An anti-inflammatory used for gout
Colchicine
A medicine that settles the intense inflammation of a gout attack — effective, but must be used at a low, careful amount because too much causes severe diarrhoea and toxicity.
What is Colchicine?
Colchicine treats the pain and swelling of an acute gout attack, and is sometimes used to prevent flares when urate-lowering treatment is being started. It calms the inflammation that uric-acid crystals trigger. It works best taken early in an attack, and the amount is kept deliberately low — taking too much causes severe diarrhoea, vomiting and dangerous toxicity, so never exceed the prescribed dose.
Education and reference only. This is a plain-language guide to Colchicine — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Colchicine is an old and effective anti-inflammatory medicine used mainly in gout. It relieves an acute gout attack, and it is also used as short-term "cover" to prevent flares in the first weeks or months of starting a urate-lowering medicine such as allopurinol. It has a role in a few other inflammatory conditions too. It is taken as a tablet, and its safe use depends entirely on keeping the amount low and not repeating it excessively.
How it works
Colchicine dampens the inflammatory response to uric-acid crystals in the joint. It interferes with the internal "skeleton" (microtubules) of white blood cells, reducing their ability to move to the crystals and release the chemicals that cause the intense pain, redness and swelling of a gout attack. It does not lower uric acid — so it treats or prevents the inflammation, not the underlying cause.
What it treats
Conditions Colchicine is used for
Practical use
How to take Colchicine
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Start it as early as possible in a gout attack for the best effect, at the low amount prescribed.
- Do not exceed the prescribed dose or repeat courses too often — more is not better and is dangerous.
- Stop taking it and seek advice if you develop diarrhoea, nausea or vomiting — these are early signs of too much.
- Tell your prescriber about all your medicines; several can raise colchicine to toxic levels.
- If you are on urate-lowering treatment (like allopurinol), keep taking that too — colchicine treats the flare, not the cause.
Weighing it up
Advantages & disadvantages of Colchicine
Advantages
- Effective for acute gout, and useful as flare "cover" when starting urate-lowering treatment.
- An option for people who cannot take anti-inflammatory painkillers or steroids.
- Long established and inexpensive.
Disadvantages
- Narrow safety margin — toxic in overdose, with diarrhoea as the first sign.
- Interacts with several common medicines that raise its level.
- Needs a reduced amount in kidney/liver impairment and in older people.
Practical use
Good to know
Colchicine has a narrow margin of safety: the same action that helps in gout can harm the gut and other rapidly dividing cells if the amount is too high. The first warning sign of too much is usually diarrhoea, often with nausea and vomiting — if this happens, stop and seek advice. It works best when started as early as possible in an attack. The amount is reduced in kidney or liver problems and in older people, and certain other medicines (such as some antibiotics, antifungals and statins) can dangerously raise colchicine levels. It does not replace urate-lowering treatment for long-term gout control.
Who should not take it / use with caution
- People with significant kidney or liver impairment (used at a much reduced amount, or avoided).
- People taking certain interacting medicines (some antibiotics, antifungals, and others) that raise colchicine levels.
- Pregnancy and breastfeeding — only on specialist advice.
Monitoring
- Kidney and liver function guide the amount
- Watch for gut side effects as a sign of toxicity
- Blood count with prolonged use
Side effects
- Very common and dose-related: diarrhoea, nausea, vomiting and stomach cramps — these are the earliest signs of too much and a cue to stop and seek advice.
- With excessive or prolonged use: effects on the blood count, muscles and nerves.
- Overdose is a medical emergency and can be fatal — keep it out of reach of children.
Key interactions
- Some antibiotics (clarithromycin, erythromycin), antifungals (such as ketoconazole and itraconazole) and other drugs raise colchicine levels dangerously — the combination is avoided or the dose reduced.
- Ciclosporin and some other medicines also increase its level.
- Care is needed alongside statins, as both can affect the muscles.
Available as: Tablets.
Answers
Colchicine: frequently asked questions
How quickly should I take colchicine in a gout attack?
As early as possible — colchicine works best when started at the very first signs of an attack, so many people keep a supply to hand if they get recurrent gout. Take only the low amount prescribed; taking more to speed things up causes toxicity, not faster relief.
Why do I get diarrhoea on colchicine?
Diarrhoea (often with nausea) is the classic early sign that the amount is too high for you. If it happens, stop taking it and seek advice — the dose may need adjusting. Modern low-dose regimens are designed to minimise this while still treating the attack.
Does colchicine cure my gout?
No — it settles the inflammation of an attack but does not lower uric acid, so it does not prevent gout in the long term. Long-term control comes from urate-lowering medicines such as allopurinol; colchicine is often used as short-term "cover" while those are started.
Can I take it with my other medicines?
Check first — several common medicines (certain antibiotics, antifungals and others) can raise colchicine to dangerous levels. Always tell your prescriber and pharmacist everything you take before starting colchicine.
The wider class
About Gout treatment (colchicine)
Colchicine belongs to the gout treatment (colchicine) class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF: Colchicine.
- electronic Medicines Compendium (SmPC): Colchicine.
- NICE NG219: Gout – diagnosis and management.
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