Colchicine in acute gout: high-dose or low-dose or no-dose?

3.5 out of 5 stars Does Colchicine Improve Pain in an Acute Gout Flare? Turner J, Cooper D. Ann Emerg Med 2015 sep;66:260-1. Reference The 7th edition of Tintinalli’s Emergency Medicine (2011) has this to say about using colchicine to treat gout: Oral colchicine is typically administered in a dose of 0.6 milligrams/h until intolerable side effects (vomiting or diarrhea) or efficacy ensues. This “typical” dosing schedule goes back decades, and even when I was a medical student who didn’t know an Ewald tube from an Ewok it never made sense to me. The instructions might as well have been “Take this until you’re better or you find you’re shitting and puking your guts out.” And this dosing made even less sense when I realized that the “intolerable side effects” were actually symptoms of colchicine toxicity which can be — and not infrequently is — life-treatening. Is there any evidence on this issue? This short synopsis summarizes a recent article updating the 2006 Cochrane review of the topic. The authors of that review found only 2 randomized controlled trials that met inclusion criteria. One trial (43 patients) gave 1 mg colchicine orally, then 0.5 mg  every 2 hours until complete relief or toxicity, or placebo. The second study (575 patients) compared placebo v. high-dose colchicine (4.8 mg over 6 hours) v. low-dose colchicine (1.2 mg then 0.6 mg one hour later.) The take-home message: “Low-quality evid...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical acute gout adverse events cochrane review colchicine toxicity dosing Source Type: news