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Anti-gout / Anti-inflammatory Pregnancy: Use with caution in pregnancy; data limited. FMF — risk of stopping outweighs teratogenic risk (reproductive studies reassuring).

Colchicine

Brand names: Colchicine

Adult dose

Dose: Acute gout: 500 micrograms 2–4 times daily; FMF/pericarditis: 500 micrograms to 1 mg twice daily
Route: Oral
Frequency: Twice to four times daily (gout); twice daily (FMF/pericarditis)
Max: 6 mg per acute gout course (NICE NG219); 2 mg/day (prophylaxis)
Acute gout: 500 micrograms 2–4 times daily for 2–5 days (max 6 mg per course — NICE 2022 update). Lower dose preferred (500 mcg BD-TDS). Do not repeat course within 3 days. Gout prophylaxis: 500 mcg OD–BD. Pericarditis (COPE trial): weight-based BD for 3 months.

Paediatric dose

Route: Oral
Frequency: Twice daily
Max: 1.8 mg/day (FMF in children)
FMF (≥4 years): 0.5 mg/day (<5 years); 1 mg/day (5–10 years); 1.5–1.8 mg/day (>10 years) in divided doses. Specialist guidance required.

Dose adjustments

Renal

eGFR 30–60: 50% dose reduction; eGFR <30: avoid or use 500 mcg OD only with monitoring.

Hepatic

Reduce dose in severe hepatic impairment; accumulation risk.

Clinical pearls

  • Low-dose colchicine (500 mcg BD-TDS) as effective as high-dose with fewer GI side effects (AGREE trial)
  • Maximum 6 mg per acute gout course — do not repeat within 3 days (NICE NG219)
  • COPE/ICAP trials: colchicine reduces pericarditis recurrence — now standard of care
  • LoDoCo trial: colchicine 0.5 mg daily reduces CV events in stable CAD
  • Myopathy risk with statins — check CK if muscle symptoms

Contraindications

  • Severe renal impairment (eGFR <30) — unless no alternative
  • Severe hepatic impairment
  • Blood dyscrasias

Side effects

  • GI toxicity (diarrhoea, nausea, vomiting — dose-related)
  • Myopathy (prolonged use or with statins/CsA)
  • Bone marrow suppression (severe overdose or prolonged high doses)
  • Alopecia (prolonged use)
  • Peripheral neuropathy

Interactions

  • Statins — increased myopathy risk (colchicine inhibits CYP3A4; monitor CK)
  • Ciclosporin — significantly increases colchicine levels (risk of toxicity)
  • Strong CYP3A4 inhibitors (clarithromycin, ketoconazole) — increase colchicine levels
  • P-glycoprotein inhibitors (verapamil) — increase colchicine levels

Monitoring

  • U&E and eGFR
  • LFTs
  • FBC (prolonged use)
  • CK (if on statin)

Reference: BNFc; BNF; NICE NG219 Gout; COPE Trial; EULAR Gout Guidelines 2022. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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