What is the recommended colchicine (Colchicine) regimen for the treatment of acute gouty arthritis?

From the Guidelines

For acute gout, the recommended colchicine regimen is 1.2 mg taken orally at the first sign of a gout attack, followed by 0.6 mg one hour later, as this lower-dose regimen provides similar efficacy with fewer gastrointestinal side effects 1.

Key Considerations

• The initial loading dose should be followed by 0.6 mg once or twice daily until the attack resolves, typically within 7-10 days.
• The total dose should not exceed 1.8 mg in the first 24 hours.
• Dose adjustments are necessary for patients with kidney or liver impairment.
• Colchicine is contraindicated in patients with renal or hepatic impairment who are using potent cytochrome P450 3A4 inhibitors or P-glycoprotein inhibitors 1.

Mechanism and Efficacy

• Colchicine works by inhibiting neutrophil migration and activity, thereby reducing inflammation in affected joints.
• It's most effective when started within the first 12-24 hours of an attack.
• High-quality evidence shows that colchicine reduces pain in patients with acute gout, with moderate-quality evidence suggesting that lower doses are as effective as higher doses with fewer gastrointestinal adverse effects 1.

Side Effects and Interactions

• Common side effects include diarrhea and abdominal pain, which often signal that the medication should be temporarily stopped.
• Avoid colchicine if you're taking certain medications like strong CYP3A4 inhibitors (e.g., clarithromycin) or P-glycoprotein inhibitors, as these can increase colchicine levels and toxicity risk 1.

From the FDA Drug Label

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 colchicine regimen for acute gout 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 2.

• Initial dose: 1.2 mg
• Follow-up dose: 0.6 mg one hour later
• Maximum dose: 1.8 mg over one hour If colchicine is being used for prophylaxis, the treatment dose for a gout flare is 1.2 mg at the first sign of the flare, followed by 0.6 mg one hour later, then wait 12 hours and resume the prophylactic dose.

From the Research

Colchicine Regimen for Acute Gout

• The efficacy and safety of colchicine for the relief of signs and symptoms of acute gouty arthritis have been evaluated in several studies 3, 4, 5, 6.
• A study published in 2006 found that colchicine is effective in reducing pain and clinical symptoms in patients with acute gout, but has a high frequency of gastrointestinal adverse events 3.
• A 2010 study found that low-dose colchicine (1.8 mg over 1 hour) is effective in reducing pain and is well tolerated in patients with acute gout 4.
• An updated review in 2014 found that low-dose colchicine is likely to be an effective treatment for acute gout, with a lower risk of adverse events compared to high-dose colchicine 5.
• A 2021 review found that low-dose colchicine may be an effective treatment for acute gout, with a similar benefit to NSAIDs, but with a lower risk of adverse events 6.

Comparison with Other Treatments

• A study comparing colchicine to NSAIDs found that low-dose colchicine may have a similar benefit to NSAIDs in terms of treatment success and pain reduction, with a similar number of adverse events 6.
• A review of NSAIDs for acute gout found that NSAIDs are effective in reducing pain and inflammation, but may have a higher risk of adverse events compared to colchicine 7.
• The same review found that systemic glucocorticoids and NSAIDs are probably equally beneficial in terms of pain relief, improvement in function, and treatment success, but NSAIDs may result in more total adverse events 7.

Dosage and Administration

• The optimal dosage and administration of colchicine for acute gout are not well established, but low-dose regimens (e.g. 1.8 mg over 1 hour) may be effective and well tolerated 4, 5, 6.
• High-dose colchicine regimens may be more effective in reducing pain and inflammation, but may also increase the risk of adverse events 3, 5, 6.