Anti-Inflammatory (Gout) Pregnancy: In gout or gout prophylaxis, avoid as a precautionary measure in pregnancy and in women of childbearing potential not using effective contraception - only consider if NSAIDs and glucocorticoids are not applicable; female patients must use effective contraception during and for at least 3 months after stopping, and male patients should not father a child during and for at least 6 months after stopping. In Familial Mediterranean Fever, a moderate amount of data indicate no malformative or feto/neonatal toxicity and use may be considered if clinically needed. Colchicine should not be used in breast-feeding women with gout.

Colchicine

Brand names: Colcrys, Columvi

Colchicine is an anti-inflammatory agent used to treat and prevent acute gout flares and is also used in pseudogout and some inflammatory conditions. In orthopaedic and trauma settings it is an option for crystal arthritis, particularly where NSAIDs are contraindicated.

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: Acute gout attack: 500 micrograms (2 mL of the 250 micrograms/mL oral solution)

Route: Oral

Frequency: Two to four (2-4) times daily until symptoms are relieved

Max: 6,000 micrograms (24 mL) per course of treatment; after completing a course, another course should not be started for at least 3 days (72 hours)

The course should end when symptoms are relieved or when a total of 6,000 micrograms (24 mL) has been taken. If diarrhoea or vomiting occurs, colchicine should be discontinued immediately as these may be the first signs of intoxication. Prophylaxis of gout attack: 500-1,000 micrograms per day (2-4 mL/day) taken in the evening. Acute and recurrent pericarditis (adults): 500 micrograms/day if body weight 70 kg or less or if intolerant of higher doses; 500 micrograms twice daily if body weight over 70 kg - treatment duration 3 months in acute pericarditis and 6 months in recurrent pericarditis. Familial Mediterranean Fever (adults): 1,000 to 3,000 micrograms per day (4-12 mL/day), as a single dose, or divided twice daily if above 1,000 micrograms/day; increase stepwise up to a maximum of 3,000 micrograms/day in patients who do not clinically respond, monitoring closely for adverse effects. Concomitant moderate or potent CYP3A4 inhibitors or P-glycoprotein inhibitors: the maximum recommended oral colchicine dose should be reduced and the patient carefully monitored. Mild and moderate hepatic impairment: 500 micrograms (2 mL) per day in gout and acute/recurrent pericarditis, and reduce the FMF starting dose by 50% (e.g. 1,000 micrograms/day or less); severe hepatic impairment is a contraindication. Paediatric use: the SPC states colchicine should not be used in children and adolescents for gout or for acute/recurrent pericarditis. For Familial Mediterranean Fever it states paediatric use only under the supervision of a specialist, with age-based (not per-kg) oral starting doses: 500 micrograms/day (2 mL/day) under 5 years; 1,000 micrograms/day (4 mL/day) 5 to 10 years; 1,500 micrograms/day (6 mL/day) over 10 years; up to 2,000 micrograms/day (8 mL/day) may be needed in children with amyloid nephropathy, increased stepwise (e.g. 250 micrograms per step) to a maximum of 2,000 micrograms/day. Verify all paediatric use against a children's formulary.

Dose adjustments

Renal

Mild and moderate renal impairment: 500 micrograms (2 mL) per day in gout and acute/recurrent pericarditis; reduce the Familial Mediterranean Fever starting dose by 50% (e.g. 1,000 micrograms/day or less). Patients with any degree of renal impairment should not be given colchicine with strong P-glycoprotein inhibitors or strong CYP3A4 inhibitors. Severe renal impairment is a contraindication.

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 the active substance or to any of the excipients
Patients with blood dyscrasias
Patients with severe renal impairment
Patients with severe hepatic impairment

Side effects

Abdominal pain, nausea, vomiting and diarrhoea
Bone marrow depression with agranulocytosis, aplastic anaemia, pancytopenia, neutropenia, thrombocytopenia, leukopenia
Peripheral neuritis, neuropathy
Myopathy, rhabdomyolysis, muscle weakness
Hepatotoxicity with increased transaminases; renal impairment; alopecia, urticaria, maculopapular rash

Interactions

Macrolides, CYP3A4 inhibitors, ciclosporin, HIV protease inhibitors, calcium channel blockers and statins may cause clinically significant interactions leading to colchicine-induced toxicity
Co-administration with P-glycoprotein inhibitors and/or strong CYP3A4 inhibitors increases colchicine exposure and may cause toxicity including fatalities - reduce the colchicine dose if such a medicine is required in patients with normal renal and hepatic function, and monitor carefully
In patients with any degree of renal or hepatic impairment, combined use with P-gp inhibitors and/or strong CYP3A4 inhibitors should be avoided whenever possible
Long-term use of colchicine may be associated with vitamin B12 deficiency

Clinical monograph

How it works

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

Prescribing in practice

Colchicine has a narrow therapeutic index and overdose can be fatal — gastrointestinal symptoms such as diarrhoea are an early sign of toxicity and a cue to stop, and accidental or intentional overdose requires urgent specialist help.
It interacts dangerously with strong CYP3A4 and P-glycoprotein inhibitors (for example clarithromycin, certain antifungals, ciclosporin) and with statins, raising the risk of toxicity and myopathy, so review interacting drugs carefully.
Reduce dose and frequency in significant renal or hepatic impairment and in older or frail patients, following the SPC.

Monitoring

Monitor for gastrointestinal toxicity, and with prolonged use review full blood count and for muscle or nerve symptoms, especially in renal impairment or with interacting drugs.

Counselling the patient

Stop taking it and seek advice if you develop diarrhoea, nausea or vomiting, as these can signal toxicity.
Tell any prescriber you take colchicine before starting new medicines, particularly certain antibiotics or antifungals.
Never take more than prescribed — taking extra can be dangerous.

Evidence & guidelines

NICE guidance on gout includes colchicine as a treatment option for acute flares, particularly when NSAIDs are unsuitable, using lower doses to limit toxicity.

Reference: ACR Gout Guidelines 2020; LoDoCo2 trial (NEJM 2020); 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