What are the dosage and regimen recommendations for colchicine in the treatment of acute gout?

Updated: Jan 26, 2021
  • Author: Bruce M Rothschild, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Dosing recommendations for colchicine in the treatment of acute gout have undergone modifications as awareness of its toxicities has increased. Newer recommendations trend toward lowered daily and cumulative doses. [142, 144]

The regimen currently favored consists of 1.2 mg of colchicine, followed by 0.6 mg 1 hour later to initiate treatment of the early gout flare. In a multicenter, randomized, double-blind, placebo-controlled, parallel-group study, Terkaltaub et al found that this regimen yielded both maximum plasma concentration and early gout flare efficacy comparable with those of high-dose colchicine (4.8 mg total over 6 hours), with a safety profile indistinguishable from that of placebo. [145]

Data from 7 separate drug-to-drug interaction (DDI) studies suggests colchicine dose reductions of 33-66% for treatment of acute gout and 50-75% for prophylaxis when colchicine is given in combination with the extended-release calcium channel blockers verapamil and diltiazem or with the numerous P-gp and/or CYP3A4 inhibitors (eg, clarithromycin and cyclosporine); in addition, patients should avoid grapefruit juice. Dosages of colchicine did not have to be adjusted when the drug was used in combination with azithromycin. [146]


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