Colchicine Indications and Dosage
- amyloidosis †
- Behcet’s syndrome †
- biliary cirrhosis †
- dermatitis herpetiformis †
- gout
- gouty arthritis
- hepatic cirrhosis †
- idiopathic thrombocytopenic purpura (ITP) †
- Mediterranean fever †
- Mediterranean fever prophylaxis †
- Paget’s disease †
- pericarditis †
- pseudogout †
- pulmonary fibrosis †
† non-FDA-approved indication
Colchicine Indications and Dosage
For the treatment of gout:
- for the chronic management of gout:
Oral dosage:
Adults: 0.5 - 0.6 mg PO, given 3 - 4 days per week for patients with < 1 attack per year or 0.5 - 0.6 mg PO once daily for patients with > 1 attack per year. Severe cases may require 1.5 - 1.95 mg/day, administered in divided doses.
Children: Safe and effective use has not been established.
- for the treatment of acute gouty arthritis:
Oral dosage:
Adults: 1 - 1.2 mg PO initially, for acute gout pain, followed by 0.5 - 0.6 mg each hour, or 1 - 1.2 mg every 2 hours as needed until pain is relieved or side effects occur.
Intravenous dosage:
Adults: Avoid parenteral use whenever possible due to the potential for severe toxicity. The standard dose is 2 mg IV infused over 12 hours, followed by 0.5 mg every 6 hours, with a total dose not to exceed 4 mg/24 hours. Some clinicians recommend 1 mg IV initially, followed by 0.5 mg IV once or twice daily if needed. A single 3 mg IV dose has also been recommended. Never exceed 4 mg per treatment course IV. If gouty pain recurs, a daily IV dosage of 1 - 2 mg/day for several days has been recommended, however some clinicians adhere to a maximum total dose of 4 mg per treatment course since administration of IV colchicine daily for several consecutive days may produce toxic and/or fatal effects. Ten milligrams of IV colchicine administered over 5 days was fatal in a 70-year old male and deaths have been reported with as little as 7 mg. Additional courses of colchicine IV should not be repeated until at least 3 days have elapsed due to the slow elimination of colchicine. Some clinicians recommend that several weeks should elapse between treatment courses with IV colchicine, especially in patients who are transferred to oral colchicine.
- for the prevention of gouty attacks during surgery in patients with gout:
Oral dosage:
Adults: 0.5 - 0.6 mg PO three times per day, 3 days before and 3 days after surgery.
Children: Safe and effective use has not been established.
For the treatment of familial Mediterranean fever † (aka: familial paroxysmal polyserositis):
- for the treatment of acute attacks:
Oral dosage:
Adults: 0.5 - 0.6 mg PO every hour for 4 hours, then 0.5 - 0.6 mg PO every 2 hours for 2 additional doses; followed by 1.2 mg PO every 12 hours for 2 additional days. Therapy may be discontinued at anytime during the regimen if the attack is suppressed.
Children: Safe and effective use has not been established.
- for secondary prophylaxis of familial Mediterranean fever (i.e., Mediterranean fever prophylaxis † ):
Oral dosage:
Adults: Initially, 0.5 - 0.6 mg PO once daily, then increase to 0.5 - 0.6 mg PO 2 - 3 times per day. Do not exceed 2 mg/day PO, which has not been more effective than lower doses.
Children > 5 years † : 1 - 1.5 mg PO per day in 2 - 3 divided doses.
Children <= 5 years † : 0.5 mg PO per day.
For the treatment of primary amyloidosis † not associated with familial Mediterranean fever:
Oral dosage:
Adults: Some reference texts list colchicine as a treatment for primary amyloidosis. The recommended dose is 0.5 - 0.6 mg PO once daily initially, then increased to 2 - 3 times per day. In a 1997 study, however, colchicine was inferior to melphalan with prednisone. The dose of colchicine in this study was 0.6 mg PO twice daily for 1 week (e.g., 7 days) and repeated every 6 weeks. The daily colchicine dose was increased by 0.6 mg each week until abdominal cramps or diarrhea developed. Treatment with colchicine was then discontinued and resumed at the highest dose that did not cause gastrointestinal side effects.
For the treatment of primary biliary cirrhosis † :
Oral dosage:
Adults: 0.6 mg PO twice daily.
Children: Safe and effective use has not been established.
For the treatment of hepatic cirrhosis † :
Oral dosage:
Adults: 1 mg PO once daily, 5 days per week.
Children: Safe and effective use has not been established.
For the treatment of dermatitis herpetiformis † or Paget’s disease † of bone:
Oral dosage:
Adults: 0.6 mg PO three times per day.
Children: Safe and effective use has not been established.
For the treatment of Behcet’s syndrome † :
Oral dosage:
Adults: 0.5 - 0.6 mg PO two to three times per day.
Children: Safe and effective use has not been established.
For the treatment of chronic idiopathic thrombocytopenic purpura (ITP) † :
Oral dosage:
Adults: A dosage of 0.6 mg PO three times per day for at least 2 months has been recommended. If a positive response occurs, the dosage should be tapered to the lowest level that will maintain a desired platelet count.
For the management of pseudogout † :
- for treatment of pseudogout †
:
Oral dosage:
Adults: 0.5 - 1.2 mg PO initially, followed by 0.5 - 0.6 mg every 1 - 2 hours, or 1 - 1.2 mg every 2 hours as needed until pain is relieved or adverse effects occur. Maximum total dose is 6 mg.
- for prevention of pseudogout † :
Oral dosage:
Adults: 0.5 - 0.6 mg PO once daily. Dosage may be increased to 0.5 - 0.6 mg PO 2 - 3 times per day, if needed.
For the treatment of inflammation in recurrent pericarditis † :
Oral dosage:
Adults: 0.5 mg PO twice daily; some patients can be maintained on 0.5 mg PO once daily.
For the treatment of idiopathic pulmonary fibrosis † :
Oral dosage:
Adults: 0.6 mg PO once or twice daily may be considered as first-line therapy or for patients refractory to corticosteroids; give either alone or in combination with immunosuppressive agents (e.g., azathioprine or cyclophosphamide).
Maximum Dosage Limits:
- Adults: INTRAVENOUS: 4 mg IV for the total treatment course. No further colchicine should be given to any patient who has received a total treatment course of 4 mg IV within 7 days. ORAL: 6 mg/day PO in patients without risk factors for colchicine toxicity (e.g., elderly, renal or hepatic impairment, weight < 50 kg); 3 mg/day PO in patients with risk factors.
- Elderly: INTRAVENOUS: 2 mg IV for the total treatment course. No further colchicine should be given to any patient who has received a total treatment course of 2 mg IV within 7 days. ORAL: 3 mg/day PO.
- Adolescents: Not recommended.
- Children: Not recommended.
Patients with hepatic impairment:
Oral colchicine is regularly prescribed in patients with cirrhosis. The recommended maximum dosage is 2 mg IV per treatment course and 3 mg/day PO.
Patients with renal impairment:
CrCl >= 50 ml/min: no dosage adjustment needed.
CrCl 10 - 50 ml/min: prolonged use is not recommended.
CrCl <10ml/min: reduce recommended dose by 50%.
† non-FDA-approved indication
[ Last revised: 8/2/2005 5:59:00 PM ]
References
. Kaplan MM, Alling DW, Zimmerman HJ et al. A prospective trial of colchicine for primary biliary cirrhosis. N Engl J Med 1986;315:1448 - 54.
. Kershenobich D, Vargas F, Garcia-Tsao G et al. Colchicine in the treatment of cirrhosis of the liver. N Engl J Med 1988;318:1709 - 13.
. Freeman DL. Frequent doses of intravenous colchicine can be lethal. N Engl J Med 1983;309:310.
. McMillan R. Therapy for adults with refractory chronic immune thrombocytopenic purpura. Ann Intern Med 1997;126:307 - 14.
. Kyle RA, Gertz MA, Greipp PR et al. A trial of three regimens for primary amyloidosis: colchicine alone, melphalan and prednisone, and melphalan, prednisone, and colchicine. N Engl J Med 1997;336:1202 - 7.
. American Thoracic Society (ATS) and European Respiratory Society (ERS). Idiopathic pulmonary fibrosis: diagnosis and treatment. International Consensus Statement. Am J Respir Crit Care Med 2000;161:646 - 64.
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