From the Guidelines
Colchicine is the preferred medication for treating acute gout flare-ups, whereas allopurinol is used for long-term management of gout. During an acute flare, colchicine works by reducing inflammation by inhibiting neutrophil migration and activity, thereby decreasing the inflammatory response to urate crystals in the joints 1. The typical dosing for acute gout is 1.2 mg initially, followed by 0.6 mg one hour later, with a maximum dose of 1.8 mg in the first 24 hours. Side effects of colchicine include gastrointestinal symptoms like diarrhea, nausea, and vomiting.
Key Considerations
- Colchicine should be started as early as possible, within 12 hours of flare onset, for optimal efficacy 1.
- Allopurinol, on the other hand, is a xanthine oxidase inhibitor that reduces uric acid production and should not be started during an acute attack as it can actually worsen symptoms initially.
- Allopurinol is typically started after the acute phase has resolved, usually 2-4 weeks after the flare has subsided, and is used for prevention of future attacks by maintaining lower serum uric acid levels.
Treatment Recommendations
- For acute gout flare-ups, colchicine is recommended as a first-line option, along with nonsteroidal anti-inflammatory drugs (NSAIDs) and oral corticosteroids 1.
- Prophylaxis against flares should be considered during the first 6 months of urate-lowering therapy (ULT), with colchicine being a recommended prophylactic treatment 1.
Important Notes
- Colchicine should be avoided in patients with severe renal impairment, and its dose should be reduced in patients with renal impairment 1.
- Allopurinol is recommended as a first-line ULT, starting at a low dose and increasing as needed to reach the target serum uric acid level 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 the treatment of acute gout flares. There is no information in the provided drug labels about allopurinol being used for acute gout flares. Therefore, based on the provided information, colchicine is the one used for acute flare up. 2
From the Research
Treatment Options for Acute Gout Flare
- Colchicine is used to treat acute gout flares, with low-dose colchicine being a preferred option due to its efficacy and safety profile 3, 4, 5
- Allopurinol is used for urate-lowering therapy to prevent gout flares, but it is not typically used to treat acute flares 6, 7
- Standard pharmacotherapies for gout flares include colchicine, NSAIDs, and oral or intramuscular corticosteroids, with IL-1 inhibitors as an option for flare refractory to standard therapies 6
Efficacy and Safety of Colchicine
- Low-dose colchicine has been shown to be effective in reducing pain and improving treatment outcomes in acute gout, with a similar safety profile to placebo 3, 4, 5
- High-dose colchicine may be more effective in reducing pain, but it is associated with a higher risk of adverse events, such as diarrhea and vomiting 3, 4, 5