Can colchicine be given to a patient taking febuxostat (Uloric)?

Can Colchicine Be Given While on Febuxostat?

Yes, colchicine can and should be given with febuxostat—in fact, colchicine prophylaxis is specifically recommended when initiating febuxostat to prevent gout flares during the first 6 months of urate-lowering therapy. 1

Standard Practice for Combining These Medications

• Colchicine prophylaxis is recommended upon initiation of any urate-lowering therapy, including febuxostat, to prevent the acute gout flares that commonly occur when serum uric acid levels begin to drop 2

• The recommended prophylactic dose is colchicine 0.5-1 mg/day for at least 6 months when starting febuxostat or other urate-lowering agents 1

• This combination is safe and well-established, with febuxostat clinical trials specifically incorporating colchicine or NSAID prophylaxis as standard practice 1, 3

Evidence Supporting Safety

• A retrospective study of 121 gout patients treated with both febuxostat and colchicine found no increased risk of hepatotoxicity compared to febuxostat alone (10.9% vs 7.0%, p=0.587) 4

• The combination does not require dose adjustment of either medication in patients with normal renal and hepatic function 2, 4

• Febuxostat rapidly lowers serum uric acid by 25-70%, and prophylaxis with colchicine specifically mitigates the gout-flare risk from this rapid urate lowering 3

Critical Dosing Considerations

For prophylaxis while on febuxostat:

• Start colchicine 0.6 mg once or twice daily (maximum 1.2 mg/day for prophylaxis) 2
• Continue for at least 6 months after initiating febuxostat 1
• Lower doses (0.6 mg/day) are as effective as higher doses (1.2 mg/day) with fewer adverse events 5

If an acute flare occurs while on prophylaxis:

• Give colchicine 1.2 mg at first sign of flare, followed by 0.6 mg one hour later 2
• Wait 12 hours, then resume the prophylactic dose 2

Important Safety Warnings

Dose reduction required in renal impairment:

• Colchicine dose must be reduced in patients with decreased kidney function 1
• In CKD stage 3, low-dose colchicine or low-dose prednisone are recommended for prophylaxis 6

Avoid strong drug interactions:

• Do not combine colchicine with strong CYP3A4 or P-glycoprotein inhibitors (clarithromycin, ketoconazole, ritonavir, cyclosporine) as this can cause fatal colchicine toxicity 1, 2
• Co-prescription with these inhibitors is contraindicated 2

Monitor for neurotoxicity/myotoxicity:

• Patients on statins with colchicine require awareness of potential muscle toxicity 1
• Pre-existing liver disease increases risk of hepatotoxicity with febuxostat (not colchicine-related) 4

Common Pitfalls to Avoid

• Failing to provide prophylaxis when starting febuxostat: This leads to substantially increased gout flares in the first 6 months, even with prophylaxis 1
• Stopping prophylaxis too early: Evidence shows flare rates double when prophylaxis is discontinued after only 8 weeks 1
• Using excessive colchicine doses: Higher doses are not more effective and cause more gastrointestinal side effects 1, 5
• Not adjusting for renal function: This is a critical safety issue that can lead to colchicine toxicity 1