Colchicine (Colcrys® or Mitigare®)

Colchicine (Colcrys® or Mitigare®) is the only medication approved by the FDA to both treat and prevent gout flares. It interferes with the interactions between monosodium urate crystals and the surfaces of cells they encounter in your joint, so it “interrupts” the inflammatory reaction to these crystals. It also appears to stop inflammatory white blood cells from activating and moving to attack the crystals, where they cause your sudden, severe gout symptoms.

Colchicine is also used as a long-term treatment to prevent future or recurrent gout flares, by chronically lowering the ability of urate crystals to cause inflammation. It doesn’t lower uric acid levels in your blood, though. Also, colchicine does not treat joint or tissue damage from chronic gout.

Why am I taking Colchicine?

Colchicine is prescribed as either a short-term medication to relieve your acute gout flare or as an ongoing, preventive treatment during the early stages of taking another medication to lower urate. Your doctor can prescribe colchicine to keep on hand in case you do have a gout flare.

Don’t take colchicine to relieve other types of arthritis pain or back pain. It’s effective in treating treat gout pain, but most types of arthritis don’t respond to colchicine. Colchicine comes in a tablet that you swallow. You can take colchicine with or without food, but some people find it easier on the stomach to take with food. For an acute gout attack, it’s usually taken twice a day. You take one dose of colchicine (usually 1.2 mg) when you first notice the symptoms, followed by a smaller dose (usually 0.6 mg) one hour later, with no further doses for at least 12 hours.

This may be followed with doses of 0.6 mg once or twice daily (every 12 hours). If you don’t get relief within a few days, let your doctor know. You may need to switch to or add another medication.

Follow your prescription directions closely when you take colchicine. Don’t take more of this medication than your doctor prescribes or directs for a gout flare. If your doctor prescribes colchicine for you to take regularly to prevent gout flares, and you have an acute gout flare while on this treatment, contact your doctor immediately. Your doctor may direct you to take a temporarily higher dose of colchicine to treat the flare, or add another medication to treat it. Follow your doctor’s directions exactly so you don’t take too much medication.

Let your doctor know if you are allergic to any of these medications that could interact with colchicine:

• Antibiotics like azithromycin (Zithromax®), clarithromycin (Biaxin®), erythromycin (E-Mycin®) andu u telithromycin (Ketek®). Be aware that the drug interaction with clarithromycin is much more significant u than the other types of antibiotics. Make sure to tell your doctor if you are prescribed colchicine and clarithromycin at the same time.
• Antifungal medications like fluconazole (Diflucan®), itroconazole (Sporanox®) and ketoconazole (Nizoral®) u Aprepitant (Emend®)
• Statins: Be aware that the interaction of statins with colchicine is different depending on the statin you take. For example, rosuvastatin (Crestor®) has no significant interaction with colchicine, and atorvastatin (Lipitor®) has a relatively minor interaction that may be addressed with a lower colchicine dose. Tell your doctor about all of your prescription medications, including anything new you’re prescribed while taking colchicine.
• Cyclosporine (Neoral®, Sandimmune®)
• Digoxin (Digitek®)
• Diltiazem (Cardizem®, Dilocor®)
• Fibrates
• Medications to treat AIDS or HIV
• Nefazodone
• Ranolazine (Ranexa®)
• Verapamil (Calan®, Covera®, Isoptin®, Veralan®)

Also, let your doctor know if you have ever had kidney disease, liver disease, or, for women, if you’re pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking colchicine for gout, let your doctor know right away.

Don’t drink grapefruit juice or eat fresh grapefruit while taking colchicine. Grapefruit juice can cause a mild increase in colchicine dose. Occasional small amounts of grapefruit or grapefruit juice are unlikely to cause a major problem.

If you miss your dose of colchicine, take your dose as soon as you remember. Don’t take your next dose for 12 hours.

If you’re very close to the time when you would take your next dose (if taking regularly for gout attack prevention), just wait until the time for your next dose and stay on your regular dosing schedule. Don’t “double-dose” colchicine to make up for the dose you missed.

Overdosing on colchicine may be fatal. Take your medication only as prescribed. Do not share colchicine with other people you know who have gout or seem to have gout attack symptoms.

Side Effects of Colchicine

Colchicine may cause some side effects, such as:

• Diarrhea
• Nausea
• Stomach pain or cramping
• Vomiting

If these persist for hours or are severe, let your doctor know. Also, if you experience any of these side effects, alert your doctor’s office immediately:

• Muscle pain or muscle weakness
• Signs of an infection: sore throat, fever, chills, body aches u Fatigue or weakness
• Numb fingers or toes
• Strange bruising or bleeding that seems unusual
• Unusually pale lips or tongue