What is the dosage frequency and length of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and colchicine for the treatment of gout?

From the Guidelines

For acute gout attacks, the recommended treatment is NSAIDs, such as naproxen (500mg twice daily) or indomethacin (50mg three times daily), for 3-5 days until symptoms resolve, or colchicine, with a loading dose of 1 mg followed by 0.5 mg one hour later, as stated in the 2016 updated EULAR evidence-based recommendations for the management of gout 1.

Key Considerations

• The choice of treatment should be based on the presence of contraindications, the patient's previous experience with treatments, time of initiation after flare onset, and the number and type of joints involved.
• Colchicine and NSAIDs should be avoided in patients with severe renal impairment.
• Colchicine should not be given to patients receiving strong P-glycoprotein and/or CYP3A4 inhibitors.
• For long-term prevention, colchicine may be prescribed at 0.5-1 mg/day, particularly during the first 6 months of urate-lowering therapy when flares are common.

Important Side Effects and Contraindications

• NSAIDs can cause gastrointestinal side effects and are contraindicated in patients with kidney disease, heart failure, or peptic ulcer disease.
• Colchicine requires dose adjustment in patients with kidney or liver impairment and can cause diarrhea as a common side effect.

Additional Recommendations

• Adequate hydration and rest of the affected joint are important supportive measures during acute attacks.
• If symptoms don't improve within 48 hours or worsen, medical attention should be sought as alternative treatments like corticosteroids may be needed.
• The American College of Physicians recommends using low-dose colchicine when using colchicine to treat acute gout, as it is as effective as higher doses but with fewer gastrointestinal adverse effects 1.

From the FDA Drug Label

The recommended dosage of Colchicine Tablets, USP for prophylaxis of gout flares for adults and adolescents older than 16 years of age is 0.6 mg once or twice daily. The maximum recommended dose for prophylaxis of gout flares is 1.2 mg/day. 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 one hour period.

The dosage frequency and length of colchicine for the treatment of gout are as follows:

• Prophylaxis of gout flares: 0.6 mg once or twice daily, with a maximum dose of 1.2 mg/day.
• Treatment of gout flares: 1.2 mg at the first sign of the flare, followed by 0.6 mg one hour later, with a maximum dose of 1.8 mg over a one hour period.

There is no information in the provided drug labels about the dosage frequency and length of NSAIDs for the treatment of gout. 2 2

From the Research

Dosage Frequency and Length of NSAIDs and Colchicine for Gout Treatment

• The optimal dosage frequency and length of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and colchicine for the treatment of gout are not explicitly stated in the provided studies 3, 4, 5, 6, 7.
• However, it is mentioned that colchicine has been widely used but toxicity, especially gastrointestinal adverse effects, are a major concern, and therapeutic regimens involving hourly or 2-hourly administration were based on the short initial half-life of colchicine in plasma 3.
• Other therapy schedules, such as early 8-hourly administration, may be equally effective and have fewer adverse effects, but comparative studies to investigate this have not been performed 3.
• For NSAIDs, it is recommended to use high dose short half-life NSAIDs for the treatment of acute gout, but the exact dosage frequency and length are not specified 4, 6.
• The choice of a drug for the treatment of acute gout will depend on the balance between its efficacy and the potential adverse effects in a particular patient 3.

Considerations for Treatment

• Colchicine should not be prescribed to patients with either severe renal insufficiency or combined hepatic-renal insufficiency, and doses should be halved in patients with moderate renal function impairment 3.
• NSAIDs are the most widely prescribed drugs in the treatment of acute gout, but comorbidities such as previous or recent gastrointestinal bleeding, anticoagulant therapy, or haemorrhage diathesis, and renal insufficiency should be taken into account when prescribing NSAIDs 3.
• Corticosteroids are probably a reasonable choice for patients in whom colchicine and NSAIDs may be hazardous or for those with a history of previous intolerance to these drugs 3.

Treatment Outcomes

• The treatment outcomes for NSAIDs and colchicine are not consistently reported across the studies, but it is mentioned that NSAIDs may improve pain at 24 hours and may have little to no effect on function, inflammation, or adverse events for treatment of acute gout 6.
• Systemic glucocorticoids and NSAIDs probably are equally beneficial in terms of pain relief, improvement in function, and treatment success, although NSAIDs probably result in more total adverse events 6, 7.