What is the duration of colchicine therapy for acute gout (gouty arthritis) flare-ups?

From the Guidelines

For a gout flare, colchicine is typically used for 1-3 days, with a recommended regimen of 1.2 mg at the first sign of a flare, followed by 0.6 mg one hour later, then no further colchicine for 12 hours, as supported by moderate-quality evidence from the American College of Physicians clinical practice guideline 1. The use of colchicine in gout flare treatment is based on its ability to reduce inflammation by preventing neutrophils from moving to the affected joint and inhibiting the formation of inflammatory compounds. Some key points to consider when using colchicine for gout flare include:

• Starting colchicine within the first 12-24 hours of a flare for maximum effectiveness
• Patients with kidney or liver disease may need lower doses
• Common side effects include diarrhea, nausea, and vomiting, which often limit the duration of use
• If gastrointestinal side effects occur, the medication should be stopped
• Colchicine should not be used with certain medications like clarithromycin or cyclosporine due to potential serious interactions, as noted in the systematic review by the American College of Physicians 1. The American College of Physicians recommends using low-dose colchicine when treating acute gout, as it is as effective as higher doses in reducing pain and is associated with fewer gastrointestinal adverse effects, as shown in a randomized controlled trial 1. Overall, the use of colchicine for 1-3 days is a common and effective treatment for gout flares, with the goal of reducing pain and inflammation while minimizing side effects.

From the FDA Drug Label

The recommended dose of Colchicine Tablets, USP for treatment of a gout flare is 1.2 mg (two tablets) at the first sign of the flare followed by 0.6 mg (one tablet) one hour later. The maximum recommended dose for treatment of gout flares is 1.8 mg over a one hour period. Colchicine Tablets, USP may be administered for treatment of a gout flare during prophylaxis at doses not to exceed 1.2 mg (two tablets) at the first sign of the flare followed by 0.6 mg (one tablet) one hour later. Wait 12 hours and then resume the prophylactic dose.

The treatment of a gout flare with colchicine typically involves a one-time dose of 1.2 mg followed by 0.6 mg one hour later, with a maximum dose of 1.8 mg over one hour. After 12 hours, the patient can resume prophylactic dosing if applicable 2.

From the Research

Duration of Colchicine Use in Gout Flare

• The duration of colchicine use in gout flare is typically short-term, with the goal of reducing pain and inflammation during an acute attack 3, 4, 5, 6.
• The recommended dosage of colchicine for the treatment of acute gout flares is 1.2 mg at the first sign of the flare, followed by 0.6 mg in 1 hour 3.
• Studies have shown that low-dose colchicine (1.8 mg over 1 h) taken as early as possible is effective in reducing pain and is well tolerated in patients with acute gout 6.
• There is no specific recommendation for the duration of colchicine use in gout flare, but it is generally used for a short period of time, typically until the symptoms of the acute attack have resolved 4, 5.

Efficacy and Safety of Colchicine

• Colchicine has been shown to be effective in reducing pain and clinical symptoms in patients with acute gout, with an absolute reduction of 34% for pain and a 30% reduction in clinical symptoms 5.
• However, colchicine has a narrow therapeutic-toxicity window and can cause gastrointestinal side effects, such as diarrhea and vomiting 5, 6.
• The number needed to treat with colchicine versus placebo to reduce pain was 3, and the number needed to harm with colchicine versus placebo was 1 5.

Comparison with Other Treatments

• Colchicine has been compared to placebo and other treatments, such as NSAIDs, in the treatment of acute gout 4, 5.
• Low-quality evidence suggests that low-dose colchicine may be an effective treatment for acute gout when compared to placebo, and its benefits may be similar to NSAIDs 4.
• However, high-dose colchicine may increase the number of adverse events compared to placebo, while low-dose colchicine may have a similar number of adverse events to NSAIDs 4.