From the Guidelines
For acute gout attacks, colchicine is typically prescribed as 1.2 mg initially, followed by 0.6 mg one hour later (total 1.8 mg), as recommended by the 2012 American College of Rheumatology guidelines 1. This dosing regimen is based on the pharmacokinetics of low-dose colchicine, where the exposure to the drug in plasma becomes markedly reduced approximately 12 hours after administration in normal, healthy volunteers. After this loading dose, maintenance therapy continues with 0.6 mg once or twice daily until the attack resolves. For gout prevention, the standard dose is 0.6 mg once or twice daily. Dosage adjustments are necessary for patients with kidney or liver impairment, and colchicine should be used cautiously in elderly patients, as recommended by the FDA-approved drug labeling 1. The medication works by reducing inflammation through inhibition of neutrophil migration and activity in affected joints. Common side effects include gastrointestinal symptoms like diarrhea, nausea, and vomiting, which often indicate the need to reduce or stop the medication, as seen in a systematic review of gout management 1. Colchicine should not be used with certain medications like strong CYP3A4 inhibitors (e.g., clarithromycin) or P-glycoprotein inhibitors due to increased risk of toxicity, as highlighted in the 2012 American College of Rheumatology guidelines 1. Some key points to consider when prescribing colchicine include:
- The importance of staying well-hydrated while taking colchicine
- The need to report any muscle pain or weakness, as these could indicate serious side effects
- The potential for drug interactions with other medications, such as cyclosporine and disulfiram
- The recommendation to consult the FDA-approved drug labeling for specific prescriptive guidance, including recommended dosing reduction in moderate to severe CKD.
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.
The prescription recommendation for colchicine for gout is:
- 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 at the first sign of the flare, followed by 0.6 mg one hour later, with a maximum recommended dose of 1.8 mg over a one hour period 2.
From the Research
Prescription Recommendation for Colchicine in Gout
- 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.
- Low-dose colchicine (1.8 mg over 1 hour) taken as early as possible is effective in reducing pain and is well tolerated in patients with acute gout 4.
- High-dose colchicine may improve symptoms, but with increased risk of harms, such as gastrointestinal adverse events 5, 6, 7.
- Low-dose colchicine may be the preferred treatment option due to its efficacy and lower risk of adverse events compared to high-dose colchicine 6, 7.
Efficacy and Safety of Colchicine
- Colchicine is effective in reducing pain and clinical symptoms in patients with acute gout 3, 5, 4, 6, 7.
- The incidence of adverse events, such as diarrhea, vomiting, and nausea, is higher with high-dose colchicine compared to low-dose colchicine or placebo 5, 6, 7.
- Low-dose colchicine may have a similar efficacy and safety profile compared to non-steroidal anti-inflammatory drugs (NSAIDs) 7.