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Anti-Inflammatory (Microtubule Inhibitor) Pregnancy: Caution in first trimester (mutagenic in animal studies); limited human data suggest safe; used for FMF throughout pregnancy

Colchicine (Acute Gout)

Brand names: Colchicine (generic)

Adult dose

Dose: Acute gout: 500 mcg TDS–QDS. Or alternatively: 1 mg stat then 500 mcg after 1 hour (new UK regimen).
Route: Oral
Frequency: TDS–QDS for acute gout (max 3 days course); OD maintenance for pericarditis/familial Mediterranean fever
Max: Acute gout: 6 mg per course (do not repeat within 3 days)
Old 'until diarrhoea' regimen is no longer recommended — associated with toxicity. Low-dose regimen (1 mg + 0.5 mg at 1h) as effective as high-dose with fewer GI side effects (AGREE trial).

Paediatric dose

Route: Oral
Frequency: OD
Max: Familial Mediterranean fever (FMF): children ≥4 years: 0.5 mg OD–BD
Concentration: 500 mcg tablet mg/ml
Not used for acute gout in children. Familial Mediterranean fever: 0.5 mg OD (≥4 years). Max 1.5 mg/day in children.

Dose adjustments

Renal

Reduce dose in renal impairment: eGFR 10–50: max 1 mg per course. Avoid if eGFR <10.

Hepatic

Reduce dose in hepatic impairment — reduced clearance

Clinical pearls

  • AGREE trial: 1 mg + 0.5 mg after 1h = equivalent efficacy to high-dose with 80% fewer GI side effects
  • Toxicity presentations: initial GI symptoms, followed by bone marrow suppression, neuromuscular toxicity, and multi-organ failure (dose-dependent)
  • Ciclosporin interaction is critical — avoid combination; if needed reduce colchicine to 0.5 mg with very careful monitoring
  • COPE and ICAP trials: colchicine 500 mcg BD effective for pericarditis prevention when added to NSAIDs/aspirin

Contraindications

  • Blood dyscrasias
  • Severe renal AND hepatic impairment combined (increased toxicity risk)

Side effects

  • Nausea, vomiting, diarrhoea (most common — dose-dependent)
  • Myopathy (prolonged use or interaction with statins)
  • Bone marrow suppression (rare)
  • Peripheral neuropathy (rare, chronic use)
  • Multi-organ failure (severe overdose)

Interactions

  • Ciclosporin/tacrolimus — 5-fold increase in colchicine levels (potentially fatal)
  • Statins — myopathy risk (especially simvastatin)
  • Clarithromycin/erythromycin — significantly increase colchicine levels (toxicity risk)
  • Verapamil/diltiazem — increase colchicine levels

Monitoring

  • GI symptoms (first sign of toxicity)
  • FBC (prolonged use — myelosuppression)
  • Renal and hepatic function (dose adjustment)
  • CK (if muscle symptoms — myopathy)

Reference: BNFc; BNF; AGREE Trial (Terkeltaub et al, Arthritis Rheum 2010); COPE/ICAP Trials; BSR Gout Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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