Colchicine is used to treat and prevent gout. Find out how to take it safely and possible side effects. Colchicine is also called Colgout.
What is colchicine?
Colchicine is used to relieve pain and swelling when you have gout flares (attacks). It is also used to prevent gout attacks while starting on urate-lowering therapy such as allopurinol or febuxostat.
How does colchicine work?
Colchicine works by reducing the build-up of uric acid crystals in the affected joints and by reducing the body’s inflammatory reaction to the uric acid crystals that are in the affected joint. This reduces pain and swelling. It is usually used when other medicines for gout, like NSAIDs or steroids, cannot be used or don’t work well enough. Read more about gout and medicines for gout.
Watch a video about colchicine for gout.
Dose
Colchicine is considered a high-risk medicine because it can cause serious side effects. There isn’t a big difference between a safe dose of colchicine and a harmful dose. This means you must always take colchicine exactly as your doctor has told you to.
- In New Zealand, colchicine is available as 0.5 mg tablets.
- The pharmacy label on your medicine will tell you how much colchicine to take, how often to take it and any special instructions.
- Never take more than the prescribed dose.
- Taking too much colchicine can cause serious side effects.
| Dose information |
To treat a gout attack (flare)
Colchicine works best if you take it at the first sign (within 12 hours) of gout pain, redness and swelling.
- Take 2 tablets at the same time, followed by 1 tablet one hour later.
- Do not repeat this course within 3 days.
- Wait 12 hours before starting or continuing prophylactic colchicine (as described below).
- If you get nausea (feeling sick) or runny poos (diarrhoea), stop taking colchicine.
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To prevent gout attacks (prophylactic colchicine)
Colchicine can be used to prevent gout attacks while starting allopurinol or febuxostat. The usual dose is:
□ 1 tablet 2 times a day for 6 months.
Your doctor may lower your dose if you get runny poos (diarrhoea) to:
□ 1 tablet once a day, OR
□ 1 tablet on alternate days (every other day).
It is generally recommended you keep taking colchicine for 3–6 months after the target serum urate level has been reached by taking allopurinol or febuxostat.
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How to take colchicine
- Food and drink: Swallow your tablet whole with a full glass of water. Take it with food to reduce stomach upset. Avoid drinking alcohol as it can cause stomach problems. Do not drink grapefruit juice as it increases the risk of side effects.
- Other medicines: Tell your doctor or pharmacist about all other medicines you are taking. Colchicine can be harmful when taken with some other medicines, such as antibiotics and medicines for pain relief.
Colchicine can be harmful — safety tips
Colchicine is a useful and effective treatment for gout and is usually safe. Most people who take colchicine have no problems but extra care is needed when taking it.
| Signs of taking too much colchicine |
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There isn’t a big difference between a safe dose of colchicine and a harmful dose. People who are over 65 years of age are especially at risk.
Signs that you may be taking too much colchicine include:
- tummy pain
- runny poos (diarhhoea)
- vomiting (being sick) or not feeling well (nausea)
- a burning feeling in your throat or stomach, or on your skin.
If you get any of these symptoms, stop taking colchicine and contact your doctor immediately or freephone Healthline 0800 611 116.
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Storage
| Store colchicine out of reach of children – as little as 1 or 2 tablets may be fatal for children. |
- If children live with you or visit your house, ask your pharmacist to put a child safety cap on your medicine bottle. Make sure the cap is relocked after each use.
- Caps on containers are not child-proof. Children may still be able to open the container, so make sure you store the medicine out of sight and reach of children.
- Store medicines in a locked cupboard or somewhere that your child cannot reach or access.
- Always return unused or expired medicines to your local pharmacy for disposal.
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Precautions – before taking colchicine
- Do you have problems with your kidneys, heart or liver?
- Do you have problems with your stomach or indigestion?
- Do you have any blood disorders?
- Are you pregnant, trying for a baby or breastfeeding?
- Are you taking any other medicines? This includes any medicines you buy without a prescription, such as herbal and complementary medicines.
If so, it’s important that you tell your doctor or pharmacist before you start colchicine. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.
Side effects
Colchicine can cause serious side effects, although not everyone gets them.
| Side effects |
What should I do? |
- Unusual bleeding or easy bruising
- Fever, sore throat
- Tiredness, muscle weakness, muscle cramps
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- Tell your doctor immediately or freephone Healthline 0800 611 116.
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- Loss of appetite
- Hair loss or thinning
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- Tell your doctor if troublesome.
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Interactions
Colchicine may interact with a few medicines and herbal supplements, so check with your doctor or pharmacist before starting colchicine and before starting any new medicines.
Learn more
The following links have more information on colchicine:
Colchicine RheumInfo
Colchicine (te reo Māori) NZ Formulary Patient Information
Colchicine SafeRx
Colgout Medsafe Consumer Information Sheet
References
- Spotlight on colchicine Medsafe, NZ, 2018
- Keeping patients informed about colchicine use Medsafe, NZ, 2014
- Managing gout in primary care BPAC, NZ, 2018
- Colchicine NZ Formulary
- Colchicine: painful insights from recent poisoning data in New Zealand Medsafe, NZ, 2021
Information for clinicians
This section will be of most interest to clinicians (eg, nurses, doctors, pharmacists and specialists).
Medicines for gout flares
Medicines for gout flares are determined by the patient’s characteristics. Patients with gout often initially present due to a flare, which will be the treatment priority. Patients should rest and elevate the affected joint during a gout flare and some may find the use of a ice pack beneficial. A NSAID, corticosteroids or colchicine may be prescribed to treat gout flares. Options for the treatment of gout flares are:
- Naproxen 750 mg initially, 500 mg 8 hours later, then 250 mg every 8 hours until the flare has settled.
- Prednisone 20–40 mg, once daily, for 5 days; tapering the dose over 10 days can reduce the likelihood of a rebound flare, but tapering is not always necessary.
- Colchicine 1 mg immediately , followed by 500 micrograms after 1 hour on day 1 , and then twice daily dosing of 500 micrograms. (Note: This is an alternative dose to the traditional regimen, which is now recommended by many experts. In patients with an estimated glomerular filtration rate (eGFR) < 50 mL/minute/1.73m2, the initial dose should not exceed 1 mg in the first 24 hours, with a total maximum of 3 mg over 4 days).
- Triamcinolone acetonide intra-articular injection 2.5–40 mg, determined by the size of the affected joint.
There is insufficient evidence to directly compare the efficacy of medicines for the treatment of gout flares. Medicine selection is therefore based on the patient’s preference, renal function, the presence of co-morbidities, eg, prednisone may be preferred over a NSAID or colchicine in a patient with reduced renal function, and the concurrent use of medicines that may interact with colchicine.
Read more: Managing gout in primary care BPAC, NZ, 2018
Contraindications
- severe renal impairment
- severe hepatic impairment
- combined hepatic and renal impairment
- serious cardiac or gastrointestinal disorders
- blood disorders (including thrombocytopenia and leucopenia)
- children
Cautions
- elderly
- gastro-intestinal disease
- cardiac disease
- concomitant use of medicines that cause blood dyscrasias or bone marrow depressants
- concomitant use of P-glycoprotein and/or CYP3A4 inhibitors e.g. erythromycin, clarithromycin and verapamil (fatalities reported)
Resources
| Resources |
Links |
| BPAC |
Managing gout in primary care 2018
An update on the management of gout 2013 |
| Medsafe |
Key Messages
- Colchicine is approved for the treatment of acute gout.
- Patients should be counselled on the appropriate use of this medicine and the signs of toxicity to ensure its safe and effective use.
- Serious adverse effects and toxicity may be potentiated by pharmacokinetic drug interactions.
- Adverse effects predominantly affect the gastrointestinal tract, skin, and blood.
- Read more: Spotlight on colchicine 2018
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| SafeRx |
Key messages
- Assess if colchicine is appropriate as a first-line treatment
- Consider renal function and interactions with other medicines
- Ensure patients understand the risks associated with colchicine
- Read more: Colchicine
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| NZ Formulary |
Colchicine |
