.5 mg daily as a prophylaxis for gout flares in patients starting allopurinol, and found that it was effective in reducing the risk of gout flares.
• A systematic review with network meta-analysis from 2024 8 found that colchicine was effective in reducing the incidence of gout flares when used as a prophylaxis, with a risk ratio of 0.50 [95% CI 0.35-0.72] compared to urate-lowering therapy alone.

Frequency of Colchicine Administration

• The frequency of colchicine administration for gout flares is not explicitly stated in the provided studies, but the studies mentioned above used daily dosing regimens.
• The study from 2021 6 used a daily dosing regimen of 0.6 mg or 1.2 mg of colchicine, while the study from 2024 7 used a daily dosing regimen of 0.5 mg of colchicine.
• The systematic review with network meta-analysis from 2024 8 did not provide information on the frequency of colchicine administration, but it did find that colchicine was effective in reducing the incidence of gout flares when used as a prophylaxis.

Colchicine in Gout Management

• Colchicine is a standard pharmacotherapy for gout flares, as mentioned in a study from 2025 9.
• It is often used in combination with other therapies, such as urate-lowering therapies, to manage gout.
• The use of colchicine in gout management is also discussed in a study from 2020 10, which reviews the current strategies for managing gout, including treating acute flares and addressing gout through the long-term regulation of serum urate.