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

Colchicine Dosing for Acute Gout

For acute gout flares, the recommended dose of colchicine is 1.2 mg (two tablets) at the first sign of the flare followed by 0.6 mg (one tablet) one hour later, for a maximum total dose of 1.8 mg over a 1-hour period. 1, 2

Detailed Dosing Protocol

Initial Treatment (First 24 Hours)

• Loading dose: 1.2 mg (two 0.6 mg tablets) at the first sign of gout flare
• Follow-up dose: 0.6 mg (one tablet) 1 hour after the initial dose
• Maximum dose: 1.8 mg total within the first hour of treatment
• Timing: Treatment should be initiated within 36 hours of symptom onset, preferably as early as possible 1

After Initial Treatment

• After the initial 1.8 mg dosing, wait 12 hours before resuming prophylactic dosing (if applicable)
• Prophylactic dosing is typically 0.6 mg once or twice daily until the gout attack resolves 1

Dosage Adjustments

For Countries with Different Tablet Strengths

• For 0.5 mg tablets: 1.0 mg loading dose, followed by 0.5 mg one hour later 1
• Continue with up to 0.5 mg three times daily until attack resolves 1

For Special Populations

1. Renal Impairment:

   • Dose reduction required in moderate to severe renal impairment 1, 2
   • Specific adjustments should be made according to creatinine clearance

2. Drug Interactions:

   • Reduce or avoid colchicine with moderate to high potency inhibitors of:
     • Cytochrome P450 3A4 (CYP3A4)
     • P-glycoprotein (P-gp)
   • Major interactions include clarithromycin, erythromycin, cyclosporine, and disulfiram 1

Efficacy and Safety Considerations

• Low-dose colchicine (1.8 mg over 1 hour) has comparable efficacy to higher doses with significantly fewer side effects 3
• At the recommended dosage, colchicine has a safety profile similar to placebo 4, 3
• Common adverse effects at recommended doses include mild diarrhea (23% vs 76.9% with high-dose) 3
• Severe diarrhea and vomiting are rare with the recommended low-dose regimen 3

Important Clinical Pearls

• Colchicine is not an analgesic and should not be used for pain from other causes 2
• Intravenous colchicine is no longer available in the USA due to potential severe toxicity 1
• For patients already on colchicine prophylaxis who develop a gout flare, consider alternative therapy (NSAIDs or corticosteroids) 1
• Colchicine has a narrow therapeutic-toxicity window with significant variability in tolerance between patients 5

Alternative Treatments

If colchicine is contraindicated or not tolerated:

• NSAIDs at full anti-inflammatory doses
• Oral corticosteroids (prednisolone 30-35 mg/day for 3-5 days)
• Intra-articular corticosteroid injections 1

Remember that colchicine should be initiated as early as possible after symptom onset for maximum effectiveness, ideally within the first 12-36 hours of the gout flare 1.