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Anti-Inflammatory (Gout) Pregnancy: C — limited data; avoid first trimester

Colchicine

Brand names: Colcrys, Columvi

Adult dose

Dose: 500 micrograms two to four times daily (acute gout). Prophylaxis: 500 mcg OD or BD
Route: Oral
Frequency: Two to four times daily (acute) or once/twice daily (prophylaxis)
Acute gout: 500mcg 2–4 times daily until pain resolves. Max 6mg per course. COLCOT protocol (pericarditis): 0.5mg BD. LoDoCo2 (CV): 0.5mg OD.

Clinical pearls

  • Diarrhoea is the commonest side effect and dose-limiting — warn patient at initiation
  • Mechanism: inhibits tubulin polymerisation → impairs neutrophil migration into joint
  • Now used in cardiovascular disease (LoDoCo2 trial: reduced CV events in stable IHD)
  • Pericarditis: first-line adjunctive treatment (COPE and ICAP trials)
  • Reduce dose in elderly and renal impairment — narrow therapeutic window

Contraindications

  • Severe renal impairment (eGFR <10)
  • Severe hepatic impairment
  • Blood dyscrasias

Side effects

  • GI toxicity: diarrhoea, nausea, vomiting (dose-limiting)
  • Myopathy
  • Peripheral neuropathy (prolonged use)
  • Bone marrow suppression (toxic doses)

Interactions

  • Ciclosporin, clarithromycin, ketoconazole — CYP3A4/P-gp inhibitors → colchicine toxicity (reduce dose or avoid)
  • Statins — myopathy risk
  • Digoxin — increased levels

Monitoring

  • FBC (prolonged use)
  • LFTs
  • CK (if myalgia)
  • Renal function

Reference: ACR Gout Guidelines 2020; LoDoCo2 trial (NEJM 2020). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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