Formulary
Colchicine: Indications, Dosing, Side Effects and Interactions
Colchicine clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Colchicine: Indications, Dosing, Side Effects and Interactions
Colchicine clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Acute gout**
- **Adult** (By Mouth): 500 micrograms 2-4 times a day until symptoms relieved, total dose per course should not exceed 6 mg, do not repeat course within 3 days.
**Short-term prophylaxis of gout during initial therapy with allopurinol and uricosuric drugs**
- **Adult** (By Mouth): 500 micrograms twice daily.
**Prophylaxis of familial Mediterranean fever (recurrent polyserositis) (under expert supervision)**
- **Adult** (By Mouth): 1-3 mg daily in 1-2 divided doses, dose increased in increments up to maximum 3 mg per day; monitor closely for side-effects.
**Prophylaxis of familial Mediterranean fever (recurrent polyserositis) (under expert supervision) for colchicine**
- **Child 1 month-4 years** (By mouth): Initially 500 micrograms once daily, increased if necessary up to 2 mg daily in 1-2 divided doses, dose increased in increments, such as 250 micrograms, in patients who do not respond or those with amyloid nephropathy; monitor closely for side-effects.
- **Child 5-10 years** (By mouth): Initially 1 mg once daily, increased if necessary up to 2 mg daily in 1-2 divided doses, dose increased in increments, such as 250 micrograms, in patients who do not respond or those with amyloid nephropathy; monitor closely for side-effects.
- **Child 11-17 years** (By mouth): Initially 1.5 mg daily in 1-2 divided doses, increased if necessary up to 2 mg daily in 1-2 divided doses, dose increased in increments, such as 250 micrograms, in patients who do not respond or those with amyloid nephropathy; monitor closely for side-effects.
Cautions
Cardiac disease; elderly; gastro-intestinal disease Cautions, further information Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: if eGFR less than 10 mL/minute/1.73 m 2 (contra-indicated in severe renal impairment; risk of toxicity) for chronic treatment of gout where there is no contraindication to a xanthine-oxidase inhibitor (xanthine-oxidase inhibitors are first choice prophylactic drugs in gout)
Contraindications
Blood disorders
Side effects
Common or very common Abdominal pain; diarrhoea; nausea; vomiting Frequency not known Agranulocytosis; alopecia; bone marrow disorders; gastrointestinal haemorrhage; kidney injury; liver injury; menstrual cycle irregularities; myopathy; nerve disorders; rash; sperm abnormalities; thrombocytopenia Overdose Early signs of toxicity include abdominal pain, diarrhoea, nausea, and vomiting. Features after 1 to 7 days include arrhythmias, bone marrow depression, confusion, decreased cardiac output, hepatic impairment, hyperpyrexia, renal impairment, and respiratory distress.
Interactions
**Severe interactions:**
- Toxicity, including fatal cases, have been reported during concurrent use of CYP3A4 or P-gp inhibitors such as macrolides (clarithromycin and erythromycin), ciclosporin, ketoconazole, itraconazole,...
**Other interactions (12):**
- Colchicine is a substrate for both CYP3A4 and the transport protein P-gp.
- In the presence of CYP3A4 or P-gp inhibitors, the concentrations of colchicine in the blood may increase.
- A reduction in colchicine dosage or an interruption of colchicine treatment is recommended in patients with normal renal or hepatic function if treatment with a P- gp inhibitor or strong CYP3A4...
- A 4-fold reduction in colchicine dosage is recommended when co-administered with a P-gp inhibitor and/or a strong CYP3A4 inhibitor.
- A 2-fold reduction in colchicine dosage is recommended when co-administered with a moderate CYP3A4 inhibitor.
- The magnitude of interactions with strong and moderate CYP3A4 inhibitors as well as with P-gp inhibitors from performed in vivo studies is summarised in the table below: Single dose of 0.6 mg...
Pregnancy
Specialist sources indicate that, although teratogenicity was noted in animal studies, human data suggested risk to the fetus is low.
Breast feeding
Present in milk. M Specialist sources indicate use with caution and note that no adverse effects have been reported in the breast-fed infant. Breast feeding can be delayed for 6-8 hours after a maternal dose to avoid peak milk concentrations.
Hepatic impairment
Caution in mild to moderate impairment; avoid in severe impairment. M Dose adjustments When used for Prophylaxis of familial Mediterranean fever (recurrent polyserositis): Reduce initial dose to 1 mg once daily in mild to moderate impairment. M
Renal impairment
Caution in mild to moderate impairment; avoid in severe impairment. M See Prescribing in renal impairment . Dose adjustments Reduce dose or increase dosage interval if eGFR 10-50 mL/minute/1.73 m 2 . A When used for Prophylaxis of familial Mediterranean fever (recurrent polyserositis): Reduce initial dose to 1 mg once daily in mild to moderate impairment. M
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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