Overview
The accumulation of uric acid crystals in the joints leads to a painful condition known as gout. A medication called colchicine, which is derived from the autumn crocus and glory lily (Gloriosa Spp) plant, has been used to treat acute gout for quite some time. It belongs to an anti-gout class of medications used to prevent gout attacks and severe Familial Mediterranean fever (FMF). This article will discuss the use of colchicine in the management of gout, including its appropriate dosing and possible drug interactions.
How to Take Colchicine for Acute Gout?
Colchicine is a prescription-only medicine and is not available for purchase over the counter. It comes packed in different dosage regimens including tablets (500mg) and solutions. For the treatment of gout usually one tablet is recommended on the onset of pain and a smaller dose is taken an hour later after the initial dose. For example, your doctor may prescribe a 1.2mg dose of colchicine followed by a 0.6 mg dose of colchicine an hour later.
Colchicine is also used to treat Familial Mediteranean Fever (FMF) where normally your doctor will prescribe a smaller dose and the dose will be gradually increased after that. Typically, the first dose is taken as soon as the initial symptoms appear, and subsequent doses are taken as needed. However, for specific dosing advice, it’s best to speak with your doctor.
How Long Does It Take Colchicine to Work?
The effectiveness of colchicine can be seen after only 24 to 48 hours of intake. The pain alleviates in one or two days after you start taking medication. It is recommended to use an oral device to take accurate dosing measurements of each dose. Do not use a spoon for the colchicine solution dose. Follow your physician’s instructions regarding how often you should take your medication.
How Long Do You Take Colchicine for Gout?
Colchicine is typically taken for a short time, just a few days, until the symptoms disappear. Contrary to gout, for FMF colchicine is prescribed for a longer duration. The duration of colchicine treatment for gout varies depending on the situation and severity of the gout flare.
How Much Colchicine Can I Take a Day?
Daily colchicine dosage is based on several factors, including the severity of gout attacks, patient tolerance, and prescribed dosage. The colchicine dose you take per day also depends upon the dosing regimen and the strength of the medicine.
To avoid unpleasant side effects, take your medication exactly as directed. You can also find recommended dosing instructions in the table below:
| Dosage Information for Colchicine |
| Dosage Form | Dosage Instructions |
| Oral Tablets | Recommended Dose for Prevention of gout attacks |
| – Adults: 0.6 mg 1 or 2 times a day | |
| – Maximum daily dose is 1.2 mg | |
| – Children: Use and dose determined by the doctor | |
| Recommended Dose for gout attacks | |
| – For Adults it is 1.2 mg at first sign, followed by 0.6 mg | |
| after 1 hour (total dose: 1.8 mg over 1 hour) | |
| – Children: Use not recommended | |
| Recommended Dose for familial Mediterranean fever (FMF) | |
| – Adults and children (>12 years): | |
| – Take 1.2 to 2.4 mg in divided doses per day | |
| – Children (6-12 years): | |
| 0.9 to 1.8 mg in divided doses daily | |
| – Children (4-6 years): | |
| 0.3 to 1.8 mg in divided doses daily | |
| – Children (<4 years): Use and dose determined by doctor | |
| Oral Capsules/Solution | Recommended Dose for Prevention of gout attacks |
| – Adults: 0.6 mg (5 mL) 1 or 2 times a day | |
| – Maximum daily dose: 1.2 mg | |
| – Children: Use and dose determined by the doctor |
Foods to Avoid When Taking Colchicine?
Colchicine is usually well tolerated but some foods can interact with colchicine and affect its effectiveness or increase the risk of side effects. These include the following:
Colchicine and grapefruit or grapefruit juice
Colchicine has a significant food interaction with grapefruit and grapefruit juice because it increases the amount of colchicine in your blood. Grape or grapefruit juice should be strictly avoided while you are taking colchicine.
Colchicine and High-purine foods
Other foods do not have any direct interaction with colchicine but if you want to prevent gout from coming back you should avoid:
- Organ meats
- Seafood
- Alcohol
It is recommended to discuss your dietary restrictions and potential interactions with your healthcare professionals before taking colchicine.
Does Colchicine pass into Breast Milk?
There is evidence that colchicine can enter breast milk, therefore, it is not usually recommended for gout. To nursing mothers, an NSAID like Ibuprofen is recommended instead of colchicine for gout.
As far as pregnancy is concerned Colchicine is classified under pregnancy category C by the FDA. This means it has shown risks to the fetus in animal studies therefore it is not prescribed for gout during pregnancy.
However, your doctor may prescribe Colchicine for Familial Mediterranean Fever (FMF) while you are a nursing mother. Although it passes into the breast milk it is not reported to be harmful to the fetus. If you are breastfeeding discuss with your healthcare provider before taking colchicine.
What are the side effects of Colchicine?
Common side effects include gastrointestinal symptoms such as,
More severe side effects are rare but can occur, including:
- Muscle weakness
- Neuropathy
- Blood disorders
- Paleness or grayness of lips, tongue, or palm
- Weakness or tiredness
- Sore throat
- Numbness or tingling in the finger or toes
- Bruising or bleeding on the skin
- Colchicine may also affect fertility in men
It is important to seek medical attention if any concerning side effects occur.
Drug interactions of Colchicine
Colchicine is known to have a drug interaction with the following medications:
- Statins
- Calcium Channel blockers
- Protease Inhibitors
- Azoles
- Cyclosporine
- Macrolides Antibiotics
Colchicine and Statins
Colchicine and statins are medications that are frequently prescribed together for conditions such as gout, cardiovascular disease, and autoinflammatory disease. These have the potential for a life-threatening drug interaction. The interaction may result in myopathies, which can lead to rhabdomyolysis.
Colchicine and Calcium Channel Blockers
Calcium channel blockers, such as Diltiazem and Verapamil, are commonly used to treat cardiovascular disease. If you take colchicine with calcium channel blockers, the concentration of colchicine in your blood may increase. It can result in muscle disorders.
Colchicine and Protease Inhibitors
Protease inhibitors are antivirals that work by preventing virus growth. They are used to treat diseases like Hepatitis C or HIV. Indinavir, Ritonavir, Darunavir, Saquinavir, Atazanavir, Fosamprenavir, and Tipranavir are some protease inhibitors. Protease inhibitors inhibit Colchicine metabolizing enzymes, resulting in increased colchicine concentrations. High levels of colchicine cause muscle problems.
Colchicine and Azoles
Colchicine interacts with Azoles similar to other colchicine interactions. Azoles, such as itraconazole and ketoconazole, are antifungals that inhibit the same enzyme that metabolizes colchicine, resulting in elevated levels of colchicine and complications.
Colchicine and Cyclosporine
Cyclosporine is used after organ transplantation to prevent rejection. Cyclosporine and colchicine interact, causing a blockade of an enzyme that metabolizes colchicine. This causes complications due to increased Colchicine levels.
Colchicine and Macrolides Antibiotics
Like other colchicine interactions, macrolide antibiotics such as clarithromycin, azithromycin, and erythromycin can cause unwanted side effects due to elevated colchicine levels. Fortunately, other antibiotics may be useful in this situation.
FAQs About Colchicine for Gout
Colchicine has a half-life of around 26-30 hours. The drug leaves the body slowly, usually over the course of several days. If you need to take other medications or have any preexisting medical conditions, knowing how long colchicine stays in your system is essential.
When taken at the first 24 hours sign of a gout attack, colchicine has the greatest impact on relieving symptoms. The medication’s gastrointestinal side effects can be lessened if it’s taken with food.
Because they act differently, ibuprofen and colchicine can usually be taken together without risk.
Colchicine is typically taken for a short duration during acute gout attacks.
Colchicine can potentially cause kidney-related side effects, especially at higher doses or in individuals with pre-existing kidney conditions.
Staying hydrated is important for managing gout. Drinking more water helps to flush out uric acid and prevent crystal buildup. Additionally, consuming cherry juice, associated with gout symptom relief, may provide some benefits.
No, alcohol consumption can increase the risk of side effects and interactions when combined with colchicine. It is recommended to avoid alcohol while taking this medication.
