Anti-Inflammatory (Microtubule Inhibitor) Pregnancy: Pregnancy and breastfeeding are contraindications for this product, as is use in women of childbearing potential not using effective contraception. For gout specifically, use in pregnancy should be avoided and considered only if other options including NSAIDs and glucocorticoids are not applicable; women must use effective contraception during and for at least 3 months after stopping colchicine, and men should not father a child during and for at least 6 months after stopping. Colchicine should not be used in breastfeeding women with gout.

Colchicine (Acute Gout)

Brand names: Colchicine (generic)

Used in: Gout

Colchicine is used here to treat acute gout flares, providing anti-inflammatory relief where NSAIDs are unsuitable.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 1 mg (2 x 500 microgram tablets) to start, followed by 500 micrograms (1 tablet) after 1 hour

Route: Oral — tablets swallowed whole with a glass of water (an oral dispersion per SPC §6.6 may be used, including via nasogastric or PEG tube)

Frequency: No further tablets for 12 hours after the initial 1 mg + 500 micrograms; after 12 hours treatment can resume if necessary at a maximum of 500 micrograms every 8 hours until symptoms are relieved

Max: 6 mg (12 tablets) as a total course — no more than 6 mg per course, and no further course for at least 3 days (72 hours) after completing one

DISCONTINUE IMMEDIATELY if diarrhoea or vomiting occurs — these may be the first signs of colchicine intoxication. Colchicine is potentially toxic and has a narrow therapeutic window; do not exceed the prescribed dose. GOUT FLARE PROPHYLAXIS during initiation of allopurinol or uricosuric therapy: 0.5-1 mg per day, taken in the evening; treatment duration decided after assessing flare frequency, gout duration, and the presence and size of tophi. FAMILIAL MEDITERRANEAN FEVER (adults, same product): 1 to 3 mg (2 to 6 tablets) per day as a single dose, or divided twice daily for doses above 1 mg/day, increased stepwise to a maximum of 3 mg/day if there is no clinical response; halve the starting dose (e.g. 1 mg/day or less) in impaired renal or liver function. INTERACTION-DRIVEN DOSE REDUCTION: if the patient is on a moderate or potent CYP3A4 inhibitor or a P-glycoprotein inhibitor, the maximum recommended oral colchicine dose must be reduced and the patient carefully monitored for colchicine toxicity. Long-term use may be associated with vitamin B12 deficiency. FOR GOUT PATIENTS: counsel about pregnancy risk and contraception (see pregnancy field). PAEDIATRIC: this product 'should not be used in children and adolescents'; colchicine tablets are not recommended for paediatric use in the prophylaxis or treatment of gout flares (US label). The only paediatric indication in the SPC is FMF, under specialist supervision, with age-based (not per-kg) starting doses — 0.5 mg/day under 5 years, 1 mg/day from 5 to 10 years, 1.5 mg/day over 10 years, increased stepwise (e.g. 0.25 mg/step) to a maximum of 2 mg/day, and up to 2 mg/day may be needed with amyloid nephropathy. Verify any paediatric use against a children's formulary.

Dose adjustments

Renal

Mild and moderate renal impairment (gout): the dose is 0.5 mg per day, with careful monitoring for adverse effects. Mild and moderate renal impairment (FMF): reduce the starting dose by 50% (e.g. 1 mg/day or less). Severe renal impairment: contraindicated. Haemodialysis: contraindicated — colchicine is not removed by dialysis or exchange transfusion. Hepatic impairment follows the same pattern (mild/moderate: 0.5 mg per day for gout; severe: contraindicated).

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to colchicine or to any of the excipients
Blood dyscrasias
Pregnancy; breastfeeding; women of childbearing potential unless using effective contraception
Severe renal impairment
Severe hepatic impairment
Patients undergoing haemodialysis — colchicine cannot be removed by dialysis or exchange transfusion
Patients with renal or hepatic impairment who are taking a P-glycoprotein (P-gp) inhibitor or a strong CYP3A4 inhibitor

Side effects

Common: abdominal pain, nausea, vomiting and diarrhoea — dose-limiting and potentially the first signs of intoxication; stop treatment immediately (diarrhoea was the most common reaction in gout trials, 23% in the treatment-of-flare trial)
Bone marrow depression with agranulocytosis, aplastic anaemia and thrombocytopenia (frequency not known; periodic blood counts are essential)
Myopathy and rhabdomyolysis
Peripheral neuritis and neuropathy
Hepatotoxicity; renal damage; gastrointestinal haemorrhage
Alopecia, rash; pharyngolaryngeal pain; amenorrhoea, dysmenorrhoea, oligospermia, azoospermia; vitamin B12 deficiency

Interactions

Strong CYP3A4 inhibitors and P-glycoprotein inhibitors — markedly increase colchicine exposure and can cause life-threatening or fatal colchicine toxicity; reduce the dose in patients with normal renal and hepatic function, and avoid entirely in renal or hepatic impairment (contraindicated)
Macrolides (fatal toxicity reported with clarithromycin), HIV protease inhibitors, ciclosporin, ketoconazole/itraconazole — named CYP3A4/P-gp inhibitors requiring dose reduction or avoidance
Calcium channel blockers — clinically significant interaction that may lead to colchicine toxicity
HMG-CoA reductase inhibitors (atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin) — myopathy and rhabdomyolysis, including a fatality, when one drug is added to a stable regimen of the other
Long-term colchicine may be associated with vitamin B12 deficiency

Clinical monograph

How it works

It binds tubulin and inhibits microtubule polymerisation, impairing neutrophil chemotaxis, activation and the inflammatory response to urate crystals.

Prescribing in practice

Colchicine has a narrow therapeutic index and toxicity (severe diarrhoea, vomiting, then multi-organ and bone-marrow effects) can be fatal; do not give a further course within a short interval and reduce dose or avoid in significant renal or hepatic impairment.
Potent CYP3A4 and P-glycoprotein inhibitors (such as clarithromycin, certain antifungals, ciclosporin and some protease inhibitors) markedly raise colchicine levels and can precipitate fatal toxicity.
Diarrhoea is an early sign of toxicity, and concurrent statins may increase the risk of myopathy.

Monitoring

Monitor for gastrointestinal toxicity as an early warning sign, and review renal and hepatic function and interacting drugs before and during use.

Counselling the patient

Stop taking it and seek advice if you develop diarrhoea, vomiting or severe stomach upset.
Do not take more than directed, as overdose can be dangerous.
Tell clinicians about this medicine if prescribed certain antibiotics or antifungals.

Evidence & guidelines

Low-dose colchicine regimens are supported by NICE for acute gout, achieving comparable efficacy to higher doses with substantially less toxicity.

Reference: AGREE Trial (Terkeltaub et al, Arthritis Rheum 2010); COPE/ICAP Trials; BSR Gout Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways