What is the treatment for acute gout with colchicine (Colcrys)?

From the Guidelines

Colchicine is an effective first-line treatment for acute gout attacks, with a recommended dosing of 1.2 mg initially, followed by 0.6 mg one hour later (total 1.8 mg on day one), then 0.6 mg once or twice daily until the attack resolves, typically within 3-7 days, as supported by high-quality evidence from studies such as 1 and 1. For acute gout, the goal is to reduce pain and inflammation, and colchicine has been shown to be effective in achieving this goal. The following key points should be considered when using colchicine to treat acute gout:

• Patients with kidney or liver impairment should use reduced doses, such as 0.6 mg initially with no follow-up dose, as recommended by 1.
• Colchicine works best when started within 12-24 hours of symptom onset, as stated in 1.
• Common side effects include diarrhea, nausea, and vomiting, which often signal the need to stop the medication, as reported in 1 and 1.
• Important drug interactions exist with certain antibiotics, antifungals, and statins, so a medication review is essential before starting treatment, as highlighted in 1 and 1.
• Colchicine works by preventing neutrophil activation and migration to inflamed joints, thereby reducing the inflammatory response triggered by urate crystals, as explained in 1. For optimal gout management, colchicine should be combined with rest, ice application, elevation of the affected joint, and adequate hydration. NSAIDs or corticosteroids are alternative options if colchicine is contraindicated or poorly tolerated, as suggested by 1, 1, and 1. It is essential to consider the potential benefits and harms of each treatment option and to individualize treatment based on patient-specific factors, such as comorbidities and medication history, as emphasized in 1 and 1.

From the FDA Drug Label

The recommended dose of Colchicine Tablets, USP for treatment of a gout flare is 1.2 mg (two tablets) at the first sign of the flare followed by 0.6 mg (one tablet) one hour later. Higher doses have not been found to be more effective. The maximum recommended dose for treatment of gout flares is 1.8 mg over a one hour period.

The treatment for acute gout with colchicine (Colcrys) is 1.2 mg at the first sign of the flare, followed by 0.6 mg one hour later, with a maximum dose of 1.8 mg over a one hour period 2.

From the Research

Treatment of Acute Gout with Colchicine (Colcrys)

• Colchicine is approved in the US for the treatment of acute gout flares in adult patients and the prophylaxis of gout flares in patients aged >16 years 3.
• The recommended dosage of Colcrys (1.2 mg at the first sign of the flare, followed by 0.6 mg in 1 hour) was significantly more effective than placebo in treating acute gout flare, as assessed by the proportion of patients experiencing a >or=50% reduction in pain within 24 hours of initiating treatment 3.
• Colchicine is an effective treatment for the reduction of pain and clinical symptoms in patients experiencing acute attacks of gout, although its low benefit to toxicity ratio limits its usefulness 4.
• Low-dose colchicine (1.8 mg over 1 h) taken as early as possible is effective in reducing pain and is well tolerated in patients with acute gout 5.
• Colchicine remains the standard treatment for the acute flare of gout in France, with the lowest dose currently used decreasing digestive toxicity 6.
• Oral colchicine demonstrated to be effective, with low-dose colchicine demonstrating a comparable tolerability profile as placebo and a significantly lower side effect profile to high-dose colchicine 7.

Dosage and Administration

• The recommended dosage of Colcrys is 1.2 mg at the first sign of the flare, followed by 0.6 mg in 1 hour 3.
• Low-dose colchicine (1.8 mg over 1 h) taken as early as possible is effective in reducing pain and is well tolerated in patients with acute gout 5.
• Doses of colchicine should be adapted to renal function and age, and possible drug interactions should be considered 6.

Efficacy and Safety

• Colchicine is an effective treatment for the reduction of pain and clinical symptoms in patients experiencing acute attacks of gout 4, 5, 7.
• The incidence of the most common adverse events was similar between recipients of the recommended dosage of Colcrys and placebo 3.
• Colchicine has a narrow therapeutic-toxicity window and an important variability in tolerance between subjects 5.
• Gastrointestinal side effects (diarrhea and/or vomiting) are common with colchicine treatment, with all participants treated with colchicine experiencing these side effects in one study 4.