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

Colchicine Dosage Regimen for Gout Management

For acute gout attacks, colchicine should be administered as 1.2 mg at the first sign of flare, followed by 0.6 mg one hour later (total 1.8 mg), and should only be used if started within 36 hours of symptom onset. 1, 2

Acute Gout Treatment

• Colchicine is effective for acute gout attacks when administered within 36 hours of symptom onset 3, 2
• The FDA-approved regimen for acute gout flares is 1.2 mg (two tablets) at the first sign of flare, followed by 0.6 mg (one tablet) one hour later, with a maximum dose of 1.8 mg over a one-hour period 1
• After the initial doses, patients should wait 12 hours before resuming prophylactic dosing 2, 1
• Low-dose colchicine (1.8 mg total over 1 hour) is as effective as higher doses with significantly fewer side effects 4, 5
• If a patient is already on prophylactic colchicine when an acute attack occurs, they should follow the acute treatment regimen (1.2 mg followed by 0.6 mg one hour later) and then resume prophylactic dosing 12 hours later 3, 2

Prophylaxis of Gout Flares

• For prophylaxis of gout flares, the recommended dose is 0.6 mg once or twice daily (maximum 1.2 mg/day) 1, 2
• Prophylaxis should be initiated with or just prior to starting urate-lowering therapy 3, 6
• Duration of prophylaxis should be:
  • At least 6 months, OR
  • 3 months after achieving target serum urate if no tophi are detected on physical exam, OR
  • 6 months after achieving target serum urate if tophi are present 3, 2

Special Considerations and Dose Adjustments

• For patients with renal insufficiency, dose reduction is required:
  • For patients on dialysis, a single dose of 0.6 mg should be administered for acute attacks, not to be repeated before two weeks 6
• Dose reduction is also required with concomitant use of moderate to high potency inhibitors of CYP3A4 and P-glycoprotein 1, 2
• Major drug interactions that require dose adjustment include clarithromycin, erythromycin, cyclosporine, and disulfiram 3, 2

Alternative Treatment Options

• If colchicine is contraindicated or not tolerated, NSAIDs at full FDA-approved doses until complete resolution of the attack are recommended 3
• Corticosteroids are another alternative:
  • Oral prednisone 0.5 mg/kg/day for 5-10 days, then stopped or tapered over 7-10 days 3, 6
  • Intra-articular corticosteroid injections (dose varies depending on joint size) for involvement of 1-2 large joints 3

Efficacy and Safety

• In clinical trials, low-dose colchicine (1.8 mg total over 1 hour) was significantly more effective than placebo in treating acute gout flare, with 38% of patients achieving >50% reduction in pain within 24 hours 1, 4
• The low-dose regimen has similar efficacy to high-dose colchicine but with significantly fewer adverse events 4
• Common side effects include diarrhea, nausea, and vomiting, which occur more frequently with high-dose regimens 7, 4

Common Pitfalls to Avoid

• Exceeding the maximum recommended dose of 1.8 mg over one hour for acute gout attacks 1
• Starting colchicine treatment more than 36 hours after symptom onset, which significantly reduces effectiveness 2, 3
• Failing to adjust dosage in patients with renal impairment or those taking interacting medications 1, 6
• Using colchicine as an analgesic for pain from other causes 1