What is the recommended dosage and management of colchicine (Colcrys) for acute gouty arthritis?

From the Guidelines

For acute gouty arthritis, the recommended dosage of colchicine (Colcrys) is 1.2 mg taken at the first sign of a gout flare, followed by 0.6 mg one hour later, for a total dose of 1.8 mg, and it typically takes 12-24 hours for symptoms to subside after taking colchicine. This regimen should be initiated within the first 12-24 hours of symptom onset for maximum effectiveness, as supported by moderate-quality evidence from studies such as 1. After completing this initial treatment, patients should wait at least 3 days before starting another course for a new flare. For patients with renal or hepatic impairment, or those taking certain medications that interact with colchicine (such as P-glycoprotein or CYP3A4 inhibitors), dose reduction is necessary - typically using half the standard dose, as recommended by the American College of Physicians in their clinical practice guideline 1.

Some key points to consider when managing acute gouty arthritis with colchicine include:

• Common side effects include gastrointestinal symptoms like diarrhea, nausea, and abdominal pain, which often signal that the medication should be temporarily stopped, as noted in studies such as 1.
• Colchicine works by inhibiting neutrophil migration and activity, thereby reducing inflammation associated with urate crystal deposition in joints, as explained in the study 1.
• While colchicine effectively relieves pain and inflammation, it does not lower uric acid levels, so patients with recurrent gout attacks may need additional urate-lowering therapy such as allopurinol or febuxostat for long-term management, as discussed in the guideline 1.
• The American College of Physicians recommends using low-dose colchicine when treating acute gout, as stated in their guideline 1, which is based on moderate-quality evidence suggesting that lower doses are as effective as higher doses at reducing pain and are associated with fewer gastrointestinal adverse effects.

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 FDA drug label does not provide information on how long it takes for gouty arthritis to subside after taking colchicine.

From the Research

Recommended Dosage and Management of Colchicine for Acute Gouty Arthritis

• The recommended dosage of colchicine for acute gouty arthritis is not explicitly stated in the provided studies, but it is mentioned that low-dose colchicine has a comparable tolerability profile to placebo and a significantly lower side effect profile compared to high-dose colchicine 2.
• Colchicine is effective in reducing pain and clinical symptoms in patients experiencing acute attacks of gout, with an absolute reduction of 34% for pain and a 30% reduction in clinical symptoms such as tenderness on palpation, swelling, redness, and pain 3.
• The number needed to treat (NNT) with colchicine versus placebo to reduce pain is 3, and the NNT to reduce clinical symptoms is 2 3.
• However, colchicine has a high frequency of gastrointestinal adverse events, with all participants treated with colchicine experiencing gastrointestinal side effects such as diarrhea and/or vomiting 3.
• Colchicine should be used as a second-line therapy when NSAIDs or corticosteroids are contraindicated or ineffective 3.

Time to Subside

• The time it takes for gouty arthritis to subside after taking colchicine is not explicitly stated in the provided studies.
• However, it is mentioned that if therapy with colchicine is initiated promptly after the onset of symptoms, relief should occur quickly 4.
• The exact duration of time for relief to occur is not specified, but it is suggested that colchicine can effectively terminate the acute attack of gouty arthritis when used promptly 4.

Prophylaxis and Prevention

• Prophylactic colchicine remains an efficacious drug in preventing recurrent attacks of acute gouty arthritis, especially in patients with frequent and severe attacks, and in those with coexisting medical complications 5.
• The use of colchicine for prophylaxis is indicated at a dosage of 0.5 or 1.0 mg, and it is most likely involved in the suppression of chemotactic factors involving the synovial lining cells 5.
• Discontinuance of the prophylactic program may be attempted in any patient who has been free from recurrent attacks for several years, particularly in older patients with no medical complications 5.