What is the recommended dosing regimen for colchicine (Colcrys) in the treatment of a gout flare?

Colchicine Dosing for Gout Flare Treatment

For treatment of a gout flare, colchicine should be taken as 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 one-hour period. 1

Dosing Regimen Details

• The low-dose colchicine regimen (1.8 mg total) is most effective when started within 12 hours of symptom onset 2
• This dosing approach has been shown to be as effective as higher doses while significantly reducing adverse effects 3
• The maximum recommended dose for treatment of gout flares is 1.8 mg over a one-hour period 1
• Higher doses have not been found to be more effective but are associated with increased side effects 1, 3

Efficacy Evidence

• In a phase III randomized controlled trial, this recommended dosing regimen was significantly more effective than placebo in treating acute gout flare, with 37.8% of patients experiencing ≥50% pain reduction within 24 hours 4, 3
• The low-dose regimen showed comparable efficacy to high-dose colchicine (4.8 mg total over 6 hours) but with a significantly better safety profile 3

Important Considerations and Dose Modifications

Renal Function

• Renal impairment requires dose adjustment:
  • Patients with eGFR < 30 ml/min should avoid colchicine due to increased toxicity risk 2
  • Patients with eGFR 30-60 ml/min should consider reduced doses 2
  • Always assess renal function before initiating therapy 2

Drug Interactions

• Dose adjustment is required with certain medications:
  • Strong CYP3A4 and/or P-glycoprotein inhibitors (e.g., cyclosporin, clarithromycin, ketoconazole) significantly increase colchicine toxicity risk 2, 1
  • If these medications cannot be avoided, colchicine dose must be reduced 1

Concurrent Prophylaxis

• If a patient experiences a gout flare while already taking colchicine for prophylaxis:
  • Administer 1.2 mg at first sign of flare followed by 0.6 mg one hour later
  • Wait 12 hours before resuming the prophylactic dose 1

Safety Profile

• At the recommended low dose, colchicine has an adverse event profile similar to placebo 4, 3
• Higher doses (>1.8 mg) are associated with significantly more gastrointestinal side effects:
  • Diarrhea (76.9% with high dose vs 23% with low dose)
  • Severe diarrhea (19.2% with high dose vs 0% with low dose)
  • Vomiting (17.3% with high dose vs 0% with low dose) 3

Common Pitfalls to Avoid

• Exceeding recommended dosage: Studies show excessive dosing is common in clinical practice, especially in patients with renal impairment 5
• Delayed administration: Colchicine is most effective when started within 12 hours of symptom onset 2
• Failure to adjust for drug interactions: Always check for potential interactions with CYP3A4 and P-glycoprotein inhibitors 2, 1
• Using colchicine for non-gout pain: Colchicine is not an analgesic and should not be used to treat pain from other causes 1