What is the recommended dose of colchicine (Colcrys) for acute gouty arthritis?

From the Guidelines

For acute gout, the recommended colchicine dosing is 1.2 mg initially, followed by 0.6 mg one hour later, as this lower-dose regimen is as effective as higher doses in reducing pain and is associated with fewer gastrointestinal adverse effects. This recommendation is based on moderate-quality evidence from the American College of Physicians 1. The use of low-dose colchicine is a strong recommendation, with the goal of minimizing adverse effects while maintaining efficacy in treating acute gout attacks.

Key Considerations

• The total initial dose is 1.8 mg, which is typically sufficient to manage the acute gout attack.
• After the initial dose, colchicine can be continued at a dose of 0.6 mg once or twice daily until the gout attack resolves, usually within a few days.
• It is crucial to start colchicine as soon as possible after symptom onset to maximize its effectiveness.
• Patients with renal or hepatic impairment, or those using potent cytochrome P450 3A4 inhibitors or P-glycoprotein inhibitors, require careful consideration and potential dose adjustment due to the risk of adverse effects 1.
• Common side effects of colchicine include gastrointestinal issues such as diarrhea, nausea, vomiting, cramps, and pain, as well as headache and fatigue 1.
• For patients who cannot tolerate colchicine, alternative treatments such as NSAIDs or corticosteroids may be considered 1.

Clinical Decision Making

When deciding on the treatment for acute gout, it is essential to weigh the benefits and risks of each option, considering the patient's individual preferences, potential side effects, and comorbid conditions. The choice of colchicine dosing should prioritize minimizing morbidity, mortality, and improving quality of life, guided by the most recent and highest-quality evidence available 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 dose of colchicine 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.

• The dose should not be exceeded due to the risk of colchicine-induced toxic effects.
• If a patient is taking interacting drugs, dose adjustments may be necessary.

From the Research

Dose of Colchicine for Acute Gout

• The optimal dose of colchicine for acute gout is not explicitly stated in the provided studies, but low-dose colchicine is mentioned as a treatment option 3.
• Low-dose colchicine may improve treatment outcome compared to placebo with little or no increased risk of adverse events 3.
• High-dose colchicine may improve symptoms, but with increased risk of harms, and low-dose colchicine may have a similar benefit to NSAIDs with a similar number of adverse events 3.
• The studies suggest that low-dose colchicine is a viable treatment option for acute gout, but the exact dose is not specified 3, 4.
• Other treatment options for acute gout include NSAIDs, corticosteroids, and IL-1 inhibitors, with the choice of treatment depending on patient comorbidities and preferences 5, 4.