Bone & metabolism
Colchicine
For acute gout and other inflammation — An anti-inflammatory for gout flares and some other conditions — effective but easy to overdose.
Education and reference only. This is a plain-language class overview — it deliberately contains no doses. Always check the current Summary of Product Characteristics (SmPC), the BNF and your local formulary before prescribing or administering any medicine.
What it is
Colchicine is used mainly to treat and sometimes prevent gout flares, and in a few other inflammatory conditions such as pericarditis and familial Mediterranean fever. It is an alternative when anti-inflammatories or steroids cannot be used.
How it works
It interferes with the internal "skeleton" (microtubules) of inflammatory cells, blunting their ability to migrate to and amplify the intense inflammation that urate crystals trigger in a gout flare. The same anti-inflammatory action helps in conditions like pericarditis.
In practice
In practice colchicine is a valuable option for an acute gout flare, especially where NSAIDs or steroids are unsuitable, but the dangerous trap is dose: the old advice to keep taking it until symptoms settled or diarrhoea began caused real harm, and modern practice uses a lower, capped regimen, because the gap between an effective amount and a toxic one is small. Diarrhoea and vomiting are the earliest signs of too much. It is cleared by the kidneys and liver, so the dose is reduced (or it is avoided) in significant impairment, and it has important interactions with drugs that block its breakdown — notably some statins (raising the risk of muscle toxicity), certain antibiotics such as clarithromycin, and other enzyme inhibitors. In overdose it is extremely toxic, so safe storage and clear dosing instructions matter.
Examples
Practical use
How to take it & use it well
- Take colchicine exactly as prescribed for a gout attack; modern advice uses a low, capped amount rather than repeated dosing until symptoms ease.
- Treat diarrhoea as a warning sign - if you develop diarrhoea, vomiting or tummy cramps, stop taking it and seek advice, as these can signal toxicity.
- Do not take more than the prescribed amount in an attack, and leave the advised gap before treating another attack.
- Tell your clinician if your kidneys or liver are not working well, as your dose may need to be lower.
- Check before combining it with certain other medicines, as some can raise colchicine to harmful levels.
Common uses
- Acute gout flares
- Short-term cover when starting urate-lowering therapy
- Pericarditis and familial Mediterranean fever (specialist settings)
Monitoring
- Response of the flare and any gastrointestinal side-effects
- Renal and hepatic function
- Interacting medicines before prescribing
Weighing it up
Advantages & disadvantages
Advantages
- Effective at easing the pain and inflammation of an acute gout attack.
- An option for people who cannot take anti-inflammatory painkillers.
- Can also be used to help prevent attacks when starting urate-lowering treatment.
- Has a long history of use in gout and similar conditions.
Disadvantages
- Diarrhoea and other gut upset are common and can be an early sign of toxicity.
- Has a narrow safety margin, so the dose must be kept low and not repeated excessively.
- Needs dose reduction in kidney or liver impairment to avoid build-up.
- Serious toxicity, though uncommon, can affect blood cells and muscles.
Key safety principles
What to watch for
- Narrow margin — use a low, capped dose; diarrhoea and vomiting are early signs of toxicity.
- Reduce the dose or avoid in significant renal or hepatic impairment.
- Serious interactions with drugs that block its breakdown (e.g. some statins → muscle toxicity, clarithromycin); extremely toxic in overdose.
Key interactions
What to avoid or check alongside
- Clarithromycin and similar macrolide antibiotics: raise colchicine levels and the risk of serious toxicity.
- Statins: combined use can increase the risk of muscle damage.
- Some antifungals and certain heart medicines (such as verapamil and diltiazem): can raise colchicine levels.
- Ciclosporin: increases colchicine levels and toxicity risk.
- Grapefruit juice: can raise colchicine levels and is best avoided.
Patient & carer advice
- Take only the amount prescribed — more is dangerous, not better
- Stop and seek advice if you get diarrhoea or vomiting
- Tell us about your other medicines, and keep it well away from children
Use with
Related clinical calculators
Dose and risk decisions for this class often depend on renal function, weight or bleeding/stroke risk. These tools help:
Answers
Colchicine: frequently asked questions
Why is diarrhoea important when taking colchicine?
Diarrhoea, vomiting or stomach cramps are often the first sign that colchicine is building up to toxic levels. If these develop, stop taking it and seek advice rather than continuing to dose.
Why is the colchicine dose kept low?
Colchicine has a narrow safety margin, so modern guidance uses a low, capped amount for a gout attack rather than repeated dosing. This reduces the risk of serious side effects while still easing the attack.
Can I take colchicine with my antibiotic?
Some antibiotics, especially clarithromycin and similar macrolides, can raise colchicine to dangerous levels. Always tell your prescriber you take colchicine before starting a new antibiotic so they can choose a safe option.
Does kidney function affect my colchicine dose?
Yes. If your kidneys or liver are not working well, colchicine can build up, so a lower dose or different treatment may be needed. Tell your clinician about any kidney or liver problems.
Authoritative sources
Always verify against the source
This overview is for orientation. For doses, interactions, contra-indications and the full monograph, use:
Related guides
Need a custom medicines or prescribing resource?
We build evidence-led clinical references, calculators and decision aids for teams.