ASK DIS: Colchicine Dosing in Acute Gout Flare

Recommendation 1:

Uptodate

The US Food and Drug Administration (FDA) has approved an initial dose of 1.2 mg of oral colchicine, followed one hour later by another 0.6 mg, for a total dose on the first day of therapy of 1.8mg.

NPS Medicine Wise

2 tablets followed by 1 tablet 1 hour later is effective when prescribed within 12 hours of onset of an acute gout flare, with a low incidence of gastrointestinal adverse effects.
This study was conducted in the United States, where colchicine is available as 0.6 mg tablets rather than the 0.5 mg tablets available in Australia.
Do not repeat the course of treatment for at least 3 days.

Australian Medicine Handbook (AMH) (as 0.5 mg tablet available in Australia)

1 mg followed by 0.5 mg 1 hour later for acute gout (maximum dose 1.5 mg per treatment course).
No additional colchicine should be administered for at least 3 days, when a repeat course may be considered.
Because of the potential for serious toxicity, colchicine should be stopped if abdominal pain, nausea, vomiting or diarrhea develops, irrespective of whether joint pain has been relieved.

Medscape

0.6 mg colchicine is taken once or twice daily to prevent gout flares (maximum, 1.2 mg/day), and a dose of 1.2 mg is taken at the first sign of an acute gout flare, followed by 0.6 mg 1 hour later.

RxList

1 to 1.2 mg (two 0.5 mg granules or two 0.6 mg tablets). This dose may be followed by one unit of either preparation (granule or tablet) every hour, or two units every two hours, until pain is relieved or until diarrhea ensues.
The drug should be stopped if there is gastrointestinal discomfort or diarrhea. An interval of three days between colchicine courses is advised in order to minimize the possibility of cumulative toxicity.

Recommendation 2:

Uptodate

0.6 mg (or 0.5 mg, available in countries other than the US) three times on the first day of flare treatment.
Approximately 60 percent of patients will not achieve a 50 percent reduction in pain within 24 hours with either first day approach alone, but most patients will respond further over several days with these doses.
Patients should be continued on treatment for the duration of the attack, usually at reduced doses (ex: 0.6 mg once or twice daily as tolerated) once a significant response is achieved.
Complete cessation of treatment can be safely done within two to three days of complete resolution of the attack.

Malaysia CPG for Gout

Renal Dose Adjustment:

Lexicomp

CrCl 30 to 80 mL/minute: Dosage adjustment not required; monitor closely for side effects
CrCl <30ml/minute: Dosage reduction not required but may be considered; treatment course should not be repeated more frequently than every 14 days.
Dialysis: 0.6mg as a single dose; treatment course should not be repeated more frequently than every 14 days. Not removed by dialysis

Drugs.com

Mild (CrCl 50 to 80 mL/min) to moderate (CrCl 30 to 50 mL/min) renal impairment: No dose adjustment required, but patients should be monitored closely for adverse effects.
Severe (CrCl less than 30 mL/min) renal impairment: No dose adjustment required, but a treatment course should not be repeated more than once every 2 weeks. For patients requiring repeated courses, consideration should be given to alternate therapy.

References:

ASK DIS