What is the dose for colchicine (Colcrys) in treating gout and familial Mediterranean fever?

Colchicine Dosing for Gout and Familial Mediterranean Fever

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 0.6 mg once or twice daily 12 hours later until the attack resolves. 1

Gout Treatment

Acute Gout Attack

• For acute gout flares, initiate treatment within 36 hours of symptom onset for best results 1
• Initial dosing regimen:
  • Loading dose: 1.2 mg at first sign of flare 1, 2
  • Follow with: 0.6 mg one hour later 1, 2
  • Total dose: 1.8 mg over a one-hour period (maximum recommended) 2
• After 12 hours, continue with prophylactic dosing of 0.6 mg once or twice daily until the gout attack resolves 1
• In countries where 1.0 mg or 0.5 mg tablets are available: 1.0 mg loading dose, followed by 0.5 mg one hour later, then up to 0.5 mg three times daily until attack resolves 1

Gout Prophylaxis

• Recommended dose: 0.6 mg once or twice daily 2
• Maximum recommended dose for prophylaxis: 1.2 mg/day 2
• Prophylaxis is recommended when initiating uric acid-lowering therapy and should be continued for at least six months 1, 2

Familial Mediterranean Fever (FMF)

Adult Dosing

• Recommended dose: 1.2 to 2.4 mg daily 2
• Dose should be increased as needed to control disease in increments of 0.3 mg/day 2
• If intolerable side effects develop, decrease dose in increments of 0.3 mg/day 2
• Total daily dose may be administered in one to two divided doses 2

Pediatric Dosing for FMF

• Children 4-6 years: 0.3 mg to 1.8 mg daily 2
• Children 6-12 years: 0.9 mg to 1.8 mg daily 2
• Adolescents >12 years: 1.2 mg to 2.4 mg daily 2
• Doses may be given as a single dose or divided twice daily 2

Important Considerations and Precautions

Dose Adjustments

• Reduce dose in moderate to severe chronic kidney disease 1
• Consider dose reduction in hepatic impairment 1, 3
• Adjust dose with drug interactions, particularly with inhibitors of CYP3A4 and P-glycoprotein 1, 2
  • Major interactions include: clarithromycin, erythromycin, cyclosporine, and disulfiram 1, 3

Safety Considerations

• Colchicine has a narrow therapeutic index with no clear distinction between therapeutic, toxic, and lethal doses 3
• Lowest reported lethal doses of oral colchicine are 7-26 mg 3
• High fatality rates reported after acute ingestions exceeding 0.5 mg/kg 3
• Low-dose regimens (as recommended above) significantly reduce gastrointestinal side effects compared to traditional high-dose regimens 4, 5

Monitoring

• For FMF patients not responding to maximum tolerated colchicine dose, consider IL-1 targeting treatments 1
• Regular monitoring for adherence and subclinical inflammation is recommended in FMF patients 1

Common Adverse Effects

• Gastrointestinal effects (diarrhea, nausea, vomiting) are most common, especially with higher doses 4
• Low-dose colchicine regimens have significantly fewer adverse events than high-dose regimens while maintaining efficacy 4

The modern approach to colchicine dosing represents a significant shift from historical high-dose regimens, with current evidence strongly supporting lower doses that maintain efficacy while substantially reducing toxicity 1, 4.