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Anti-Gout Agent Pregnancy: Avoid in pregnancy unless clearly necessary

Colchicine

Brand names: Colcrys, Colchicine (generic)

Adult dose

Dose: 500 micrograms two to four times daily
Route: Oral
Frequency: Two to four times daily until pain relieved (max 6 mg per course)
Max: 6 mg per acute gout course; do not repeat within 3 days
NICE CG177: Colchicine is first-line for acute gout if NSAIDs contraindicated. Low-dose regimen (500 micrograms twice daily) is as effective as high-dose with fewer GI side effects

Paediatric dose

Dose: Seek specialist opinion N/A/kg
Route: Oral
Frequency: Seek specialist opinion
Max: Seek specialist opinion
Seek specialist opinion

Dose adjustments

Renal

Reduce dose if eGFR 10-50; avoid if eGFR under 10 — risk of neuromuscular toxicity

Hepatic

Use with caution in hepatic impairment

Paediatric weight-based calculator

Seek specialist opinion

Clinical pearls

  • Colchicine toxicity can be fatal — clarithromycin interaction is potentially lethal; avoid co-prescribing or reduce colchicine dose significantly
  • NSAIDs preferred for acute gout in fit adults, but colchicine is often preferred in elderly where NSAIDs are contraindicated (renal impairment, heart failure, anticoagulants)
  • Low-dose regimen (500 micrograms twice daily x 3 days) equally effective and better tolerated than traditional high-dose (AGREE trial)
  • Does NOT lower uric acid — treats acute attack only; allopurinol or febuxostat for urate-lowering therapy (ULT) started after acute attack resolves
  • Prophylactic use (500 micrograms once or twice daily) during ULT initiation prevents flares — continue for 6 months

Contraindications

  • Severe renal impairment (eGFR under 10)
  • Severe hepatic impairment
  • Concurrent colchicine use within 3 days

Side effects

  • Nausea, vomiting and diarrhoea (most common — dose-limiting)
  • Abdominal cramps
  • Myopathy and neuropathy (particularly with statins or renal impairment)
  • Bone marrow suppression (rare, overdose)

Interactions

  • Statins (myopathy risk — particularly simvastatin, atorvastatin)
  • Ciclosporin (dramatically increases colchicine toxicity)
  • Clarithromycin / erythromycin (CYP3A4 and P-gp inhibition — increase colchicine levels, potentially fatal)
  • P-glycoprotein inhibitors (increase exposure)

Monitoring

  • Renal function (eGFR)
  • Signs of toxicity (GI, myopathy)
  • FBC (long-term use)

Reference: BNFc; BNF 90; NICE CG177 (Gout); AGREE Trial; BSR Gout Guidelines 2017. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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