What is the recommended dosing for colchicine (Colcrys) in patients with acute gout attacks and for prophylaxis, especially in those with impaired renal function?

From the Guidelines

For acute gout attacks, colchicine should be dosed at 1 mg initially, followed by 0.5 mg one hour later, and for prophylaxis, the standard dose is 0.5-1 mg/day, with adjustments necessary for patients with renal impairment, as recommended by the 2016 updated EULAR evidence-based recommendations for the management of gout 1. The dosing of colchicine for acute gout attacks and prophylaxis is crucial for effective management of the condition.

• For acute gout attacks, the recommended dose is 1 mg initially, followed by 0.5 mg one hour later, as stated in the 2016 updated EULAR evidence-based recommendations for the management of gout 1.
• For prophylaxis, the standard dose is 0.5-1 mg/day, which should be reduced in patients with renal impairment. Some key points to consider when dosing colchicine include:
• Colchicine should be avoided in patients with severe renal impairment, and dose adjustments are necessary when used with CYP3A4 inhibitors or P-glycoprotein inhibitors.
• The American College of Physicians also recommends using low-dose colchicine to treat acute gout, with a dose of 1.2 mg followed by 0.6 mg 1 hour later, as this is as effective as higher doses but with fewer gastrointestinal adverse effects 1.
• However, the most recent and highest quality study, the 2016 updated EULAR evidence-based recommendations for the management of gout, recommends a dose of 1 mg initially, followed by 0.5 mg one hour later for acute gout attacks, and 0.5-1 mg/day for prophylaxis, with adjustments for renal impairment 1.
• It is essential to monitor patients for gastrointestinal symptoms, such as diarrhea, nausea, and vomiting, which can signal the need to stop the medication.
• Treatment should be initiated at the first sign of a gout flare for maximum effectiveness.

From the FDA Drug Label

For prophylaxis of gout flares in patients with mild (estimated creatinine clearance [Cl cr] 50 to 80 mL/min) to moderate (Cl cr 30 to 50 mL/min) renal function impairment, adjustment of the recommended dose is not required, but patients should be monitored closely for adverse effects of colchicine. However, in patients with severe impairment, the starting dose should be 0.3 mg/day and any increase in dose should be done with close monitoring. For the prophylaxis of gout flares in patients undergoing dialysis, the starting doses should be 0.3 mg given twice a week with close monitoring. For treatment of gout flares in patients with mild (Cl cr 50 to 80 mL/min) to moderate (Cl cr 30 to 50 mL/min) renal function impairment, adjustment of the recommended dose is not required, but patients should be monitored closely for adverse effects of colchicine. However, in patients with severe impairment, while the dose does not need to be adjusted for the treatment of gout flares, a treatment course should be repeated no more than once every two weeks. For patients undergoing dialysis, the total recommended dose for the treatment of gout flares should be reduced to a single dose of 0.6 mg (one tablet).

The recommended dosing for colchicine (Colcrys) in patients with acute gout attacks and for prophylaxis, especially in those with impaired renal function, is as follows:

• Prophylaxis of gout flares:
  • Mild to moderate renal impairment: no dose adjustment required, but monitor closely for adverse effects.
  • Severe renal impairment: start with 0.3 mg/day and increase with close monitoring.
  • Dialysis patients: 0.3 mg twice a week with close monitoring.
• Treatment of gout flares:
  • Mild to moderate renal impairment: no dose adjustment required, but monitor closely for adverse effects.
  • Severe renal impairment: repeat treatment course no more than once every two weeks.
  • Dialysis patients: single dose of 0.6 mg, repeat no more than once every two weeks. 2

From the Research

Colchicine Dosing for Acute Gout Attacks

• 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.
• This dosing regimen has been shown to be effective in reducing pain in patients with acute gout, with a significant proportion of patients experiencing a ≥50% reduction in pain within 24 hours of initiating treatment 3.
• Colchicine doses should be adapted to renal function and age, and possible drug interactions should be considered 4.

Colchicine Dosing for Prophylaxis

• For prophylaxis of gout flares, colchicine 0.6 mg once or twice daily (up to 6 months) has been shown to be effective in preventing gout flares in patients receiving allopurinol as urate-lowering therapy 3.
• The recommended dose for prophylaxis is not explicitly stated, but 0.6 mg once or twice daily is a commonly cited dose 3, 5.

Dosing Considerations in Impaired Renal Function

• Colchicine doses should be adapted to renal function, as impaired renal function can increase the risk of toxicity 4.
• The exact dosing adjustments for impaired renal function are not specified, but it is recommended to consider renal function when determining the dose 4.
• In patients with severe renal impairment, the dose of colchicine may need to be reduced to avoid toxicity 5.

Alternative Formulations

• Colchicine ointment has been formulated as a potential alternative to oral colchicine for the treatment of acute gout, with the goal of reducing adverse effects associated with oral administration 6.
• The ointment has been shown to be effective in delivering colchicine transdermally, although absorption was not 100% 6.