From the Guidelines
For acute gout attacks, colchicine is typically administered as 1.2 mg initially, followed by 0.6 mg one hour later (total 1.8 mg), then 0.6 mg once or twice daily until symptoms resolve, as recommended by the American College of Physicians (1). This lower-dose regimen is preferred over older high-dose protocols due to better tolerability with similar efficacy. Methylprednisolone can be given as 40-80 mg intramuscularly as a single dose, or orally at 20-40 mg daily for 3-5 days, followed by a rapid taper over 7-10 days. Both medications work through different anti-inflammatory mechanisms: colchicine prevents neutrophil activation and migration by disrupting microtubule formation, while methylprednisolone suppresses multiple inflammatory pathways. Some key points to consider when choosing between these medications include:
- Common side effects of colchicine include gastrointestinal symptoms (diarrhea, nausea, vomiting), and it requires dose adjustment in renal impairment and with certain drug interactions (1).
- Methylprednisolone may cause mood changes, increased blood glucose, and fluid retention.
- Either medication can be effective for acute gout, with the choice depending on patient comorbidities, medication contraindications, and previous response to therapy. It's also important to note that the American College of Physicians recommends against initiating long-term urate-lowering therapy in most patients after a first gout attack or in patients with infrequent attacks (1). However, for patients with recurrent gout attacks, urate-lowering therapy may be considered, and the benefits and harms of this therapy should be discussed with the patient (1). Overall, the treatment of acute gout should be individualized based on the patient's specific needs and circumstances.
From the FDA Drug Label
The recommended dosage of Colchicine Tablets, USP for prophylaxis of gout flares for adults and adolescents older than 16 years of age is 0.6 mg once or twice daily. The maximum recommended dose for prophylaxis of gout flares is 1.2 mg/day. 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.
Colchicine Dose in Gout:
- Prophylaxis of Gout Flares: 0.6 mg once or twice daily, maximum 1.2 mg/day.
- Treatment of Gout Flares: 1.2 mg at the first sign of the flare, followed by 0.6 mg one hour later.
Methylprednisolone Dose in Gout: There is no information in the provided drug labels about the dose of methylprednisolone in gout. 2, 2, 2
From the Research
Colchicine and Methylprednisolone Dose in Gout
- The optimal dose of colchicine for acute gout is not well established, but low-dose colchicine (1.8 mg over one hour) may be an effective treatment with fewer adverse events compared to high-dose colchicine 3, 4.
- High-dose colchicine (4.8 mg over six hours) may improve symptoms, but with increased risk of harms, such as diarrhea, vomiting, or nausea 3, 4.
- There is low-quality evidence that low-dose colchicine is more efficacious than placebo in reducing pain and improving treatment outcomes, with a number needed to treat to benefit (NNTB) of 5 4.
- Methylprednisolone dose is not specified in the provided studies, but systemic corticosteroids, such as methylprednisolone, have similar efficacy to therapeutic doses of NSAIDs in treating acute gout attacks 5.
- The use of colchicine and corticosteroids, such as methylprednisolone, may be limited by comorbidities and potential adverse events, and further studies are needed to compare their efficacy and safety in treating acute gout 6, 7, 3, 4, 5.