What is the treatment for gout flare-up with Colchicine (colchicine)?

From the Guidelines

For a gout flare-up, I recommend starting colchicine as soon as possible after symptom onset, with a loading dose of 1.2 mg followed by 0.6 mg one hour later, as this regimen has been shown to be effective in reducing pain with fewer gastrointestinal adverse effects, as supported by high-quality evidence from studies such as 1 and 1.

Key Considerations for Colchicine Treatment

• The initial dose of colchicine should be 1.2 mg, followed by 0.6 mg one hour later, as this low-dose regimen has been found to be as effective as higher doses in reducing pain, with fewer gastrointestinal adverse effects, as reported in studies such as 1 and 1.
• The maximum daily dose of colchicine should not exceed 1.8 mg, and dosing should be reduced in patients with kidney or liver impairment, as cautioned in 1.
• Colchicine should be taken with food to minimize gastrointestinal side effects like nausea, vomiting, or diarrhea, and treatment should be stopped if severe digestive symptoms develop, as advised in 1.

Additional Recommendations for Gout Management

• During treatment, rest the affected joint, apply ice for 20-minute intervals, and maintain hydration, as these measures can help alleviate symptoms and support recovery.
• NSAIDs like naproxen or ibuprofen can be added if needed and not contraindicated, as they may provide additional pain relief, but their use should be carefully considered in light of potential gastrointestinal and renal risks, as discussed in 1 and 1.
• After the acute flare resolves, discuss with your doctor about long-term urate-lowering therapy to prevent future attacks, as this may be beneficial for patients with recurrent gout or problematic gout, as recommended in 1.

From the FDA Drug Label

2 DOSAGE AND ADMINISTRATION

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.

The recommended dose for treatment of gout flares with colchicine is 1.2 mg at the first sign of the flare, followed by 0.6 mg one hour later, with a maximum dose of 1.8 mg over one hour.

• Key points:
  • Initial dose: 1.2 mg
  • Follow-up dose: 0.6 mg one hour later
  • Maximum dose: 1.8 mg over one hour
  • Reference: 2

From the Research

Gout Treatment with Colchicine

• Colchicine is a standard pharmacotherapy for gout flares, along with NSAIDs and oral or intramuscular corticosteroids 3
• Colchicine is effective for treating acute gout attacks, but it is not sufficient to prevent the disease from progressing 4
• The optimal agent, dose, and duration for gout prophylaxis, including colchicine, are unknown and require further investigation 4

Comparison with Other Treatments

• Colchicine was compared to NSAIDs, glucocorticoids, and other treatments in several studies, but the results were often limited by bias and imprecision 5
• One study found that colchicine may be effective for treating acute gout, but the evidence was low-certainty and downgraded for bias and imprecision 5
• Another study found that colchicine was effective for preventing gout flares, but the study was limited by its small sample size and short duration 6

Patient Characteristics and Healthcare Utilization

• Patients who started colchicine for gout generally had hyperuricemia and multiple comorbidities, including hypertension, hyperlipidemia, and diabetes mellitus 6
• Colchicine initiators had fewer comorbidities and lower healthcare utilization compared to febuxostat initiators, but more comorbidities and higher healthcare utilization compared to allopurinol initiators 6
• The median daily dose of colchicine was 1.2 mg, and the dose was rarely increased during follow-up 6

Emerging Therapies and Personalized Treatment

• There are emerging therapies for gout, including novel uricosurics and IL-1β antagonists, which may offer alternative treatment options for patients who are intolerant or refractory to standard therapies 3, 7
• Personalized treatment is becoming increasingly important, with adjustments made based on comorbidities, such as chronic kidney disease and ischemic heart disease, as well as patient preference 3