From the Guidelines
For acute gout, colchicine (Colcrys) is recommended as a 1.2 mg initial dose followed by 0.6 mg one hour later, for a total of 1.8 mg on the first day, as this regimen has been shown to be effective in reducing pain with fewer gastrointestinal adverse effects 1. This approach is supported by the American College of Physicians, which suggests that low-dose colchicine is as effective as higher doses in managing acute gout, with the added benefit of reduced side effects 1.
Key Considerations
- The treatment should be initiated as soon as possible after symptom onset, ideally within 24 hours, to maximize effectiveness.
- Patients with kidney or liver impairment require dose reduction, and colchicine should be avoided in those with severe dysfunction.
- Common side effects include gastrointestinal symptoms like diarrhea, nausea, and vomiting.
- Colchicine should not be used with certain drugs like clarithromycin or cyclosporine due to potential interactions that can increase colchicine toxicity.
Additional Guidance
- According to the 2016 updated EULAR evidence-based recommendations for the management of gout, colchicine at a loading dose of 1 mg followed 1 hour later by 0.5 mg on day 1 is a recommended first-line option for acute flares, especially when initiated within 12 hours of flare onset 1.
- It is crucial to educate patients on the importance of early treatment and the potential side effects of colchicine to ensure compliance and effective management of acute gout attacks.
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 1 hour period.
The recommended treatment for acute gout using colchicine (Colcrys) 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 1 hour period. 2
From the Research
Recommended Treatment for Acute Gout using Colchicine (Colcrys)
- The recommended dosage of Colcrys 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.
- Colchicine is a tricyclic alkaloid that interrupts multiple inflammatory response pathways, and its principal mechanism of action in gout is thought to be inhibition of cytoskeletal microtubule polymerization 3.
- A phase III, randomized, double-blind, placebo-controlled, multicentre trial found that the recommended dosage of Colcrys was significantly more effective than placebo in treating acute gout flare, as assessed by the proportion of patients experiencing a ≥50% reduction in pain within 24 hours of initiating treatment 3.
Efficacy and Safety of Colchicine
- Low-dose colchicine (1.8 mg total over 1 hour) was found to be effective in treating acute gout, with a similar safety profile to placebo 4.
- High-dose colchicine (4.8 mg total over 6 hours) was associated with significantly more adverse events, including diarrhea, vomiting, and other gastrointestinal symptoms 4.
- A Cochrane review found that low-dose colchicine may be an effective treatment for acute gout, with low-quality evidence suggesting that it may improve treatment outcome compared to placebo with little or no increased risk of adverse events 5, 6.
Comparison with Other Treatments
- There is low-quality evidence that low-dose colchicine may be as effective as non-steroidal anti-inflammatory drugs (NSAIDs) in treating acute gout, with a similar number of adverse events reported 6.
- No trials have compared colchicine to glucocorticoids, and further trials are needed to determine the effectiveness and safety of colchicine in comparison to other treatments 5, 6.