What is the recommended dosage and treatment regimen for colchicine (Colchicine) in acute gout attacks?

Colchicine Dosing for Acute Gout Attacks

For acute gout attacks, colchicine should be administered as a loading dose of 1.2 mg followed by 0.6 mg one hour later, then continued at 0.6 mg once or twice daily until the acute attack completely resolves. 1, 2, 3

Recommended Treatment Regimen

Initial Dosing

• First dose: 1.2 mg (two 0.6 mg tablets) at the first sign of gout flare
• Second dose: 0.6 mg (one tablet) one hour later
• Maximum dose: 1.8 mg over a one-hour period 3

Continuation Therapy

• After the initial loading doses, continue with 0.6 mg once or twice daily (12 hours after the initial doses) until the gout attack resolves 2, 1
• Most acute attacks resolve within 3-10 days with appropriate treatment 1

Timing Considerations

• Colchicine is most effective when started within 36 hours of symptom onset 2, 1
• Initiate treatment as soon as possible after symptom onset for maximum effectiveness 1

Dose Adjustments

For Patients Already on Prophylactic Colchicine

• If a patient is already taking colchicine for prophylaxis and experiences a gout flare, they may take 1.2 mg at the first sign of flare followed by 0.6 mg one hour later
• Wait 12 hours and then resume the prophylactic dose 3

For Renal Impairment

• Dose reduction is required in moderate to severe chronic kidney disease 2, 1
• Consult FDA-approved labeling for specific adjustments based on renal function 1

For Drug Interactions

• Reduce or avoid colchicine when used with moderate to high potency inhibitors of Cytochrome P450 3A4 or P-glycoprotein 2, 1
• Major interactions include clarithromycin, erythromycin, cyclosporine, and disulfiram 2

Important Considerations and Cautions

• The low-dose regimen (1.8 mg total over 1 hour) has been shown to be as effective as higher doses while causing fewer adverse effects 4, 5
• High-dose colchicine regimens can cause severe toxicity and are not recommended 1
• Colchicine is not an analgesic medication and should not be used to treat pain from other causes 3
• The safety and efficacy of repeat treatment for gout flares has not been evaluated 3

Alternative Treatments

If colchicine is contraindicated or not tolerated, consider:

• NSAIDs at full anti-inflammatory doses until the attack resolves 2, 1
• Oral corticosteroids (prednisone or prednisolone) at 0.5 mg/kg per day for 5-10 days 2, 1
• Intra-articular corticosteroid injections for involvement of 1-2 large joints 2

Common Pitfalls to Avoid

• Using outdated high-dose colchicine regimens, which increase risk of toxicity without improving efficacy 5
• Failing to start treatment promptly (within 36 hours of symptom onset) 1
• Not adjusting doses for renal impairment or drug interactions 2, 1
• Continuing treatment beyond resolution of the acute attack 2
• Overlooking the narrow therapeutic-toxicity window of colchicine 5

This low-dose colchicine regimen has been shown to be effective while minimizing gastrointestinal and other adverse effects, representing a significant improvement over older high-dose protocols 4, 5.