The Gout & Colchicine Dosage Facts are answers to questions about colchicine dose. So, they help answer questions such as how should you take colchicine, and when should you stop, etc.
The complete facts about colchicine are in the Colchicine guidelines. But here is a selection of questions commonly asked in the gout forums. Please remember that these are only a quick guide to general dosage aspects of colchicine. If you are in doubt, you should ask your doctor.
Colchicine is a powerful weapon in the fight against gout pain, but it is not without critics.
In America, controversy rages about the decision to remove its generic status. But, politics and financial considerations aside, gout sufferers need to know how colchicine can help their gout.
Here we look at how colchicine (sold as Colcrys in the United States) can help gout patients, along with its drawbacks and advantages.
Colchicine As An Anti-Inflammatory
Though I include colchicine in the anti-inflammatory drugs that cure gout pain, it is not a true anti-inflammatory, and it does not directly act on gout pain.
Colchicine stops inflammation getting worse. That is why it is important to take the first tablet at the first sign of a gout attack. If you leave it too late, and inflammation has already started to subside naturally, there is no point taking colchicine.
Colchicine will not reduce inflammation, but it does allow natural anti-inflammatories in your body to reduce inflammation over a few hours. The exact time varies from person to person, and also depends on the severity of the gout attack. In severe gout attacks, it can take two or three days for inflammation to reduce.
If you do not feel less pain in an hour, you can take a second colchicine, but no more than 2 per day. You can also reduce inflammation with NSAIDs (naproxen, ibuprofen, etc), and you can block pain with analgesics. Your pharmacist and doctor can advise you about safe combinations to support colchicine. My Stop Gout program can help you create your own personal treatment plan, including how to select the right colchicine support package to maximize gout pain relief.
Colchicine & Gout Introduction
Due to the large amount of information on colchicine & gout, I have created different pages to cover different aspects:
What Is Colchicine?
How Does Colchicine Help Gout?
What are the Side Effects of Colchicine?
How Much Colchicine Is Required?
Other Aspects Of Colchicine (including spelling)
What Is Colchicine, and How Does Colchicine Help Gout?
Colchicine for gout is a great way to stop gout pain, but unsafe the wrong way. Longterm, or without uric acid control, Colcrys is dangerous. See safe practice at Colchicine For Gout.
What are the Side Effects of Colchicne?
Colchicine side effects worry many gout patients. Is it a blissful gout pain reliever or dangerous poison? See how to balance risks safely. Take care with gout, and read the colchicine side effects information.
Colcrys (colchicine) dosage has been confusing for many years. Now we know exactly what to take. See what to do if you are still in pain.
Other Aspects Of Colchicine
Colchicine is also available combined with probenecid, marketed as Colbenemid and Proben-C
Like many medicines, colchicine is often misspelled. Though spelling is often overrated, it pays to take extra care with medicines, as a misunderstanding might cause treatment problems in the unlikely event of a similar sounding drug being taken mistakenly.
In the list below, I have included brand names, where the active ingredient is colchicine alone. When buying medicine, it is usually best to use the generic name rather than a brand name, unless additional active ingredients make the gout medicine more useful to you.
Incorrect spelling of the brand Colcrys.
First i replaced with a, second i replaced with e.
first i replaced with a.
First i replaced with e.
ic replaced with es.
Extra h after third c.
This is the correct spelling of the gout medicine that is used to relieve gout pain by reducing inflammation. Full details can be found in the colchicine pages in the Anti-Inflammatory Gout Cure part of the Gout Treatments Section.
Colchimax is a brand name for colchicine in parts of Europe.
First i replaced with o.
Incorrect spelling of the brand Colcrys.
Incorrect spelling of the Colcrys brand.
Incorrect spelling of the Colcrys brand
Colcrys is the brand name for colchicine in the USA.
Colgout is a brand of colchicine in Australia.
chi replaced with tra.
chic replaced with tras.
If you are aware of other alternative spellings, or if you have any questions or opinions about colchicine, please discuss them in the gout remedies forum.
This Colcrys dosage report is a layman’s summary of an investigation into suspected unnecessary prescribing of high cost Colcrys, presented at the 2012 ACR meeting.
Colcrys is a brand of colchicine. In fact, it is *the* brand given the exclusive license granted by the FDA. We have had many long and often heated discussions about this. Disregarding opinions about the morality of the decision, I want to focus on the facts. I will summarize the study first, then offer a glimmer of hope to those gout patients who cannot afford Colcrys.
Colcrys Dosage Study
Evaluating Appropriate Use of Prophylactic Colchicine and Urate Lowering Therapy in Gout
Michael George, Hospital of the University of Pennsylvania, Philadelphia, PA, Sally W. Pullman-Mooar, University of Pennsylvania and Philadelphia Veterans Hospital, Philadelphia, PA and H. Ralph Schumacher, University of Pennsylvania and VA Medical Center, Philadelphia, PA
ACR Annual Meeting Nov 2012
Colcrys Dosage Study: Background/Purpose
Colchicine ought to be used during uric acid lowering treatment to prevent, or reduce, gout attacks. It should be used:
At the start of treatment (most effectively a few days before)
Whenever uric acid lowering medicine dose is increased
This should continue until uric acid reaches 5mg/dL. The authors do not state how long colchicine should be taken for. My doctor recommended 2 weeks, and I found one week to be effective.
This study notes the following problems with colchicine prescriptions:
Given without adequate uric acid lowering treatment
Continued after uric acid has reached safe levels
Dramatically increased in cost since it became Colcrys in the USA
These problems underline the importance of the study, which aims to:
Examine current prescribing practices
Identify what drives these practices
Promote appropriate colchicine use
Colcrys Dosage Study: Methods
193 patients were studied who had prescriptions for colchicine, and 126 were selected who used it for preventative purposes. These were analyzed into appropriate and inappropriate groups. The colchicine prescription was deemed inappropriate for any of the following reasons:
Uric acid lowering treatment was not prescribed
Uric acid was not at goal and uric acid lowering therapy had not been started or increased in the past 3 months
Uric acid goals were met for beyond 1 year and flares had resolved in the absence of tophi
The researchers performed some statistical analysis of characteristics of the people in each group.
Colcrys Dosage Study: Results
33 of the 126 patients were prescribed appropriately. The inappropriate groups were divided as followss:
34 : Uric acid lowering treatment was not prescribed
50 : Uric acid was not at goal and uric acid lowering therapy had not been started or increased in the past 3 months
9 : Uric acid goals were met for beyond 1 year and flares had resolved in the absence of tophi
Patients appropriately prescribed colchicine were younger, had shorter time on colchicine, and were more likely to have been seen by Rheumatology as opposed to being managed solely by primary care.
Colcrys Dosage Study: Conclusion
There is a high incidence of inappropriate preventative colchicine use. The main reasons are failure to prescribe any, or enough uric acid lowering medications. Rheumatologists performed better than primary care physicians. The researchers believe doctors need educating to avoid unnecessary colchicine exposure and to reduce excessive health care system costs.
Colcrys Dosage: Next Steps
Although there are alternatives to colchicine, when used wisely, it can make a real difference. I say used wisely because I see little point in taking colchicine just to treat gout pain. As these researchers state, colchicine should be used as a preventative measure during the relevant stages of uric acid lowering therapy. There it can make the difference between completing the treatment plan with safe uric acid levels, or abandoning the plan due to pain from gout flares. Abandoning the plan is dangerous, as the gout flares will return anyway, and also the excess uric acid will destroy joints.
If you can afford colchicine, use it wisely to support uric acid lowering. If you cannot afford it, please see the assistance programs on www.needymeds.org/. As well as finding free Colcrys, you may also get help with all aspects of gout care, and general medical care.
Colchicine has been available as a gout pain reliever since before modern drug controls began. Colchicine dosage, therefore, has never been standardized for gout, until recently.
Many gout patients have adopted a regime of one tab per hour up to a maximum advised by your doctor until pain stops or diarrhea becomes intolerable.
Colchicine Dosage – The Facts
The problem with the old approach is that it is very hard on the stomach, and excess colchicine is dangerous. Studies in and around 2010 have shown that small doses, of up to three tabs per day, are just as effective as larger doses. Logically, this makes sense, as colchicine acts to stop inflammation getting worse, but it has no direct pain relief effect. Therefore if you supplement colchicine with anti-inflammatories, as advised by your doctor or pharmacist, you will find that most gout pain is tolerable within an hour. If it is not, you should also consult your doctor or pharmacist about supplementing with a non-antiinflammatory pain reliever. These combination pain relieving treatments work, giving you an easy ride through the early months of uric acid lowering treatment. It is the 21st century – there is no reason to be immobilized by gout.
Colchicine Dosage – The Brands
In America, colchicine is branded as Colcrys, and sold as a 0.6mg tablet. The aforementioned report was used as the basis for Colcrys dosage. As mentioned elsewhere in these colchicine pages, the medication can be taken as required (when gout pain strikes) or in prophylaxis (as a preventative). In these cases, the Colcrys dosages are:
1.2 mg (2 tablets) at the first sign of the flare followed by 0.6 mg (1 tablet) one hour later. The maximum recommended dose for treatment of gout flares is 1.8 mg over a 1 hour period.
0.6 mg once or twice daily. The maximum recommended dose for prophylaxis of gout flares is 1.2 mg/day
Note that rheumatologists warn against inappropriate Colcrys prescribing. In an investigation of Colcrys dosage, they report that colchicine is being prescribed when it is not appropriate. Colcrys should only be used for gout during the early months of uric acid lowering treatment.
In Australia, New Zealand, and elsewhere, colchicine is branded as Colgout, and sold as a 0.5mg tablet. Colchicine is a very old, long-established treatment for gout, and the source of dosage recommendations is less clear. Colgout dosage guidelines include a consideration of a maximum total dose over 4 days, as well as a maximum daily dose. It excludes additional colchicine for three days, so gout patients should ensure that they discuss preventative dosage with their doctor.
The Colgout dosage is:
The total amount of oral colchicine needed to control an acute attack of gout in otherwise healthy adults usually ranges from 4 to 6mg over 4 days. A cumulative oral dose of 6mg over four days should not be exceeded. Additional colchicine should not be administered for at least 3 days after a course of oral treatment.
2 tablets (1mg) followed every six hours by 1 tablet (500 micrograms) until relief is obtained, up to a maximum daily dose of 5 tablets (2.5mg) in the first 24 hours. The total dose given in an acute attack should not exceed 6mg over four days. If gastrointestinal adverse effects occur, discontinue immediately.
Colchicine Dosage – Next Steps
You can see that colchicine dosage for gout is not completely straightforward, but as with all medicines, you should discuss any doubts with your doctor. Once you realize that colchicine may not bring immediate relief, you can discuss combination therapies with your doctor and develop a personal regime that is safe and effective.
Title: High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Authors: Terkeltaub RA, Furst DE, Bennett K, Kook KA, Crockett RS, Davis MW. Published: Arthritis Rheum. 2010 Apr;62(4):1060-8. Colchicine Dosage
Title: Colcrys Prescribing Information. Author: AR Scientific Inc. Published: Sept 2009. Colcrys Dosage
Title: Colgout Health Professionals Data Sheet. Author: Pharmacy Retailing (NZ) Limited Trading as Healthcare Logistics. Published: Feb 2011.Colgout Dosage