From the Guidelines
For acute gout flares, colchicine should be started at 1.2 mg at the first sign of an attack, followed by 0.6 mg one hour later (total 1.8 mg), as this low-dose regimen is as effective as higher doses in reducing pain and is associated with fewer gastrointestinal adverse effects, as supported by moderate-quality evidence from the American College of Physicians guideline 1.
Key Considerations for Colchicine Dosing
- The initial loading dose of 1.2 mg followed by 0.6 mg one hour later is recommended for acute gout flares.
- For prophylaxis of recurrent gout, the typical dose is 0.6 mg once or twice daily.
- Patients with renal impairment (CrCl <30 mL/min) or hepatic dysfunction should use reduced doses, typically 0.3 mg daily or every other day.
- Elderly patients may also require lower doses due to decreased clearance.
Important Safety Considerations
- Colchicine should be avoided in patients taking strong CYP3A4 or P-glycoprotein inhibitors like clarithromycin or cyclosporine due to the risk of toxicity, as highlighted in the guideline recommendations 1.
- Common side effects include diarrhea, nausea, and vomiting, which can signal early toxicity.
- Patients should stop taking colchicine and contact their healthcare provider if gastrointestinal symptoms develop.
Evidence-Based Recommendations
- The American College of Physicians recommends using low-dose colchicine for treating acute gout, based on moderate-quality evidence 1.
- The guideline also emphasizes the importance of discussing benefits, harms, costs, and individual preferences with patients before initiating urate-lowering therapy, including concomitant prophylaxis, in patients with recurrent gout attacks 1.
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. Higher doses have not been found to be more effective. The maximum recommended dose for treatment of gout flares is 1.8 mg over a one hour period.
Colchicine Dosing for Gout:
- Prophylaxis of Gout Flares: 0.6 mg once or twice daily, with a maximum recommended dose of 1.2 mg/day.
- Treatment of Gout Flares: 1.2 mg (two tablets) at the first sign of the flare, followed by 0.6 mg (one tablet) one hour later, with a maximum recommended dose of 1.8 mg over a one hour period. 2
From the Research
Colchicine Dosing for Gout
- Colchicine is an effective treatment for acute gout, with low-dose colchicine (1.8 mg over 1 hour) being well-tolerated and effective in reducing pain 3.
- High-dose colchicine may improve symptoms, but with increased risk of harms, such as gastrointestinal adverse events 4, 5.
- The number needed to treat (NNT) with colchicine versus placebo to reduce pain was 3, and the number needed to harm (NNH) with colchicine versus placebo was 1 6.
- Low-dose colchicine may be the preferred treatment option due to its efficacy and lower risk of adverse events compared to high-dose colchicine 4, 5.
Comparison to Other Treatments
- There is low-quality evidence that low-dose colchicine may be an effective treatment for acute gout when compared to placebo, and its benefits may be similar to NSAIDs 5.
- No trials have compared colchicine to glucocorticoids, and there is a need for further research to determine the effectiveness of colchicine compared to other treatments 6, 4, 5.
Dosage and Administration
- Low-dose colchicine (1.8 mg over 1 hour) is effective in reducing pain and is well-tolerated in patients with acute gout 3.
- High-dose colchicine regimens have varied in studies, but have been associated with increased risk of adverse events 4, 5.
- The optimal dosage and administration of colchicine for acute gout require further research to determine the most effective and safe regimen 5.