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What is colchicine?

Colchicine (kowl·chuh·seen) is a medication prescribed mainly to manage or resolve gout, a form of arthritis that causes joint inflammation and pain.

It belongs to a class of drugs known as antigout agents

Antigout agents are medications prescribed to prevent or treat gout flare-ups (acute gout). 

Colchicine has several anti-inflammatory properties and can disrupt inflammatory immune cell responses. 

Colchicine is the generic drug name for the brands Mitigare, Gloperba, and Colcrys, and it is only available with a doctor’s prescription.

What is colchicine used to treat?

Colchicine is US FDA-approved to prevent or treat gout attacks, sometimes known as gouty arthritis. 

Gout is an inflammatory disease that occurs when there is too much uric acid in the bloodstream (hyperuricemia).

Colchicine is also approved for treating Familial Mediterranean Fever (FMF). FMF is a rare, genetic autoinflammatory disorder that causes painful joints, recurring fevers, and inflammation in the chest and abdomen.

The Colcrys brand is approved for treating or preventing gout in adults. It is also approved for the treatment of Familial Mediterranean Fever in adults and children four years old and up. The Mitigare brand is approved for the prevention of gout flare-ups in adults. The Gloperba brand is approved for the prevention of gout in adults. It is also the first liquid formulation of colchicine approved by the US FDA.

Colchicine is also prescribed off-label to treat multiple conditions, including but not limited to: 

  • Pseudogout (a condition with gout-like symptoms but caused by calcium pyrophosphate crystals instead of excessive uric acid).

  • Pericarditis (inflammation of one of the structures in the heart known as the pericardium).

  • Behçet’s syndrome (a rare blood vessel disorder). 

“Off-label” medication refers to a drug prescribed therapeutically for conditions other than what is FDA-approved to treat. The FDA has not yet reviewed such uses for safety or efficacy.

Colchicine is not intended to treat other kinds of pain. It is not an analgesic (pain relief drug), and should not be taken in place of over-the-counter-pain medication.

How do you take colchicine?

Colchicine is available in the following forms:

  • Oral solution

  • Capsule (0.6mg)

  • Tablet (0.6mg)

Always take colchicine as directed. Do not suddenly start, stop, or adjust your dose without instruction and guidance from your doctor. Do not take more than your prescribed dosage of colchicine.

You can take colchicine with or without food, but it is easier on the stomach when taken with food. 

If you are using the tablet form of colchicine, it should be swallowed whole with water.

Do not take colchicine with grapefruit juice, as it can slow down the rate of absorption and cause excessive levels of colchicine, which can lead to side effects.

When taking colchicine as a liquid solution, use an approved measuring tool. A pharmacy-bought measuring tool can be used if the package doesn’t come with one. 

Do not use a household spoon to measure colchicine. It won’t be accurate enough. Taking more than what is prescribed can cause serious complications. There is a risk of fatal overdose if too much is taken.

The following are typical dosages for colchicine. 

Still, always follow your doctor’s instructions for taking colchicine, as dosing may change if you have chronic kidney disease or take drugs that interact.

  • Treatment of gout A standard dosage of colchicine for gout is two tablets (1.2mgs), taken at any sign of a flare, and then one additional tablet (0.6mg) an hour later. After the first day, one tablet (0.6mg) can be taken once or twice daily until the flare resolves. A stronger dose (1.8mgs) may be indicated for treating a flare-up if you were already taking colchicine to prevent gout.  Check with your prescribing doctor before making adjustments. Higher doses of colchicine are associated with more side effects and are not necessarily more effective.

  • Treatment of Familial Mediterranean Fever (FMF) Colchicine for FMF treatment is usually long-term, or in some cases, lifetime. The initial dosage can vary from two to three tablets a day (1.2–1.8mgs). Depending on your response, your doctor may increase the maximum daily dose to 3mgs Your prescribed amount will depend on the intensity of your condition and the presence or absence of other medical conditions. For example, if you have liver or kidney disease, your doctor will likely prescribe a low dosage. You will require regular blood and urine tests while taking colchicine.

Seeing results

When using colchicine for gout treatment, the medication should start to work approximately 30 minutes to two hours after you first take it. Full results will take one to two days. 

If you are using colchicine for the prevention of FMF flare-ups, they should be reduced or eliminated within two to three days.¹

Potential side effects of colchicine

Common side effects of using colchicine include:

  • Vomiting

  • Nausea

  • Stomach cramps

  • Diarrhea

Although these side effects are common, be sure to report any of the above symptoms to your doctor. They can also be early warning signs of colchicine toxicity. 

Less common side effects caused by colchicine may include:

  • Numbness in the fingers and toes

  • Unusual bleeding

  • Unusual bruising

  • Muscle pain

  • Weakness

  • Tiredness

  • Paleness

  • Sore throat

  • Reduced sperm count

If you experience any of these side effects, contact your doctor.

Colchicine overdoses

It is possible to overdose fatally on colchicine if it is taken incorrectly or accidentally. Possible symptoms of colchicine toxicity (poisoning) include the following:

  • Nausea

  • Stomach pain

  • Diarrhea

  • Vomiting

  • Unusual bruising

  • Unusual bleeding

  • Paleness

  • Slowed breathing

  • Fainting

  • Irregular heartbeat

  • Muscle weakness

  • Seizures

  • Unusual tiredness

  • Cough

  • Confusion

  • Chills

  • Chest pain

  • Burning sensation in the throat, stomach, or skin

  • Eye pain

Call 911 or visit the nearest emergency room if someone takes colchicine accidentally or takes more than the prescribed amount. 

Long-term use of colchicine

The long-term use of colchicine is generally considered safe, provided that you follow your doctor’s instructions.

However, taken long-term, high doses of colchicine are associated with reversible peripheral nerve dysfunction, muscle weakness and damage, anemia, liver failure, and skin eruptions. If not recognized and treated early, these side effects can be life-threatening. 

Patients taking colchicine long-term can expect to have their progress frequently evaluated, ensuring that the medication is working correctly and minimizing the risk of side effects. Doses may need to be adjusted based on your liver and kidney function.

Missed doses

If you miss a colchicine dose, do not take a double dosage. Instead, wait until your next scheduled dose. 

What to discuss with your doctor before taking colchicine

  Here are some of the topics you must discuss with your doctor before taking colchicine:

  • Medications you are currently taking (prescribed or non-prescribed), including vitamins and supplements you take (or plan to take). Colchicine can interact with other drugs and lead to severe side effects and health complications.

  • Existing health conditions, especially diabetes, liver problems, or kidney problems.

  • Upcoming medical or dental procedures (or plans to have one). 

  • Allergies you have or past allergic reactions to medications (especially any allergic reactions to colchicine).

  • Whether or not you consume alcohol, how much, and how frequently.

  • Whether you are pregnant or trying to get pregnant. 

  • Whether you are currently breastfeeding or planning to breastfeed. 

  • Circulatory (blood flow) problems in your legs and feet. 

Stopping colchicine

If you are using colchicine to relieve gout attacks, there are instances when stopping the medication is indicated, such as:

  • When the pain is relieved

  • Once you reach the maximum prescribed dosage (even if pain persists)

  • If you experience vomiting, nausea, or stomach pain

If you are using colchicine for the preventive maintenance of FMF, suddenly stopping the medication is not recommended, as it can worsen symptoms.

Colchicine and pregnancy

Colchicine falls into US FDA Category C, meaning that risk to the fetus is possible. If you become pregnant while taking this medication, inform your doctor. Discuss the possible risks and benefits and whether or not you should continue this medication. Taking colchicine to treat gout while breastfeeding is not recommended. Your doctor may suggest an alternative to colchicine while breastfeeding, such as a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen.

Colchicine to treat Familial Mediterranean Fever (FMF) while breastfeeding is generally considered safe. However, contact your doctor if the baby experiences vomiting or diarrhea or if they are not feeding well.

Colchicine and interactions with other drugs

Colchicine can interact with other medicines that you are taking. It can interact with either prescription drugs, nonprescription drugs, or herbal supplements.

 Taking any of the following drugs with colchicine is not recommended:

  • Antifungal drugs like ketoconazole (Nizoral) and itraconazole (Sporanox)

  • Anti-HIV drugs like atazanavir (Reyataz), indinavir (Crixivan), saquinavir (Invirase), ritonavir (Norvir), nelfinavir (Viracept)

  • Antibiotics like telithromycin (Ketek) and clarithromycin (Biaxin)

  • Antidepressants such as nefazodone (Serzone, Dutonin, and Nefadar)

  • Cholesterol drugs like fluvastatin (Lescol), atorvastatin (Lipitor), lovastatin (Mevacor), simvastatin (Zocor), pravastatin (Pravachol), gemfibrozil (Lopid), and fibrates (cholesterol-lowering medication)

  • Antiarrhythmic drugs like digoxin (Lanoxin)

  • Heart medication like diltiazem (Cardizem) and verapamil (Verelan)

Taking these medications while using colchicine can cause:

  • High levels of colchicine

  • Increased risk of severe muscle damage

  • Stomach pain, diarrhea, constipation, vomiting, and nausea

At your doctor’s discretion, they may prescribe a lower dosage of colchicine to help you avoid unwanted interactions and side effects.

Allergy information

Allergic reactions to colchicine are rare. Call 911 or visit the nearest emergency room if you experience:

  • Hives

  • Rashes

  • Difficulty breathing

  • Swelling of the face, throat, and lips

Clinical trial history

The use of colchicine to treat gout has been around longer than the US FDA. The first FDA-regulated form of colchicine, Colcrys, was approved in 2009 to treat gout and Familial Mediterranean fever (FMF) in those aged four or older.  Mitigare was FDA-approved in 2014 for the prevention of gout flares in adults. Gloperba was FDA-approved in 2019 for the prevention of gout flares in adults.

Tips and advice for taking colchicine

  • Colchicine can cause dizziness. Avoid driving, using machinery, or doing activities that require full attention. 

  • Using alcohol while taking colchicine is not recommended and increases the risk of side effects. Avoid drinking alcohol when taking colchicine.

  • Not all pharmacies stock colchicine. It is best to call in advance when re-filling your prescription.

  • While taking colchicine, follow your doctor’s recommendations for diet and exercise.

  • Keep colchicine away from children and pets. It can cause a fatal overdose.

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Disclaimer

Here at HealthMatch, we’ve done our best to ensure that the information provided in this article is helpful, up to date, and, most importantly, accurate.

However, we can’t replace the one-to-one advice of a qualified medical practitioner or outline all of the possible risks associated with this particular drug and your circumstances.

It is therefore important for you to note that the information contained in this article does not constitute professional medical or healthcare advice, diagnosis or recommendation of treatment and is not intended to, nor should be used to, replace professional medical advice. This article may not always be up to date and is not exhaustive of all of the risks and considerations relevant to this particular drug. In no circumstances should this article be relied upon without independent consideration and confirmation by a qualified medical practitioner.

Your doctor will be able to explain all possible uses, dosages, precautions, interactions with other drugs, and other potential adverse effects, and you should always talk to them about any kind of medication you are taking, thinking about taking or wanting to stop taking.

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