What is the dosage and administration of Colchicine (colchicine) tablets?

Colchicine Dosage and Administration

For acute gout flares, administer colchicine 1.2 mg at the first sign of flare followed by 0.6 mg one hour later (total 1.8 mg over one hour), then continue 0.6 mg once or twice daily until the attack resolves. 1

Acute Gout Treatment

Standard Dosing

• Loading dose: 1.2 mg (two tablets) at first sign of flare, followed by 0.6 mg (one tablet) one hour later 1
• Maximum dose: 1.8 mg over one hour period 1
• Continuation: After initial doses, resume prophylactic dosing of 0.6 mg once or twice daily (starting 12 hours after initial doses) until attack resolves 2, 1
• Critical timing: Only use for attacks with onset within 36 hours prior to treatment initiation 3, 2

Evidence Supporting Low-Dose Regimen

• The low-dose regimen (1.8 mg total) is as effective as high-dose colchicine (4.8 mg) but with significantly fewer gastrointestinal side effects 3, 4
• Higher doses provide no additional benefit but substantially increase toxicity 3
• The obsolete regimen of 0.5 mg every 2 hours until relief should never be used as it causes severe diarrhea in most patients 3

Gout Flare Prophylaxis

Standard Dosing

• Recommended dose: 0.6 mg once or twice daily 2, 1
• Maximum dose: 1.2 mg/day 1
• Duration: Continue for at least 6 months when initiating urate-lowering therapy, or 3 months after achieving target serum urate (if no tophi), or 6 months after achieving target serum urate (if tophi present) 2

Timing with Urate-Lowering Therapy

• Initiate prophylaxis with or just prior to starting uric acid-lowering therapy (allopurinol, febuxostat, pegloticase) 1
• Prophylaxis is particularly important during the first 6 months of urate-lowering therapy when flares commonly increase 1

Familial Mediterranean Fever (FMF)

Adult Dosing

• Recommended range: 1.2 to 2.4 mg daily 1
• Titration: Increase as needed in increments of 0.3 mg/day to control disease, up to maximum recommended daily dose 1
• Administration: May be given as single dose or divided into two doses daily 1

Pediatric Dosing (Age 4 and Older)

• Ages 4-6 years: 0.3 to 1.8 mg daily 1
• Ages 6-12 years: 0.9 to 1.8 mg daily 1
• Ages >12 years: 1.2 to 2.4 mg daily 1
• May be administered as single or divided dose twice daily 1

Critical Dose Adjustments for Drug Interactions

Strong CYP3A4 Inhibitors (CONTRAINDICATED)

• Do not use colchicine with clarithromycin, erythromycin, ketoconazole, itraconazole, ritonavir, atazanavir, indinavir, nelfinavir, saquinavir, telithromycin, or nefazodone 3, 1
• Fatal colchicine toxicity has been reported with these combinations 1

Moderate CYP3A4 Inhibitors (Dose Reduction Required)

• Drugs: Diltiazem, verapamil, fluconazole, grapefruit juice, aprepitant 1
• Prophylaxis adjustment: 0.3 mg twice daily or 0.6 mg once daily (instead of 0.6 mg twice daily) 1
• Acute gout adjustment: 1.2 mg × 1 dose only; do not repeat for at least 3 days (instead of standard 1.8 mg regimen) 1
• FMF adjustment: Maximum 1.2 mg/day (may be given as 0.6 mg twice daily) 1

P-glycoprotein Inhibitors

• Cyclosporine is an absolute contraindication for colchicine use 3, 2
• Significant increase in colchicine plasma levels occurs with P-gp inhibitors 1

Renal Impairment Adjustments

Mild to Moderate Impairment (CrCl 30-80 mL/min)

• Prophylaxis: No dose adjustment required, but monitor closely for adverse effects 1
• Acute gout: No dose adjustment required, but monitor closely 1

Severe Impairment (CrCl <30 mL/min)

• Prophylaxis: Start 0.3 mg/day; increase cautiously with close monitoring 1
• Acute gout: Standard dose acceptable, but repeat no more than once every 2 weeks 1
• FMF: Start 0.3 mg/day; increase with adequate monitoring 1

Dialysis Patients

• Prophylaxis: 0.3 mg twice weekly with close monitoring 1
• Acute gout: Single dose of 0.6 mg; do not repeat more than once every 2 weeks 1
• FMF: Start 0.3 mg/day; increase with adequate monitoring 1
• Clearance reduced by 75% in end-stage renal disease 1

Hepatic Impairment Adjustments

Mild to Moderate Impairment

• All indications: No dose adjustment required, but monitor closely for adverse effects 1

Severe Impairment

• Prophylaxis: Consider dose reduction 1
• Acute gout: Standard dose acceptable, but repeat no more than once every 2 weeks 1
• FMF: Dose reduction should be considered with careful monitoring 1

Administration Guidelines

• Timing: Administer without regard to meals 1
• Not an analgesic: Do not use to treat pain from other causes 1
• Repeat treatment: Safety and efficacy of repeat treatment for gout flares has not been established 1

Common Pitfalls to Avoid

• Never delay treatment beyond 36 hours after symptom onset, as effectiveness significantly decreases 3, 2
• Never use high-dose regimens (>1.8 mg in first hour) as they provide no additional benefit but substantially increase gastrointestinal toxicity 3
• Never combine with strong CYP3A4 or P-glycoprotein inhibitors due to risk of fatal toxicity 3, 1
• Never treat acute flares in patients already on prophylactic colchicine who are also taking CYP3A4 inhibitors 1
• Never use the obsolete regimen of 0.5 mg every 2 hours until relief or toxicity 3
• Always adjust doses in patients with severe renal or hepatic impairment to prevent toxicity 1