Colchicine: Uses, Dosage & Side Effects

Colchicine is a plant alkaloid derived from autumn crocus that disrupts microtubule assembly, inhibiting neutrophil migration and reducing inflammatory cytokine release. It has a narrow therapeutic index.

• Acute gouty arthritis (first-line for gout flares)
• Gout prophylaxis during initiation of urate-lowering therapy
• Familial Mediterranean fever (FMF; recurrent febrile attacks)
• Recurrent pericarditis
• Prevention of acute coronary syndrome in post-MI patients (emerging evidence)

Acute Gout Attack:

• FDA approved: 1.2 mg immediately, followed by 0.6 mg one hour later
• Older regimens: 0.6-1.2 mg every 1-2 hours until relief or GI toxicity
• Most effective when given within 24-36 hours of attack onset

Gout Prophylaxis:

• 0.6 mg once or twice daily during initiation of allopurinol/febuxostat
• Continue for 3-6 months after urate goal achieved

Familial Mediterranean Fever:

• 0.6-1.8 mg daily in divided doses (0.6 mg BID or TID)
• Dosage may be increased gradually for inadequate response

Common: Diarrhea (dose-limiting), nausea, vomiting, abdominal cramping Serious: Myelosuppression, myopathy, rhabdomyolysis, peripheral neuropathy, bone marrow suppression with chronic use

• Severe renal impairment (CrCl <30 mL/min; dose reduction essential if CrCl 30-50)
• Severe hepatic impairment
• Concurrent use with strong CYP3A4 inhibitors (unless dose reduced or use avoided)
• Pregnancy (except FMF if benefits outweigh risks)
• Elderly patients with renal/hepatic impairment (high toxicity risk)

• Strong CYP3A4 inhibitors (ritonavir, clarithromycin, ketoconazole): significantly increase colchicine levels; reduce dose or avoid
• P-glycoprotein inhibitors (cyclosporine, amiodarone): increase colchicine concentrations
• Macrolide antibiotics: increased myopathy/rhabdomyolysis risk
• Statins: increased myopathy risk when combined with colchicine

COLCOT trial (NEJM 2019) demonstrated low-dose colchicine reduces recurrent cardiovascular events post-MI. Multiple RCTs confirm efficacy for acute gout and FMF prophylaxis. GI tolerance remains major limiting factor.

• Baseline assessment before initiating therapy
• Regular clinical follow-up per indication
• Laboratory parameters as specified in sections above
• Drug interaction screening at each visit

Dosing adjustments may be necessary in:

• Renal impairment
• Hepatic impairment
• Elderly patients
• Pregnancy and lactation
• Pediatric patients

• Take exactly as directed; do not modify dose without consulting healthcare provider
• Report any unusual symptoms or adverse effects
• Maintain regular follow-up appointments
• Store at room temperature away from moisture and light
• Keep out of reach of children

Disclaimer: This information is for educational purposes only and should not substitute for professional medical advice. Always consult with a qualified healthcare provider before starting, stopping, or modifying any medication.