Can I administer 1.8 milligrams of colchicine at once?

From the Guidelines

You should not take 1.8 mg of colchicine at once, as the recommended initial dose for acute gout is typically 1.2 mg, followed by 0.6 mg one hour later, with a maximum of 1.8 mg over a 24-hour period. This is based on the strong recommendation and moderate-quality evidence from the American College of Physicians guideline on the management of acute and recurrent gout 1. Taking the full 1.8 mg at once increases the risk of serious side effects, including severe gastrointestinal issues, such as diarrhea, nausea, vomiting, cramps, and pain, as well as infrequent headache and fatigue.

Some key points to consider when using colchicine for gout treatment include:

• The medication has a narrow therapeutic window, meaning the difference between an effective dose and a toxic dose is small
• Colchicine is contraindicated in patients with renal or hepatic impairment who are using potent cytochrome P450 3A4 inhibitors or P-glycoprotein inhibitors
• Lower doses of colchicine (1.2 mg followed by 0.6 mg 1 hour later) are as effective as higher doses at reducing pain and are associated with fewer gastrointestinal adverse effects, as supported by moderate-quality evidence 1
• It is essential to consult with your healthcare provider for proper dosing instructions tailored to your specific situation, especially if you have kidney or liver problems which may require dose adjustments.

From the FDA Drug Label

The maximum recommended dose for treatment of gout flares is 1.8 mg over a one hour period. The answer is no, you should not give 1.8 mg of colchicine at once. According to the label, the recommended dose 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, which totals 1.8 mg over a one hour period, not all at once 2.

From the Research

Colchicine Dosage

• The provided studies do not specifically address the safety of administering 1.8 mg of colchicine at once 3, 4, 5, 6, 7.
• However, the studies suggest that low-dose colchicine (0.5-1.2 mg per day) is generally considered safe and effective for the treatment of acute gout and prevention of gout flares 4, 6.
• High-dose colchicine has been associated with an increased risk of adverse events, including gastrointestinal and muscle symptoms 4.
• The relationship between colchicine plasma concentrations and clinical efficacy or adverse events is not well established, and therapeutic drug monitoring may be of limited value in clinical practice 5.

Adverse Events

• The risk of adverse events associated with colchicine use is generally considered to be low, especially at low doses 4, 6.
• However, high-dose colchicine has been associated with an increased risk of adverse events, including gastrointestinal and muscle symptoms 4.
• The studies do not provide specific guidance on the management of adverse events associated with colchicine use, but suggest that the benefits of colchicine therapy may outweigh the risks in many cases 4, 6.

Special Considerations

• Patients with renal or liver disease may require dose adjustments or closer monitoring due to the potential for increased colchicine toxicity 6.
• Colchicine may interact with other medications, including statins, and patients should be monitored for potential adverse interactions 5.
• The studies suggest that colchicine may have beneficial effects on cardiovascular disease and chronic kidney disease, but further research is needed to fully understand these effects 6, 7.