In a patient with acute gout, how long should colchicine be taken?

Duration of Colchicine Treatment for Acute Gout

Continue colchicine at prophylactic dosing (0.6 mg once or twice daily) until the acute gout attack has completely resolved, typically within a few days to a week. 1

Initial Loading Dose

• Administer 1.2 mg at the first sign of flare, followed by 0.6 mg one hour later (total 1.8 mg over one hour) 1, 2
• This loading dose should only be given if treatment starts within 36 hours of symptom onset, as effectiveness drops significantly beyond this timeframe 1, 2
• The most effective timing is within 12 hours of symptom onset 1

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 the regular prophylactic dose 1
• Continue at full prophylactic dose until all symptoms of the gouty attack have resolved 1

Duration Considerations

The duration is symptom-driven rather than time-fixed:

• Treatment continues until complete resolution of the acute attack, which typically occurs within a few days 1
• Low-dose colchicine (1.8 mg total loading dose) is as effective as high-dose regimens but with significantly fewer gastrointestinal side effects 1, 2
• The older regimen of 0.5 mg every 2 hours until relief or toxicity is obsolete and causes severe diarrhea in most patients 1

Critical Contraindications Affecting Duration

• Avoid colchicine entirely in patients with severe renal impairment (GFR <30 mL/min) 1, 2
• Absolute contraindication with concurrent use of strong CYP3A4 inhibitors (clarithromycin, erythromycin) or P-glycoprotein inhibitors (cyclosporine) 1, 2
• For patients with moderate renal impairment or drug interactions, use 0.6 mg once daily rather than twice daily 3

Alternative Options if Colchicine Cannot Be Continued

• NSAIDs at full FDA-approved doses (naproxen, indomethacin, or sulindac) until complete resolution 1, 2
• Oral corticosteroids such as prednisone 0.5 mg/kg/day for 5-10 days, then stop or taper over 7-10 days 1, 2
• Intra-articular corticosteroid injection for monoarticular involvement 1, 2

Common Pitfall to Avoid

• Do not stop colchicine at a predetermined time point (e.g., 3 or 5 days) if symptoms persist; continue until the attack has completely resolved 1
• High-dose regimens (>1.8 mg in first hour) provide no additional benefit but substantially increase gastrointestinal toxicity 1