What is the recommended dose and frequency of colchicine for acute gout flare-up?

From the Guidelines

For a gout flare-up, the recommended colchicine dosing is 1.2 mg at the first sign of symptoms, followed by 0.6 mg one hour later (total 1.8 mg), as this regimen has been shown to be as effective as higher doses with fewer gastrointestinal adverse effects 1. This dosing strategy is supported by moderate-quality evidence, which suggests that lower doses of colchicine are associated with reduced gastrointestinal adverse effects while maintaining efficacy in reducing pain and inflammation 1. The American College of Physicians recommends using low-dose colchicine to treat acute gout, with a strong recommendation based on moderate-quality evidence 1. Key considerations for colchicine dosing include:

• Initial loading dose: 1.2 mg followed by 0.6 mg one hour later
• Maintenance dose: 0.6 mg once or twice daily until the flare resolves, typically for no more than 7-10 days
• Dose adjustment for patients with kidney or liver impairment: reduced doses, such as 0.6 mg once daily or every other day
• Potential interactions with other medications, such as statins or certain antibiotics, which may require dose adjustment or avoidance of colchicine use 1. It is essential to take colchicine with food to minimize gastrointestinal side effects and to stop taking colchicine and contact a healthcare provider if severe side effects occur. Combining colchicine with adequate hydration, rest, ice application to affected joints, and avoidance of alcohol and purine-rich foods during flares can help optimize gout management. If you have heart or kidney disease or take certain medications, consult your doctor before taking colchicine due to potential interactions. Overall, the use of low-dose colchicine for acute gout treatment is supported by recent and high-quality evidence, and its benefits in reducing pain and inflammation while minimizing adverse effects make it a recommended treatment option 1.

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. The maximum recommended dose for treatment of gout flares is 1.8 mg over a one hour period. Colchicine Tablets, USP may be administered for treatment of a gout flare during prophylaxis at doses not to exceed 1.2 mg (two tablets) at the first sign of the flare followed by 0.6 mg (one tablet) one hour later. Wait 12 hours and then resume the prophylactic dose.

The recommended colchicine dose for a gout flare is:

• 1.2 mg at the first sign of the flare
• 0.6 mg one hour later The maximum dose for treatment of a gout flare is 1.8 mg over one hour. After treatment of a gout flare, wait 12 hours and then resume the prophylactic dose 2.

From the Research

Colchicine Dose and Frequency for Flare-Up

• The ideal colchicine dose and frequency for flare-up are not explicitly stated in the provided studies 3, 4, 5, 6, 7.
• However, it is mentioned that low-dose colchicine may have a cost and toxicity advantage over NSAIDs in the prophylaxis of gout when commencing therapy aimed at reducing elevated plasma urate concentrations 3.
• Colchicine 0.5 mg daily is used as a prophylactic dose in some studies, such as the one published in 2024 5.
• The management of gout in older adults involves careful selection of treatment based on potential benefits and consequences of therapy, considered in tandem with individual patient-specific characteristics, and colchicine is one of the options for acute gout treatment in this population 6.
• Colchicine is also mentioned as an option for the treatment of acute flares and prophylaxis of flares, along with NSAIDs, corticosteroids, and anti-IL-1 agents 4, 7.

Considerations for Colchicine Use

• Colchicine use in older adults may be limited by high cost, dosing restrictions in severe renal and hepatic dysfunction, gastrointestinal intolerance, and potential drug interactions 6.
• The dose of colchicine may need to be adjusted in patients with renal impairment 6.

Gout Flare Prophylaxis

• Anti-inflammatory prophylaxis when starting allopurinol using the "start-low go-slow" dose escalation strategy may be best targeted at those who have had a gout flare in the month before starting allopurinol and are commencing allopurinol 100 mg daily 5.
• For those with ongoing gout flares during the first six months of starting allopurinol who have not yet achieved serum urate target, a longer period of prophylaxis may be required 5.