Duration of Colchicine Treatment for Acute Gout
Continue colchicine at 0.6 mg once or twice daily until the acute gout attack has completely resolved, typically within a few days, then stop the medication. 1, 2, 3
Acute Treatment Phase
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), but only if treatment starts within 36 hours of symptom onset 1, 2, 3
Continuation dosing: After the initial loading doses, wait 12 hours, then resume 0.6 mg once or twice daily until the attack completely resolves 1, 3
If already on prophylactic colchicine when the attack occurs: Take the loading dose (1.2 mg followed by 0.6 mg one hour later), then wait 12 hours before resuming your regular prophylactic dose 1
Critical Timing Considerations
Treatment must begin within 36 hours of symptom onset for colchicine to be effective; effectiveness drops significantly beyond this window 1, 2, 3
Maximum benefit occurs when started within 12 hours of symptom onset 1, 2
The acute attack typically resolves within a few days with appropriate treatment 1, 3
When to Stop Acute Treatment
Discontinue colchicine once the gouty attack has completely resolved - do not continue at full dose beyond symptom resolution 1, 2
Complete resolution means no pain, swelling, or inflammation in the affected joint 1
Prophylactic Therapy (Different from Acute Treatment)
If you are starting urate-lowering therapy (allopurinol or febuxostat) after the acute attack resolves, prophylactic colchicine is a separate consideration:
Duration of prophylaxis: Continue for at least 6 months, or 3 months after achieving target serum urate without tophi, or 6 months after achieving target serum urate and resolution of tophi 3
Prophylaxis should be longer than 8 weeks to effectively reduce recurrent gout attacks 4
Renal Impairment Adjustments
Severe renal impairment (CrCl <30 mL/min or eGFR <30 mL/min): Avoid colchicine entirely and use alternative therapy such as oral corticosteroids 1, 2
Moderate renal impairment: Doses should be reduced by half 5
Always calculate creatinine clearance before prescribing, especially in elderly patients 3
Alternative Options if Colchicine Cannot Be Used
NSAIDs at full FDA-approved doses (naproxen, indomethacin, or sulindac) until complete resolution 1, 2
Oral corticosteroids: Prednisone 30-35 mg daily for 3-5 days, then stop or taper over 7-10 days 1, 2
Intra-articular corticosteroid injection for monoarticular gout 1, 2
Common Pitfalls to Avoid
Never use the obsolete high-dose regimen (0.5 mg every 2 hours until relief or toxicity) - this causes severe diarrhea with no additional benefit 2, 6
Do not continue acute-dose colchicine indefinitely - stop once the attack resolves 1, 2
Absolute contraindication: Never give colchicine to patients taking strong P-glycoprotein or CYP3A4 inhibitors (cyclosporine, clarithromycin, ketoconazole) if they have renal or hepatic impairment 1, 3