What is the recommended dose of colchicine (Colcrys) for acute gout flare?

From the Guidelines

For acute gout flare, the recommended colchicine dosing is 1.2 mg followed by 0.6 mg 1 hour later, as this regimen has been shown to be as effective as higher doses in reducing pain while minimizing gastrointestinal adverse effects. This recommendation is based on moderate-quality evidence from the American College of Physicians 1. The use of low-dose colchicine is a strong recommendation, with the goal of maximizing effectiveness while minimizing adverse effects.

Key Considerations

• The initial dose of 1.2 mg should be taken at the first sign of a flare, followed by 0.6 mg one hour later.
• Patients with renal or hepatic impairment, or those using potent cytochrome P450 3A4 inhibitors or P-glycoprotein inhibitors, should avoid colchicine or use it with caution and consider dose reduction 1.
• Common side effects of colchicine include gastrointestinal issues such as diarrhea, nausea, vomiting, cramps, and pain, as well as infrequent headache and fatigue 1.
• It is essential for patients to stay hydrated while taking colchicine and to avoid grapefruit juice, which can increase colchicine levels.

Monitoring and Adjustment

• Patients should be monitored for severe gastrointestinal symptoms, unusual bleeding, muscle weakness, or numbness, and colchicine should be discontinued if these occur, with medical attention sought immediately.
• The dose may need to be adjusted in patients with kidney disease, liver disease, or those taking certain medications, typically to half the standard dose 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.

The recommended dose of colchicine for a gout flare is:

• 1.2 mg at the first sign of the flare
• Followed by 0.6 mg one hour later
• Maximum dose: 1.8 mg over a one hour period 2

From the Research

Colchicine Dose for Gout Flare

• The recommended dosage of colchicine for the treatment of acute gout flares is 1.2 mg at the first sign of the flare, followed by 0.6 mg in 1 hour 3.
• Low-dose colchicine (0.6 mg) may be an effective treatment for acute gout when compared to placebo, with low-quality evidence suggesting its benefits may be similar to NSAIDs 4.
• A study comparing low-dose (0.6 mg/day) versus regular-dose (1.2 mg/day) colchicine found that low-dose colchicine can adequately prevent gout flare with fewer adverse events compared to regular-dose colchicine 5.

Adverse Events

• The incidence of adverse events was similar between recipients of the recommended dosage of colchicine and placebo 3.
• Low-dose colchicine was associated with a lower rate of adverse events than regular-dose colchicine 5.
• High-dose colchicine may increase the number of adverse events compared to placebo, while low-dose colchicine may have a similar number of adverse events to NSAIDs 4.

Prevention of Gout Flares

• Colchicine is recommended to prevent gout flares in patients initiating and increasing uric acid–lowering therapy until serum uric acid is maintained at ≤6 mg/dl 6.
• A study found that colchicine use was considered inappropriate in 73.8% of patients, largely due to failure to prescribe concurrent urate-lowering therapies or adequately increase these medications 6.