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Colchicine is a type of anti-inflammatory with roots going back at least 2,000 years, though its mechanism of action is still poorly understood.

The medication is typically used in three scenarios:

• As a preventive treatment for familial Mediterranean fever (FMF);
• As a preventive treatment for gout flare-ups;
• As an abortive treatment for acute gout attacks.

In all three cases treatment works by reducing inflammation, which reduces pain. It does not reduce levels of uric acid, and it is not a cure; as a preventive treatment, colchicine is usually taken long-term.

Colchicine as a Preventive Treatment

Treatment is similar when taking this product as a preventive measure in gout and FMF:

• In FMF, patients start on 0.6 mg per day, which is increased after a few weeks to 1.2 mg and, in severe cases, 2.4 mg per day.
• With gout, depending on the frequency and severity of flare-ups, patients should take 0.6 to 1.2 mg per day.
• Doses consisting of more than 1 tablet (0.6 mg) may be split into two smaller doses twice a day.

In both conditions the medication will reduce the frequency of flare-ups and, if flare-ups do occur during treatment, it will reduce the severity and duration.

Stopping Acute Gout Attacks

Colchicine is often used as-needed to stop a gout attack that has already started:

• Take 1.6 mg at the earliest symptoms of a flare-up.
• Additional doses of 0.6 mg may be taken at intervals of at least one hour if needed.
• Do not exceed 8 mg in 24 hours.

Some relief should be noticed within a couple hours of administering the first dose, but it may take up to 12 hours for results to be significant, and up to 24 hours for the attack to dissipate completely.

Colchicine as a Preventive & Acute Treatment

Some individuals take colchicine in small daily doses and also use larger doses to treat flare-ups as-needed. This is not an ideal scenario, as the medication can be quite toxic at higher doses; this approach is usually chosen only when alternative abortive treatments do not work.

If using the medication in this manner dosage strengths should be determined by a doctor, but are likely to be similar to the above descriptions of gout treatment.

Safety Guidelines

In the interest of preventing potentially dangerous side effects, there are some basic guidelines to follow regardless of the condition being treated:

• Do not exceed 1.2 mg in a 1 hour period.
• Do not exceed 8 mg in a 24 hour period.
• If 8 mg is taken in a 24 hour period, do not take additional doses for at least 72 hours.

When the body's tolerance for colchicine is reached, side effects will start to develop. The earliest symptoms involve gastrointestinal upset, including:

• Stomach cramps
• Nausea
• Vomiting
• Diarrhea

If these symptoms are noticed, do not take additional doses of colchicine, even if less than 8 mg has been taken. Taking more of the medication after the body begins reacting negatively can cause serious organ damage and even death. If too much is ingested, seek emergency medical treatment even if symptoms do not appear to be serious.

Once the tolerance threshold has been established, Side effects can be avoided by stopping treatment before it is reached. For example, if stomach cramps and vomiting occur after taking 5 tablets during initial treatment, do not exceed 4 tablets when treating the next flare-up.

Before Using Colchicine

Colchicine should be used with extreme caution in patients who:

• Are pregnant or breast feeding
• Are under 16 or over 65 years of age
• Have a history of major gastrointestinal issues
• Have serious kidney or liver issues
• Have low white blood cell counts

To prevent serious complications, discuss risks with a doctor before use.