Duration of Colchicine Treatment for Acute Gout
Continue colchicine at prophylactic dosing (0.6 mg once or twice daily) until the acute gout attack completely resolves, typically within a few days, after the initial loading dose. 1, 2
Initial Treatment Window and Loading Dose
- Start colchicine within 36 hours of symptom onset—effectiveness drops significantly beyond this timeframe 1, 2
- Administer 1.2 mg at first sign of flare, followed by 0.6 mg one hour later (total 1.8 mg over one hour) 1, 2
- This low-dose regimen is as effective as high-dose colchicine (4.8 mg) but with significantly fewer gastrointestinal side effects 1, 3
Continuation Phase After Loading Dose
- Wait 12 hours after the initial loading doses, then resume prophylactic dosing of 0.6 mg once or twice daily until the acute attack completely resolves 1, 2
- If already taking prophylactic colchicine when the attack occurs, take the loading dose, then wait 12 hours before resuming regular prophylactic dose 1
- Continue at full dose until the gouty attack has completely resolved—do not stop prematurely 1
The American College of Rheumatology emphasizes that treatment should continue until complete resolution rather than a fixed number of days, as attack duration varies between patients 1. This typically takes a few days but may extend longer depending on severity 1.
Combination Therapy Considerations
- For severe attacks involving multiple large joints, combination therapy with colchicine and NSAIDs is appropriate 1
- Continue NSAIDs at full FDA-approved doses until complete resolution as well 1
Critical Contraindications Requiring Alternative Treatment
- Avoid colchicine in severe renal impairment (GFR <30 mL/min) 1, 2
- Absolute contraindication with strong P-glycoprotein and/or CYP3A4 inhibitors (cyclosporine, clarithromycin, erythromycin) 1, 2
- For these patients, use oral corticosteroids (prednisone 30-35 mg/day for 3-5 days) or intra-articular corticosteroid injection instead 1, 2