Position Statement
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 pain1. The use of large doses 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 six hourly, up to a maximum dose of 2.5 mg per 24 hours. Corticosteroids can be used in combination with NSAIDs or colchicine to provide further relief. 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 stool in the patient2.
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. Oxford University Press, 2004: 32.
3. Gow P. Gout – An Update on a Deadly Disease. NZ Pharmacy Journal: 2005; 25; 4: 21-24, see treatment algorithm.
November 2005, New Zealand Rheumatology Association
