- Gout flare treatment and prevention
- Familial Mediterranean fever
- Pericarditis
- Cardiovascular disease secondary prevention (emerging)
Back to Medication Guide
Colchicine
Generic Name: Colchicine
Brand Names: Colcrys, Mitigare
Colchicine treats and prevents gout attacks by reducing inflammation. Also used for familial Mediterranean fever and pericarditis.
RheumatologyGoutAnti-inflammatory
Drug Class
Anti-inflammatory (Tubulin Polymerization Inhibitor)
Pregnancy
Category C (animal studies showed adverse effects; no adequate human studies — use only if clearly needed)
Available Forms
Tablet 0.6 mg, Capsule 0.6 mg
What It's Used For
Dosage Quick Reference
These are general dosage guidelines. Your doctor will determine the appropriate dose for your specific situation.
| Condition | Starting Dose | Maintenance Dose |
|---|---|---|
| Acute gout flare | 1.2 mg at first sign, then 0.6 mg one hour later (total 1.8 mg) | May repeat regimen no sooner than 3 days later |
| Gout prophylaxis | 0.6 mg once or twice daily | 0.6 mg once or twice daily (continue ≥6 months after target urate achieved) |
| Familial Mediterranean fever (adults) | 1.2 mg daily (may give as 0.6 mg twice daily) | 1.2–2.4 mg/day in 1–2 divided doses |
| Acute/recurrent pericarditis | 0.5 mg twice daily (or 0.6 mg twice daily based on formulation) | 0.5 mg twice daily for 3 months (acute) or 6 months (recurrent) |
Side Effects
Common Side Effects:
- Diarrhea
- Nausea
- Vomiting
- Abdominal pain and cramping
Serious Side Effects (seek immediate medical attention):
- Signs of bone marrow suppression (fever, unusual bleeding or bruising, sore throat)
- Severe muscle weakness or pain (neuromyopathy)
- Numbness or tingling in fingers or toes (neuropathy)
- Signs of severe toxicity (severe vomiting, bloody diarrhea, confusion)
- Signs of multi-organ failure
Drug Interactions
Clarithromycin and other strong CYP3A4 inhibitors (ketoconazole, itraconazole, HIV protease inhibitors): Significantly increase colchicine levels, raising the risk of life-threatening toxicity (bone marrow suppression, multiorgan failure). Dose reduction required; contraindicated in patients with renal or hepatic impairment.
Cyclosporine: Inhibits P-glycoprotein and CYP3A4, markedly increasing colchicine levels. Can cause severe myopathy, rhabdomyolysis, and nephrotoxicity. Avoid combination or reduce colchicine dose substantially.
Statins (e.g., atorvastatin, simvastatin): Concurrent use with colchicine increases the risk of myopathy and rhabdomyolysis. Monitor for muscle pain, weakness, and elevated creatine kinase.
Digoxin: Colchicine may increase digoxin levels by inhibiting P-glycoprotein-mediated efflux. Monitor digoxin levels and watch for toxicity signs.
Additional Information
Colchicine is an anti-inflammatory medication with a unique mechanism of action that has been used for centuries to treat gout. Beyond gout, modern clinical trials have established its role in cardiovascular disease prevention and treatment of other inflammatory conditions including familial Mediterranean fever and pericarditis.
Mechanism of Action
Colchicine works primarily by inhibiting microtubule polymerization through binding to tubulin. This disrupts multiple cellular functions including neutrophil migration, chemotaxis, and phagocytosis. By preventing microtubule formation, colchicine inhibits the assembly of the inflammasome, reducing the production of interleukin-1β (IL-1β), a key cytokine in the inflammatory response to urate crystals in gout.
The anti-inflammatory effects extend beyond the inflammasome. Colchicine reduces neutrophil adhesion to endothelium, decreases oxidative stress, and may have direct effects on atherosclerotic plaque stability, which explains its cardiovascular benefits beyond its effects on gout.
Available Formulations
Colchicine is available as oral tablets in 0.6 mg strength (Colcrys) and as oral capsules (Mitigare). An oral solution is available for patients who have difficulty swallowing tablets. The 0.6 mg dose replaced the older 0.5 mg formulation following FDA standardization. Generic formulations are available.
FDA-Approved Indications
Colchicine is FDA-approved for prophylaxis and treatment of gout flares in adults, treatment of familial Mediterranean fever (FMF) in adults and children 4 years and older, and treatment of acute and recurrent pericarditis in adults and children. The COLCOT trial has also established benefits for secondary cardiovascular prevention, though this is not yet an FDA-approved indication.
Dosing Guidelines
For acute gout flare: 1.2 mg at first sign of flare, followed by 0.6 mg one hour later (total 1.8 mg). For gout prophylaxis: 0.6 mg once or twice daily. For FMF: 1.2-2.4 mg daily in divided doses. For pericarditis: Loading dose followed by 0.5-1 mg daily depending on body weight and tolerability. Lower doses are required with renal or hepatic impairment and with certain drug interactions.
Cardiovascular Benefits
The COLCOT trial demonstrated that low-dose colchicine (0.5 mg daily) significantly reduced cardiovascular events in patients with recent myocardial infarction. The LODOCO2 trial showed similar benefits in patients with chronic coronary disease. These findings support the inflammatory hypothesis of atherosclerosis and have expanded the potential uses of colchicine.
Important Safety Considerations
Colchicine has a narrow therapeutic index, and toxicity can be fatal. Symptoms of toxicity include nausea, vomiting, diarrhea, abdominal pain, and may progress to multi-organ failure. The maximum recommended dose for gout flares should not be exceeded. Use is contraindicated in patients with both renal and hepatic impairment. Blood dyscrasias including aplastic anemia, agranulocytosis, and thrombocytopenia have been reported. Neuromyopathy can occur with long-term use.
Drug Interactions
Strong CYP3A4 inhibitors (clarithromycin, ketoconazole, HIV protease inhibitors) and P-glycoprotein inhibitors (cyclosporine) significantly increase colchicine levels and can lead to toxicity; dose reduction is mandatory and repeat dosing must be delayed. Statins and other myotoxic drugs may increase the risk of myopathy. Grapefruit juice should be avoided. Concurrent use with digoxin may increase digoxin levels.
Special Populations
Dose adjustments are required in renal impairment. In severe renal impairment, lower doses and extended intervals between courses are necessary. Colchicine is contraindicated in patients with both renal and hepatic impairment taking P-gp or strong CYP3A4 inhibitors. Use during pregnancy should weigh benefits against potential risks. Male patients should be aware that colchicine may affect sperm production and function.
Learn more at MedlinePlus
Frequently Asked Questions
For an acute gout flare, colchicine works best when taken within the first 12–24 hours of symptom onset. Most patients notice significant pain relief within 24–48 hours. It is much less effective if started more than 36 hours after the flare begins.
The current FDA-approved regimen (1.2 mg followed by 0.6 mg one hour later) is as effective as the older high-dose regimens but with far fewer gastrointestinal side effects. Taking more colchicine does not improve efficacy and dramatically increases the risk of diarrhea, nausea, and potentially dangerous toxicity.
Yes. Low-dose colchicine (0.6 mg once or twice daily) is commonly used for gout prophylaxis, especially when starting urate-lowering therapy such as allopurinol or febuxostat. Prophylaxis is typically continued for at least 3–6 months after the target serum urate level is reached.
Diarrhea is the most common side effect and often signals that you are at the upper limit of tolerable dosing. If diarrhea occurs, stop taking colchicine temporarily and contact your doctor. The dose may be reduced. Persistent or severe diarrhea warrants medical evaluation.
Grapefruit and grapefruit juice inhibit CYP3A4, which can increase colchicine levels in the blood and raise the risk of toxicity. It is best to avoid grapefruit products while taking colchicine.
Questions to Ask Your Doctor
Consider discussing these topics at your next appointment:
- ✓Is colchicine the right choice for my condition, or would an NSAID or corticosteroid be better?
- ✓Do any of my current medications interact with colchicine?
- ✓How long should I continue taking colchicine for gout prophylaxis?
- ✓Should my kidney and liver function be monitored while on colchicine?
- ✓What should I do if I experience muscle weakness or numbness while taking colchicine?
Medical Disclaimer: This information is for educational purposes only and should not be considered medical advice. Always consult with your healthcare provider before starting, stopping, or changing any medication. Your doctor can provide personalized recommendations based on your specific health condition and medical history.
Related Medications
Other medications in the same category
Adalimumab
Allopurinol
Etanercept
Hydroxychloroquine
Infliximab
Methotrexate
Methylprednisolone
Prednisone-InflammatoryPrednisone
Sulfasalazine
Related Articles
Questions About This Medication?
Talk to your doctor or pharmacist about whether Colchicine is right for you.
Contact UsCall: (727) 820-7800