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Gout - Management
What dosing regimen of colchicine should I use?

  • For acute gout:
    • The British Society for Rheumatology (BSR) guideline recommends colchicine should be used in doses of 500 micrograms, two to four times a day, until relief of pain is achieved, or diarrhoea or vomiting occurs [Jordan et al, 2007]. Consider using a low starting dose of 500 micrograms twice a day in people with moderate renal impairment.
    • A maximum of colchicine 6 mg in total should be used (i.e. up to 6 days with colchicine 500 micrograms twice a day, or up to 3 days with colchicine 500 micrograms four times a day), and treatment should not be repeated within 3 days.
    • The licensed daily dose of colchicine (1 mg followed by 500 micrograms every 2–3 hours, up to a maximum of 6 mg) [ABPI Medicines Compendium, 2004] has been found to commonly cause gastrointestinal adverse effects [Morris et al, 2003], although there may be a faster clinical response than with the dose recommended by the BSR [Jordan et al, 2007].
  • For prophylaxis of gout (during urate-lowering treatment):
    • The BSR recommends colchicine 500 micrograms twice a day (low-dose) should be given following initiation of long-term treatment with allopurinol (or uricosuric drugs), for up to 6 months [Jordan et al, 2007]. Colchicine 500 micrograms two to three times a day is the licensed dose for prophylaxis. Doses varying from colchicine 500 micrograms once a day to colchicine 500 micrograms three times a day have historically been commonly used [ABPI Medicines Compendium, 2004; Jordan et al, 2007].
    • Prophylactic treatment is usually given for up to 3 months when using allopurinol [BNF 53, 2007], but may be needed for at least 6 months when starting febuxostat therapy [ABPI Medicines Compendium, 2010].
    • In elderly people, and in people with moderate renal impairment, use colchicine 500 micrograms once a day for prophylaxis of gout.

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