From the Guidelines
The recommended treatment approach for acute gout is to use colchicine and NSAIDs, such as indomethacin, as first-line therapy, with the option to use them in combination for severe attacks. According to the 2012 American College of Rheumatology guidelines 1, initial combination therapy with colchicine and NSAIDs is an appropriate option for patients with severe acute gout attacks. The guidelines recommend using full doses of two pharmacologic modalities, such as colchicine and NSAIDs, or oral corticosteroids and colchicine, for severe attacks.
Some key points to consider when using colchicine and NSAIDs in combination include:
- Colchicine should be used at a dose of 1.2mg initially, followed by 0.6mg one hour later, then 0.6mg once or twice daily until symptoms resolve 1.
- Indomethacin can be used at a dose of 50mg three times daily for 5-7 days 1.
- Patients should be monitored for potential adverse effects, such as gastrointestinal toxicity, and adjusted accordingly.
- The use of combination therapy should be individualized based on patient-specific factors, such as disease severity and comorbidities.
It's also important to note that patients should continue their usual urate-lowering therapy (if already prescribed) during an acute attack, but new urate-lowering therapy should not be initiated until 1-2 weeks after the acute attack has resolved 1. Additionally, adequate hydration and avoiding alcohol and purine-rich foods during an attack may help reduce symptom severity. Treatment should begin as soon as possible after symptom onset, as early intervention leads to faster resolution of pain and inflammation.
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.
Acute Gout Treatment with Colchicine: The recommended dose for acute gout treatment with colchicine is 1.2 mg (two tablets) at the first sign of the flare, followed by 0.6 mg (one tablet) one hour later.
- Key Points:
- Maximum recommended dose for treatment of gout flares is 1.8 mg over a one-hour period.
- Colchicine 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. However, there is no information in the provided drug labels about the use of indomethacin with colchicine for acute gout treatment. The FDA drug label does not answer the question about using both colchicine and indomethacin for acute gout treatment.
From the Research
Acute Gout Treatment
The recommended treatment approach for acute gout involves the use of various medications, including:
Combination Therapy
Some studies suggest that combination therapy, such as using both colchicine and indomethacin, may be effective in treating acute gout:
- Low-dose colchicine may be an effective treatment for acute gout when compared to placebo, with similar benefits to NSAIDs 2
- High-dose colchicine may improve symptoms, but with increased risk of harms 2
- NSAIDs, such as indomethacin, are effective agents for the treatment of acute gout attacks 3
Treatment Guidelines
Guidelines for treatment recommend the following:
- NSAIDs, corticosteroids, and colchicine as first-line treatments for acute gouty arthritis 3, 5
- Xanthine oxidase inhibitors (XOI) or uricosuric drugs for patients with recurrent or severe gout 5
- Comprehensive patient education and counseling, as well as regular laboratory follow-up, are important components of treatment 5
Adverse Events
The incidence of adverse events varies depending on the treatment used: