Colchicine
Low-dose colchicine treats acute gout as well as high doses, with less diarrhoea. Watch kidney function and interactions.
On this page
Uses
- Acute gout.
- Prevention of gout flares when starting urate-lowering treatment.
- Pericarditis (with an NSAID).
How it works
Colchicine binds tubulin and stops microtubules forming inside white cells. Neutrophils then cannot move into the joint, engulf urate crystals or set off the inflammatory cascade (including the NLRP3 inflammasome). It has no effect on uric acid levels and is not a painkiller in general. Its therapeutic window is narrow: the gap between a useful dose and a toxic one is small.
When it is used
- Acute gout, best started within the first 24 hours of a flare. It is especially useful when NSAIDs are unsuitable, for example in heart failure, peptic ulcer disease or with anticoagulants. See acute gout.
- Flare prevention for the first months after starting allopurinol or febuxostat, which can trigger attacks as urate levels fall.
- Acute and recurrent pericarditis, added to an NSAID or aspirin to speed recovery and reduce recurrence.
- Familial Mediterranean fever and Behçet's disease (specialist).
- Not for: a hot swollen joint before septic arthritis has been excluded (see septic arthritis), or general joint or back pain.
Adult dose
| Indication | Dose |
|---|---|
| Acute gout | 500 micrograms 2–4 times daily until symptoms improve, max 6 mg per course; don't repeat within 3 days |
| Flare prevention | 500 micrograms once or twice daily for up to 6 months |
| Pericarditis | 500 micrograms once or twice daily for 3 months |
500 micrograms is the same as 0.5 mg. Lower doses within these ranges cause less diarrhoea and work as well for gout.
Kidney and liver
Reduce dose in kidney impairment; avoid if creatinine clearance below 10.
Use the creatinine clearance calculator. Use lower doses or longer intervals in liver disease and in older patients.
Side effects and cautions
- Diarrhoea, nausea (stop if diarrhoea).
- Toxic with clarithromycin, erythromycin, ciclosporin, some antifungals and statins.
Contraindications
- Severe kidney impairment.
- Kidney or liver impairment in a patient who also takes a strong CYP3A4 or P-glycoprotein inhibitor (clarithromycin, itraconazole, ketoconazole, ritonavir, ciclosporin).
- Pre-existing blood disorders.
Serious toxicity
Severe vomiting and diarrhoea, followed by bone marrow suppression, muscle breakdown, nerve damage, kidney failure and shock. There is no antidote. Any suspected overdose needs urgent hospital assessment even if the patient looks well; see overdose and poisoning.
Interactions
- Clarithromycin and erythromycin: avoid together, or use a much lower colchicine dose with specialist advice.
- Verapamil, diltiazem and azole antifungals: reduce the colchicine dose.
- Statins and fibrates: higher risk of muscle damage with long-term use. Grapefruit juice also raises levels.
Monitoring
- Creatinine before starting, and the full drug chart for interacting medicines.
- During long-term use: full blood count and, if there is muscle pain or weakness, CK.
- Ask about diarrhoea at every review; persistent diarrhoea means stop or reduce the dose.
Pregnancy and breastfeeding
Manufacturers advise avoiding colchicine in pregnancy. In conditions such as familial Mediterranean fever, specialists may continue it because the disease poses more risk than the drug. Small amounts pass into breast milk; seek specialist advice before using it while breastfeeding.
Practical tips
- Start as early in the flare as possible. A practical gout regimen is 500 micrograms two or three times a day until the pain settles, staying within 6 mg for the course.
- Do not stop allopurinol during a gout flare in a patient already taking it.
- Combine with rest, ice and elevation. If the patient can take an NSAID safely, naproxen is an alternative; prednisolone is the option when both are unsuitable.
- In pericarditis, a common approach is 500 micrograms once daily under 70 kg and twice daily at 70 kg or more.
- Counsel patients to stop the tablets and seek help with severe diarrhoea, vomiting, muscle weakness, unusual bleeding or bruising.
- Keep tablets out of reach of children; small numbers can be fatal.
- For FCPS revision, see arthritis and metabolic bone disease.
Frequently asked questions
What is the maximum colchicine dose for a gout attack?
6 mg in total per course, with no further course within 3 days.
Should colchicine be stopped if diarrhoea starts?
Yes, stop or reduce it. Diarrhoea is the first sign of excess dose, and continuing increases the risk of serious toxicity.
Can colchicine be taken with clarithromycin?
Avoid the combination. Clarithromycin blocks colchicine breakdown and fatal toxicity has occurred, especially in kidney or liver impairment.
Can colchicine be used in kidney disease?
Use lower doses or longer intervals in moderate kidney impairment, and avoid it when creatinine clearance is below 10 mL/min.
How long is colchicine given for pericarditis?
Usually 3 months for a first episode, and longer (often 6 months) for recurrent pericarditis, alongside an NSAID or aspirin.
Used in these guides
Sources
Doses on this page are typical doses from the sources above. Always confirm with a current drug reference, the product leaflet and your hospital protocol, especially in children, pregnancy and kidney or liver disease.
For FCPS Part 1
Revising for FCPS Part 1? Colchicine is covered in our textbook chapter Analgesics and NSAIDs, with practice MCQs.