From the FDA Drug Label
For the prophylaxis of gout flares in patients undergoing dialysis, the starting doses should be 0.3 mg given twice a week with close monitoring For patients undergoing dialysis, the total recommended dose for the treatment of gout flares should be reduced to a single dose of 0.6 mg (one tablet). For patients with severe renal failure (Cl cr less than 30 mL/min), start with 0. 3 mg/day; any increase in dose should be done with adequate monitoring of the patient for adverse effects of colchicine For patients undergoing dialysis, the total recommended starting dose should be 0. 3 mg (half tablet) per day.
The recommended dose of Colchicine for pericarditis in a patient with End-Stage Renal Disease (ESRD) cannot be determined as there is no information in the provided drug labels about the use of colchicine for pericarditis. 1 1
From the Research
For patients with end-stage renal disease (ESRD), the recommended dose of colchicine for pericarditis is 0.3 mg once daily or 0.3 mg every other day, depending on the severity of renal impairment and patient tolerance. This dosing recommendation is based on the need to reduce the risk of colchicine toxicity in patients with impaired renal function, as colchicine is partially eliminated by the kidneys 2. The standard dose of colchicine used in patients with normal renal function is 0.5-0.6 mg twice daily, but this dose is not suitable for ESRD patients due to the increased risk of toxicity.
Some key points to consider when using colchicine in ESRD patients include:
- Avoiding concomitant use of strong CYP3A4 or P-glycoprotein inhibitors, such as clarithromycin, cyclosporine, and certain antifungals, as these can increase colchicine levels and toxicity risk 2
- Monitoring patients for gastrointestinal symptoms, such as nausea, vomiting, and diarrhea, which are early signs of toxicity, as well as myopathy and myelosuppression 3
- Continuing treatment for 3 months, with close monitoring for side effects, to reduce the risk of recurrence 4
- Considering the use of colchicine as adjunctive therapy to nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce the number of pericarditis recurrences in patients with recurrent pericarditis or acute pericarditis 5
It's essential to note that the evidence for colchicine dosing in ESRD patients is limited, and the recommended dose is based on the need to balance efficacy and safety. The most recent and highest-quality study on this topic is from 2024, which highlights the importance of careful dosing and monitoring in ESRD patients 2.