Colchicine in acute gout

Colchicine is used in patients with heart failure or other contra-indications to treatment with NSAIDs.

• colchicine is a naturally occurring alkaloid derived from autumn crocus
  • for acute gout it should be given orally in doses of 0.5 mg 2-4 times daily (1). Previously, the British National Formulary (BNF) recommended the use of colchicine in higher doses, for example 1 mg immediately followed by 0.5 mg every 2-4 hours until pain abates or gastrointestinal side-effects occur. Gastrointestinal symptoms such as diarrhoea and vomiting occur very frequently with such highdose regimes. Low-dose colchicine, as advocated above, is as effective as high-dose regimes but has fewer gastrointestinal side-effects.

Adverse effects of colchicine

• common side effects are diarrhoea and gastric irritation
• rare side effects include renal failure, myopathy, cardiac arrhythmia, respiratory failure and peripheral neuropathy
• chronic treatment may cause a blood dyscrasia.

The summary of product characteristics must be consulted before prescribing this drug.

Reference:

1. Arthritis Research UK (2011). Hands On (9) - gout: presentation and management in primary care.
2. Drug and Therapeutics Bulletin 2004 ;42(5):37-40.