Part of the Access Doctor gout guide.
Colchicine for Gout: Uses, Dosing & UK Guide
A clinically reviewed guide to colchicine for acute gout — how it works, the correct modern low-dose regimen, side effects, when to use it instead of NSAIDs, and how to access it in the UK.
Colchicine treats acute gout. For long-term prevention: Allopurinol guide → · For the NSAID alternative: Naproxen for gout →
500µg
Standard tablet strength — modern low-dose regimen
Rx only
Prescription-only in the UK
24–48h
Time to significant relief in acute gout
NICE
First-line for acute gout alongside NSAIDs
What Is Colchicine?
Colchicine is an anti-inflammatory alkaloid derived from the autumn crocus plant, used in medicine for over 2,000 years. In the UK it is prescribed primarily for acute gout attacks and as prophylaxis during the early phase of allopurinol treatment. It is a prescription-only medicine that works by a completely different mechanism to NSAIDs, making it an important alternative when NSAIDs are contraindicated or not tolerated.
How Colchicine Works
Colchicine binds to tubulin and inhibits microtubule polymerisation — disrupting the cytoskeleton of neutrophils, the white blood cells that flood into a gouty joint and drive its intense inflammatory response. By impairing neutrophil migration, activation, and NLRP3 inflammasome signalling (the sensor that detects urate crystals and triggers IL-1β release), colchicine effectively brakes the inflammatory cascade that makes gout so painful.
This mechanism is specific to crystal-induced and certain other inflammatory pathways — it does not inhibit COX enzymes and has no analgesic effect on non-inflammatory pain. It is precisely targeted for gout.
When to Use Colchicine Instead of NSAIDs
- Renal impairment — NSAIDs reduce renal blood flow and are relatively contraindicated in CKD; colchicine is preferred with dose adjustment
- Peptic ulcer disease or GI bleeding history — NSAIDs increase GI bleeding risk significantly; colchicine is safer
- Anticoagulants (warfarin, DOACs) — NSAIDs increase bleeding risk; colchicine does not affect coagulation
- Heart failure — NSAIDs cause sodium and water retention and are contraindicated; colchicine is safe
- NSAID intolerance — previous GI intolerance or allergy to NSAIDs
Dosing: Acute Attack and Prophylaxis
| Indication | Regimen | Notes |
|---|---|---|
| Acute gout | 1mg initially (2×500µg), then 500µg every 2–3 hours until pain relieved or GI side effects occur. Maximum 6mg per course; do not repeat within 3 days. | Start as early as possible; most effective within 24 hours of attack onset |
| Prophylaxis during allopurinol initiation | 500µg twice daily | Continue for 6 months while serum urate is being reduced to target; reduces crystal mobilisation attacks |
The old high-dose colchicine regimen (1mg every 1–2 hours until diarrhoea) is no longer recommended. The AGREE trial demonstrated that the modern low-dose regimen is equally effective with significantly fewer gastrointestinal side effects. Always use low-dose.
Side Effects
- Diarrhoea, nausea, abdominal cramps — most common; dose-dependent; much reduced with modern low-dose regimen
- Neuromuscular toxicity — peripheral neuropathy and myopathy with prolonged high-dose use; rare at recommended doses
- Bone marrow suppression — rare; more likely with overdose or severe renal impairment
Contraindications
- Severe renal impairment (eGFR <10 mL/min) — dose adjustment needed with moderate CKD
- Severe hepatic impairment
- Pregnancy and breastfeeding
- Concurrent strong CYP3A4 or P-glycoprotein inhibitors (clarithromycin, ritonavir, ciclosporin) — dramatically increase colchicine levels; risk of toxicity
Colchicine vs NSAIDs for Acute Gout
| Colchicine | NSAIDs (naproxen/ibuprofen) | |
|---|---|---|
| Mechanism | Anti-tubulin; blocks neutrophil migration | COX inhibition; reduces prostaglandins |
| Onset | 24–48 hours for meaningful relief | 4–6 hours for initial relief |
| GI risk | Diarrhoea; no ulceration risk | Ulceration/bleeding risk; take with food + PPI |
| Renal safety | Preferred in CKD (dose-adjusted) | Relatively contraindicated in significant CKD |
| Heart failure | Safe | Contraindicated |
| NICE first-line? | Yes — equal to NSAIDs | Yes — equal to colchicine |
Getting Colchicine in the UK
Colchicine is prescription-only in the UK. Access Doctor can prescribe it following an online clinical consultation reviewed by GPhC-registered pharmacist independent prescribers.
Prescription Gout Treatment at Access Doctor
Colchicine and naproxen for acute gout attacks, plus allopurinol for prevention — all via online consultation. GPhC pharmacy #9011198.
View Gout Treatments →Frequently Asked Questions
What is colchicine used for?
Colchicine treats acute gout attacks and prevents crystal mobilisation attacks when starting allopurinol. It is NICE first-line for acute gout alongside NSAIDs, and works by blocking neutrophil migration into the inflamed joint.
What is the correct dose of colchicine for gout?
1mg initially (2×500µg tablets), then 500µg every 2–3 hours until pain is relieved or diarrhoea occurs. Maximum 6mg per course. Do not repeat within 3 days. The old high-dose regimen is no longer recommended.
When should colchicine be used instead of NSAIDs?
Colchicine is preferred over NSAIDs in patients with renal impairment, peptic ulcer disease, heart failure, or those on anticoagulants. Both are equally first-line in patients without these contraindications.
Does colchicine cause diarrhoea?
Diarrhoea is the most common side effect and is dose-dependent. The modern low-dose regimen significantly reduces this compared to older high-dose protocols.
Can colchicine be taken with allopurinol?
Yes. Low-dose colchicine (500µg twice daily) is recommended alongside allopurinol for the first 6 months of treatment to reduce gout flares from crystal mobilisation.
References
- NICE CKS. Gout. Updated 2023.
- Terkeltaub RA et al. High versus low dosing of oral colchicine for early acute gout flare (AGREE trial). Arthritis Rheum. 2010.
- BNF. Colchicine. bnf.nice.org.uk
- NHS. Colchicine. nhs.uk/medicines/colchicine
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting or changing any treatment. In a medical emergency, call 999.