NZRA Consensus Statement on the use of colchicine in the Treatment of Gout:
In most patients, non steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are the treatment of choice for acute gout.When NSAIDs are contraindicated and corticosteroids are not providing an adequate response, colchicine is an option, particularly if taken within the first 24 hours of the onset of pain.1The use of two hourly dosing of colchicine to treat acute gout is no longer appropriate, especially in older patients, because of the serious adverse effects arising from large doses.The recommended dose for colchicine in the treatment of acute gout is 1.0 mg stat, followed by 0.5 mg stat six hourly, up to a maximum dose of 2.0 mg per 24 hours on the first day. An alternative regimen to consider in acute gout of less than 12 hours duration is 1.0 mg stat followed by 0.5 mg one hour later.On the subsequent days, the total dose should not exceed 1.5 mg daily.The total dose should not exceed 6 mg over four days.A prophylactic dose of Colchicine may then be started after three days.Corticosteroids can be used in combination with NSAIDs or colchicine to provide further relief during acute gout.
Colchicine can also be used prophylactically in the treatment of gout with a dose ranging from 0.5 mg ever other day to 0.5 mg twice daily, just short of that which will induce diarrhoea or soft stools in the patient. 2
Fatal and non-fatal cases of colchicine toxicity have been reported with concomitant use of P-gp and CYP3A4 inhibitors such as cyclosporin, clarithromycin, erythromycin, verapamil, diltiazem, ketaconazole, HIV protease inhibitors etc.Toxicity can also be increased by daily consumption of a litre of grapefruit juice, hepatic and renal impairment, statins, fibrates and digoxin.
References:1.Morris I, Varughese G, Mattingly P.Colchicine in acute gout. BMJ 2003; 327: 1275-1276.
2.Calkins E. The Geriatric Age Group.In: Isenberg DA, Maddison PJ, Woo P,
Glass D, Breedveld FC (Eds).Oxford Textbook of Rheumatology.OxfordUniversity Press, 2004: 32.
3.Gow P.Gout and its management – the devil is in the detail.NZ Family Physician:
2005; 32; 4: 261-264, see treatment algorithm.
December 2009,New Zealand Rheumatology Association.
The links below to guidelines on Gout and alert from FDA are recommended:
