Colchicine Dosage and Monitoring for Gout Attacks
For acute gout attacks, colchicine should be administered as 1.2 mg (two tablets) at the first sign of flare followed by 0.6 mg (one tablet) one hour later, for a maximum dose of 1.8 mg over a one-hour period. 1, 2
Acute Gout Attack Treatment
- Colchicine is most effective when started within 36 hours of symptom onset, with significantly decreased effectiveness beyond this timeframe 2, 3
- After the initial doses (1.2 mg + 0.6 mg), continue with prophylactic dosing of 0.6 mg once or twice daily until the attack resolves 2, 4
- Low-dose colchicine (1.8 mg total over 1 hour) is as effective as higher doses with significantly fewer side effects 3, 5
- Alternative first-line options for acute flares include NSAIDs (plus proton pump inhibitors if appropriate) or oral corticosteroids (30-35 mg/day of equivalent prednisolone for 3-5 days) 6
Prophylaxis Dosing
- For gout flare prophylaxis, the recommended dose is 0.6 mg once or twice daily (maximum 1.2 mg/day) 4, 1
- Prophylaxis should be initiated with or just prior to starting urate-lowering therapy 2, 4
- Continue prophylaxis for at least 6 months, or 3 months after achieving target serum urate if no tophi are present, or 6 months after achieving target serum urate if tophi are present 2, 4
Dose Adjustments for Special Populations
- For patients with severe renal impairment, reduce the dose to a single dose of 0.6 mg with no repeat treatment for at least two weeks 2, 4
- For patients on dialysis, a single dose of 0.6 mg should be administered and not repeated before two weeks 2
- Dose reduction is required with concomitant use of moderate to high potency inhibitors of CYP3A4 and P-glycoprotein 4, 1
- Colchicine should not be given to patients receiving strong P-glycoprotein and/or CYP3A4 inhibitors such as cyclosporin or clarithromycin 6, 3
Pathology Checks for Long-term Management
- Every person with gout should be systematically screened for associated comorbidities and cardiovascular risk factors 6
- Regular monitoring should include:
- Renal function tests (creatinine, GFR) - particularly important as colchicine dosing must be adjusted in renal impairment 6, 2
- Serum uric acid levels - target should be maintained at <6 mg/dL (360 μmol/L) 6
- Liver function tests - especially important when using colchicine long-term 7
- Complete blood count - to monitor for potential hematologic toxicity 8
- Cardiovascular risk assessment - including blood pressure, lipid profile, and glucose levels 6, 3
Important Precautions and Monitoring
- Colchicine has a narrow therapeutic-toxicity window with significant variability in tolerance between individuals 5
- Common side effects include gastrointestinal symptoms (diarrhea, nausea, vomiting) 9
- Monitor for signs of toxicity including muscle weakness, neuropathy, and myelosuppression 10, 8
- After treatment of an acute attack, patients should receive no more colchicine by any route for 7 days to avoid cumulative toxicity 10
- Patients should be educated on early self-medication at the first warning symptoms ("pill in the pocket" approach) 6, 5