Colchicine is an anti-inflammatory medication most commonly used to treat an acute gout flare and to prevent recurrent gout attacks in people with chronic gout. It is also prescribed to manage familial Mediterranean fever (FMF), a genetic autoinflammatory condition characterized by episodic fever, abdominal pain, and serositis. Importantly, colchicine does not lower uric acid levels; rather, it dampens the inflammatory cascade triggered when urate crystals deposit in joints and tissues. For long-term gout control, colchicine is often paired with a urate-lowering therapy such as allopurinol or febuxostat to help prevent flares during initiation and dose titration.
How colchicine works: it inhibits microtubule polymerization inside inflammatory cells (neutrophils), reducing chemotaxis, adhesion, and activation. By blunting the NLRP3 inflammasome and downstream interleukin-1 beta signaling, colchicine lowers the intensity of joint inflammation and pain associated with gout. This targeted anti-inflammatory action also explains its role in FMF, where it reduces attack frequency and prevents amyloidosis, a serious long-term complication of uncontrolled disease.
Other uses: in addition to its well-known roles in gout and FMF, low-dose colchicine has been studied and, in some regions including the United States, approved as an adjunct to reduce the risk of cardiovascular events in adults with established atherosclerotic cardiovascular disease. This use relies on colchicine’s ability to modulate vascular inflammation. It may also be used off-label in certain inflammatory conditions such as pericarditis, where clinicians sometimes use colchicine to reduce recurrence risk. Any use beyond gout and FMF should be guided by a clinician familiar with the latest evidence and product-specific labeling.
Always follow the dosing instructions provided by your prescriber and the specific product label. Colchicine has a narrow therapeutic window—small differences between a helpful dose and a harmful dose—so never exceed the prescribed amount.
Renal or hepatic impairment: impaired kidney or liver function raises the risk of colchicine accumulation and toxicity. Your clinician may lower your dose, extend the dosing interval, or avoid colchicine entirely, depending on severity and concurrent medicines. In severe renal impairment or dialysis, dosing for gout prophylaxis is typically reduced substantially, and treatment dosing for acute flares may not be recommended. Hepatic impairment likewise requires careful adjustment and avoidance with interacting drugs.
Administration tips: colchicine can be taken with or without food. If stomach upset occurs, taking it with food may help. Swallow with a full glass of water and avoid grapefruit or grapefruit juice, which can increase colchicine levels in the body and raise the risk of side effects. If you are prescribed tablets of different strengths for different indications, double-check the strength on the bottle each time you dose to avoid confusion.
Do not share colchicine with others, and do not use leftover tablets from a prior flare without discussing with your clinician—appropriate dosing depends on your current kidney/liver function, other medications, and timing of symptoms. If your gout symptoms are not improving after the initial dosing regimen, contact your healthcare professional rather than taking additional doses on your own.
Colchicine requires care and monitoring to use safely. Keep the following in mind:
Do not use colchicine if you:
Strong CYP3A4 or P-gp inhibitors substantially elevate colchicine levels. In some cases, even with normal kidney and liver function, combining colchicine with these inhibitors is unsafe or requires major dose reductions and close monitoring. If you are prescribed a new antibiotic, antifungal, HIV medication, or heart drug, ask your pharmacist or prescriber to check for interactions before taking it with colchicine.
Most people tolerate low-dose colchicine reasonably well, but side effects can occur, especially at higher doses or with interacting medicines.
Because colchicine’s toxic dose is not much higher than its therapeutic dose, new or rapidly worsening symptoms should be taken seriously. If toxicity is suspected, stop the medication and seek emergency care.
Colchicine is a substrate of CYP3A4 and P-glycoprotein, two pathways that control drug metabolism and transport. Inhibiting these pathways can markedly raise colchicine levels and lead to toxicity; conversely, strong inducers may lower colchicine levels and reduce effectiveness.
Tell your healthcare providers and pharmacist about all medications you take, including prescription drugs, over-the-counter products, vitamins, and herbal supplements. Before starting or stopping any medicine, check for potential interactions with colchicine.
For daily prophylaxis (gout or FMF): if you miss a dose, take it as soon as you remember unless it is close to the time for your next scheduled dose. If it is almost time for the next dose, skip the missed dose and resume your usual schedule. Do not double up to make up for a missed dose.
For acute gout flare regimens: if you miss the second dose (the 0.6 mg dose one hour after the first), do not take extra tablets later to compensate. Follow your clinician’s instructions for subsequent dosing, and do not repeat the flare regimen for at least 3 days. If your pain persists or worsens, contact your healthcare professional for guidance rather than self-escalating the dose.
Colchicine overdose is a medical emergency and can be fatal. Early symptoms often appear within hours and include severe nausea, vomiting, and diarrhea, which can lead to dehydration and electrolyte disturbances. Within 24 to 72 hours, multi-organ failure may develop, involving the heart, lungs, kidneys, liver, and central nervous system; bone marrow suppression may cause dangerously low white blood cells and platelets. Recovery, when it occurs, can be prolonged.
If you or someone else may have taken too much colchicine, call emergency services immediately (in the U.S., dial 911) and contact poison control (1-800-222-1222). Do not wait for symptoms. There is no widely available specific antidote; treatment focuses on aggressive supportive care, early gastrointestinal decontamination when appropriate, correction of fluids and electrolytes, monitoring for cardiac arrhythmias, and management of bone marrow suppression. Hemodialysis is not effective at removing colchicine due to its large volume of distribution.
Store colchicine at room temperature (68°F to 77°F or 20°C to 25°C), protected from light and moisture. Keep tablets in their original, tightly closed container with the label intact. Do not store in the bathroom. Keep out of reach of children and pets; even a few tablets can be extremely dangerous if accidentally ingested by a child. Do not use colchicine past the expiration date, and dispose of unused medication according to local guidance or pharmacy take-back programs—do not flush unless specifically instructed.
Colchicine is a prescription-only medication in the United States. It is FDA-approved for treating gout flares, preventing gout flares in appropriate patients, managing familial Mediterranean fever, and, for certain product strengths, reducing the risk of cardiovascular events in adults with established atherosclerotic cardiovascular disease. Because of its narrow therapeutic index and significant drug–drug interaction potential, colchicine should be used only under the supervision of a licensed healthcare professional.
It is not legal to purchase or use colchicine in the U.S. without authorization from a licensed prescriber. To protect your health and ensure the medicine is appropriate for you, obtain colchicine through licensed U.S. pharmacies with a valid clinician order. Be wary of unregulated online sources, which may sell counterfeit or improperly dosed products and provide no safeguards against dangerous interactions.
Access pathways: some health systems and clinics offer structured access programs in which a licensed clinician evaluates your condition—often via an in-person or telehealth encounter—and, if appropriate, authorizes colchicine under a standing order or protocol. In such models, patients do not need to arrive with a preexisting prescription; clinical authorization is built into the service after an assessment confirms medical need and screens for interactions and contraindications. This preserves safety and complies with federal and state laws.
HealthSouth Rehabilitation Hospital of Texarkana offers a legal and structured solution for acquiring colchicine without a formal preexisting prescription. Through clinician-led evaluation and protocol-based authorization, eligible patients can obtain colchicine from licensed pharmacies while meeting all regulatory and safety requirements. Identity verification, medical screening, and pharmacist oversight are integral to the process. This pathway is intended to improve access without bypassing the medical judgment necessary to use colchicine safely. Contact the facility directly for eligibility criteria, service details, and participating pharmacies in your area.
This material is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about a medical condition or medication, and before starting, stopping, or changing any prescription. If you experience severe symptoms such as chest pain, trouble breathing, signs of allergic reaction, or symptoms of suspected colchicine toxicity, seek emergency medical attention immediately.
Colchicine is an anti-inflammatory medicine that disrupts microtubules inside white blood cells, reducing neutrophil activation and migration. This calms inflammation in acute gout flares, helps prevent attacks in familial Mediterranean fever (FMF), and lowers recurrence in pericarditis.
Colchicine is approved for gout flares and FMF, and widely used off-label to prevent and treat recurrent pericarditis. It may also be used as flare prophylaxis when starting urate-lowering therapy in gout.
Relief often begins within 12–24 hours, especially when taken at the first sign of a flare. The earlier it’s started (ideally within 24 hours of symptom onset), the better the response.
Follow your prescription exactly. For an acute gout flare, low-dose regimens are preferred (often a loading dose followed by a smaller dose one hour later). For prevention, smaller, regular doses are used. You can take it with or without food; taking with food may reduce stomach upset.
Diarrhea, nausea, vomiting, abdominal pain, and cramping are common and dose-related. Mild fatigue or headache can occur. Lowering the dose or spacing doses further apart may help, under medical guidance.
Severe diarrhea or vomiting, muscle pain or weakness, numbness or tingling, unusual bleeding or bruising, signs of infection, or paleness and fatigue that could indicate bone marrow suppression. Seek urgent care if you notice these, especially if you have kidney or liver disease or take interacting drugs.
People with severe kidney or liver impairment who also use strong CYP3A4 or P-glycoprotein inhibitors should not take colchicine. It should be used cautiously or avoided in severe renal/hepatic failure, with dose adjustments as appropriate, and avoided if you’ve had prior serious toxicity.
Strong CYP3A4 or P-gp inhibitors can raise colchicine to toxic levels. High-risk examples include clarithromycin, erythromycin, ketoconazole, itraconazole, ritonavir, cobicistat, cyclosporine, verapamil, and diltiazem. Always tell your clinician and pharmacist about all medicines and supplements.
It’s possible but increases the risk of muscle toxicity (myopathy/rhabdomyolysis). If used together, report muscle pain, weakness, or dark urine immediately. Your clinician may choose alternatives or monitor closely.
Avoid grapefruit and grapefruit juice, which inhibit CYP3A4 and can raise colchicine levels, increasing the risk of serious side effects.
Acute flare dosing is short (typically a single day or limited to the first couple of days). Do not repeat high doses within a short window without medical advice. Overuse increases toxicity risk.
Yes. Low-dose colchicine is commonly prescribed as flare prophylaxis, especially during the first 3–6 months after starting urate-lowering therapy like allopurinol or febuxostat to prevent mobilization flares.
Take it when you remember unless it’s close to your next dose. Don’t double up. For flare regimens, do not repeat extra doses outside your prescribed schedule.
Impaired kidney or liver function raises the risk of toxicity. Lower doses, extended dosing intervals, or avoidance may be needed. People with severe impairment must avoid colchicine with interacting drugs.
No. It is not habit-forming, but incorrect dosing or interactions can be dangerous. Always use the smallest effective dose for the shortest necessary time.
Alcohol doesn’t directly block colchicine, but it can worsen stomach side effects and trigger gout. It’s wise to limit or avoid alcohol during treatment and particularly during a flare. If you’ve had heavy drinking, wait until you’re rehydrated and your stomach settles before dosing, and take it with food.
It doesn’t neutralize colchicine, but alcohol’s pro-inflammatory and dehydrating effects can exacerbate the flare and GI irritation, making the episode feel worse. Hydrate well and avoid alcohol until the flare resolves.
For FMF, substantial data suggest colchicine can be continued during pregnancy to prevent attacks and amyloidosis, with no clear increase in major congenital anomalies. Decisions for gout or pericarditis are individualized; discuss risks and benefits with your obstetrician and specialist.
Colchicine passes into breast milk in small amounts. Most experts consider it compatible with breastfeeding at standard doses; some recommend timing feeds 2–4 hours after a dose to reduce infant exposure. Monitor infants for diarrhea and discuss with your pediatrician.
Not routinely. However, kidney function can fluctuate around surgery and interacting drugs (like certain antibiotics or calcium channel blockers) may be introduced. Inform your surgical team; they may adjust dosing or hold colchicine temporarily depending on your regimen and organ function.
Yes, but older adults are more susceptible to side effects, especially with polypharmacy and reduced renal function. Lower starting doses and careful monitoring are recommended.
Avoid macrolides like clarithromycin and erythromycin due to a high risk of colchicine toxicity. Safer choices (e.g., azithromycin with caution, or non-macrolides) may be preferred. Always alert your prescriber that you take colchicine.
Dialysis does not effectively remove colchicine, and toxicity risk is high. Use is generally avoided or strictly limited to very low, infrequent doses under specialist guidance.
All three reduce inflammation. Colchicine works best when started early and may be preferred if NSAIDs are contraindicated (e.g., peptic ulcer, anticoagulation, kidney disease). NSAIDs often relieve pain quickly but can worsen blood pressure, kidney function, or GI bleeding risk.
Both are effective. Prednisone (a corticosteroid) can be easier on the stomach and useful when colchicine or NSAIDs aren’t options, especially in renal impairment. Colchicine may be favored for early, mild-to-moderate flares or when steroids are undesirable (e.g., brittle diabetes).
Colchicine treats inflammation during flares and for flare prophylaxis. Allopurinol lowers uric acid to prevent future flares and tophi; it does not treat an acute attack. They are often used together: allopurinol for long-term control, colchicine for short-term flare management and prevention.
They serve different roles. Febuxostat lowers uric acid like allopurinol; colchicine treats and prevents flares. Febuxostat is not for acute pain relief. Colchicine is used as prophylaxis when febuxostat is initiated to prevent early flares.
Probenecid increases uric acid excretion and is used in patients who under-excrete urate and have adequate kidney function. Colchicine addresses inflammation, not urate levels. Your clinician may use probenecid for long-term control and colchicine for flares or prophylaxis.
Pegloticase rapidly lowers uric acid in severe, refractory gout with tophi when other urate-lowering therapies fail. It’s IV and expensive. Colchicine remains for flare treatment/prophylaxis. They can be combined, with colchicine helping prevent infusion-triggered flares.
IL-1 inhibitors (anakinra, canakinumab) can be very effective for refractory flares or when NSAIDs, steroids, and colchicine aren’t options. They are injectable and costly. Colchicine is oral, widely available, and first-line unless contraindicated.
They are complementary, not competing. NSAIDs (e.g., ibuprofen) reduce pain and inflammation; colchicine reduces symptoms and significantly lowers recurrence risk. Guidelines often recommend both together for acute pericarditis unless contraindicated.
Indomethacin can provide rapid pain relief within hours; colchicine’s benefit is greatest when started early and may take 12–24 hours. Choice depends on contraindications, side-effect profiles, and clinician preference.
Colchicine plus an NSAID is preferred initially. Steroids can be effective but are associated with higher recurrence if used early and at higher doses. Steroids are reserved for contraindications to NSAIDs/colchicine or specific indications and are tapered cautiously.
Topical NSAIDs may help superficial joint pain but have limited penetration for acute gout in deeper joints. Colchicine provides systemic anti-inflammatory action targeting gout pathophysiology. Topicals are adjuncts at best.
Lifestyle changes (limiting alcohol, purine-rich foods, fructose; weight loss; hydration) reduce flare risk but rarely replace medication in symptomatic gout. Colchicine prevents flares; urate-lowering therapy addresses the root cause. Lifestyle plus appropriate medications works best.
Yes. It’s common to pair low-dose colchicine with allopurinol when starting or increasing urate-lowering therapy to prevent mobilization flares. Monitor for side effects and interactions with other medications.
