Colchicine
Also known as: Colchicine
Colchicine is a medicine I commonly use in rheumatology, particularly for gout. It can help settle the inflammation during a gout attack and can also be used for a period of time to reduce the chance of further attacks. I also sometimes use colchicine in patients with calcium pyrophosphate crystal arthritis, often called CPPD or pseudogout. One important thing to understand is that colchicine does not lower your uric acid. It controls inflammation caused by crystals in and around the joint.
Calm, careful medication review by a consultant rheumatologist.
Colchicine does not lower uric acid. It calms the inflammation that crystals cause. If you have repeated attacks, a separate uric-acid-lowering plan is usually what protects your joints in the long run.
What this medicine is
Colchicine is an anti-inflammatory medicine for crystal arthritis. It has been used for many years to treat inflammation caused by crystals inside joints, and it works differently from ordinary painkillers and differently from medicines such as steroids. During a gout attack, uric acid crystals trigger a strong inflammatory response inside the joint, and colchicine reduces the activity of inflammatory cells involved in that reaction. That is why it can reduce the pain, swelling, redness and warmth of a crystal arthritis attack. Colchicine does not remove uric acid crystals and does not lower your blood uric acid level. For long-term gout control, you may still need a uric-acid-lowering medicine such as allopurinol or another appropriate treatment.
Uses and context
I may use colchicine during an acute gout flare, for a period of time while uric-acid-lowering treatment is being started or adjusted, and in selected patients with calcium pyrophosphate crystal arthritis when attacks keep recurring.
How this relates to rheumatology care
Settling an attack is not the same as treating the underlying gout. Colchicine controls the inflammation from the attack, but it does not correct the high uric acid that allowed the crystals to form in the first place.
What safety checks may matter
Why colchicine is being used, and whether the painful joint is genuinely crystal arthritis rather than infection or injury
Kidney function, including whether you are receiving dialysis
Liver function and any known liver disease
Your full medicine list, including antibiotics, heart medicines, ciclosporin, antivirals and statins
Your age and general frailty, since clearance of colchicine can be slower
Whether you are also on uric-acid-lowering treatment such as allopurinol, and whether it needs adjusting
Pregnancy, breastfeeding or plans for pregnancy
How your stomach and bowels tolerate the medicine
Side effects and red flags
If you have emergency symptoms such as severe allergic reaction, breathing difficulty, chest pain, stroke-like symptoms, severe abdominal pain, vomiting blood, black stools, sudden vision loss, severe infection symptoms, or severe weakness or confusion, please seek urgent medical care first rather than waiting for a WhatsApp reply.
Severe or persistent diarrhoea
Repeated vomiting
Significant abdominal pain
New muscle pain or muscle weakness
Unusual tingling, numbness or weakness
Dark or brown-coloured urine
Unexplained bruising or bleeding
Fever or signs of a significant infection
A severe rash, swelling or difficulty breathing
Things worth knowing day to day
The stomach is usually where side effects show up first: diarrhoea, nausea, vomiting and stomach cramps or abdominal discomfort are the most common problems.
Mild symptoms can occur, but significant diarrhoea, vomiting or abdominal symptoms can also be an early sign that too much colchicine is accumulating. Please do not simply continue taking more doses if this happens, and message my clinic if you are unsure.
Do not take extra tablets to make colchicine work faster. Colchicine can become toxic if too much builds up in the body.
Avoid grapefruit juice while taking colchicine unless your treating clinician has specifically advised otherwise.
Tell your doctor or pharmacist that you take colchicine before starting any new prescription, over-the-counter medicine or supplement.
Do not stop your uric-acid-lowering medicine during a gout flare unless your treating clinician specifically advises you to.
Keep colchicine safely away from children, and do not use somebody else's tablets or an old prescription from a previous attack.
There are a few different reasons I may prescribe colchicine.
Colchicine can be used to reduce inflammation during an acute gout flare, particularly when treatment is started appropriately.
When we start or adjust uric-acid-lowering treatment, gout attacks can temporarily become more likely. I may prescribe colchicine for a period of time to reduce this risk while we bring the uric acid under control.
Colchicine may also be useful in selected patients with calcium pyrophosphate crystal arthritis, or CPPD, particularly when attacks keep recurring.
Settling an attack is not the same as treating the underlying gout.
This is one of the most important conversations I have with patients.
A patient may take colchicine, feel much better and assume the gout problem is solved.
But colchicine controls the inflammation from the attack. It does not correct the high uric acid that allowed the crystals to form in the first place.
If you have repeated gout attacks, tophi, kidney stones or persistently high uric acid, we need to look at the bigger picture. You can read more about gout and about CPPD or pseudogout.
Controls crystal-driven inflammation
Reduces the underlying uric acid burden
Fewer crystals · Fewer attacks · Better joint protection
The medicines have different jobs, and sometimes we use them together.
Take colchicine exactly as prescribed.
The amount of colchicine I prescribe depends on why you are taking it, your kidney and liver function, your age, your other medicines and how well you tolerate it.
For that reason, I do not publish a standard dose schedule here.
Please follow the instructions on your prescription rather than using somebody else's dose or an old prescription from a previous attack.
Colchicine can become toxic if too much builds up in the body. Taking doses closer together or taking more tablets than prescribed can be dangerous.
- •Swallow the tablets with water.
- •Take them only according to your prescribed schedule.
- •Do not double a dose because you missed one.
- •If you are unsure what to do after a missed dose, ask your doctor or pharmacist.
- •Keep colchicine safely away from children.
Please tell me what else you are taking.
Colchicine is cleared from the body through pathways that are affected by several other medicines.
Some combinations can cause the colchicine level in your body to rise significantly and, in certain circumstances, become dangerous.
- •Certain antibiotics, particularly clarithromycin and erythromycin
- •Some heart medicines including verapamil and diltiazem
- •Ciclosporin
- •Some antiviral and HIV medicines
- •Certain medicines that affect the same drug-processing pathways
- •Statins and other medicines that can increase the risk of muscle toxicity
This is not a complete interaction list. Always tell your doctor or pharmacist that you are taking colchicine before starting a new prescription, over-the-counter medicine or supplement.
Avoid grapefruit juice while taking colchicine unless your treating clinician has specifically advised otherwise, because it can increase colchicine levels.
Kidney and liver function matter with colchicine.
Your body needs to clear colchicine properly.
If kidney or liver function is reduced, colchicine may stay in the body for longer and the risk of toxicity can increase.
This is particularly important if you are also taking another medicine that increases colchicine levels.
- •Have kidney disease
- •Are receiving dialysis
- •Have liver disease
- •Are older or frail
- •Have recently started a new antibiotic
- •Take several regular medicines
Sometimes the dose needs to be adjusted, the medicine needs to be avoided, or another treatment is more appropriate.
If you have taken more colchicine than prescribed, seek urgent medical attention immediately.
Do not wait for symptoms to appear.
Colchicine overdose can be serious and potentially life-threatening.
In Malaysia, please go to the nearest Emergency Department or call local emergency medical services rather than waiting for a WhatsApp reply.
“Why am I taking colchicine if I have already started allopurinol?”
Because they do different jobs.
Allopurinol helps lower uric acid over time.
When uric acid starts changing, existing crystals in the joints can become unstable and occasionally trigger an attack.
For some patients, I use colchicine temporarily during this period to reduce the chance of a flare while the uric-acid-lowering treatment starts doing its job.
Lower the uric acid
Reduce flare inflammation
Different roles in the same gout plan
Do not stop your uric-acid-lowering medicine during a gout flare unless your treating clinician specifically advises you to.
Tell me if you are pregnant, breastfeeding or planning a pregnancy.
Colchicine can be used in some patients during pregnancy or breastfeeding when clinically appropriate, but this should always be reviewed individually.
Please do not stop a prescribed medicine automatically because you discover you are pregnant.
Instead, contact me so we can review why you are taking it, your dose and the balance of benefits and risks.
If the attacks keep coming back, we should ask why.
Repeated gout attacks are a reason to look beyond treating each flare individually. Depending on your situation, I may review:
- •Your uric acid level
- •How often attacks occur
- •Which joints are affected
- •Kidney function
- •Kidney stones
- •Tophi or visible uric acid deposits
- •Other medicines that may affect uric acid
- •Blood pressure and metabolic health
- •Diet and alcohol where relevant
- •Family history
- •Whether uric-acid-lowering treatment is needed or needs adjustment
The goal is not simply to get you through the next painful attack. It is to reduce the chance of the next one happening.
Questions patients often ask me about this medicine
Speak with me
Not sure why you have been prescribed colchicine? If you have been prescribed colchicine for gout, recurrent crystal arthritis or CPPD, or you keep experiencing sudden painful swollen joints, you are welcome to speak with me. We can review what is causing the attacks, whether colchicine is appropriate and whether there is an underlying problem that needs longer-term treatment.
Trusted patient information sources
Other medications used in rheumatology care
This page is for general education only and does not replace medical advice. Please consult a qualified healthcare professional for diagnosis and treatment. Do not start, stop, or change any medicine without advice from your doctor.