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Colchicine is an anti-inflammatory gout medicine for the acute attack and attack prophylaxis. It has a narrow therapeutic window and is deliberately dosed low today – diarrhoea is regarded as an early warning sign of overdose.
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Colchicine has a narrow therapeutic window and is toxic in overdose. Stick strictly to the prescribed dose, never increase it on your own, and if severe diarrhoea occurs stop taking it and contact your GP practice. Colchicine (brand name Colchicum-Dispert®) is a very old, plant-derived gout medicine obtained from the autumn crocus. It has an anti-inflammatory effect, but it is not a classic painkiller and it does not lower uric acid either. Today it is used at a markedly lower dose than in the past – no longer "up to the point of diarrhoea", but in a targeted, low-dose way.
| Property | Details |
|---|---|
| Active ingredient | Colchicine |
| Brand name | Colchicum-Dispert® |
| ATC code | M04AC01 |
| Drug class | Gout medicine (anti-inflammatory, mitosis inhibitor) |
| Form | Tablets / coated tablets (e.g. 0.5 mg) |
| Intake | Orally, with plenty of fluid |
| Standard dose (acute attack) | 1 mg at the start, 0.5 mg after 1 hour – max. 1.5 mg/day |
| Prescription required | Yes |
| Special feature | Narrow therapeutic window – toxic in overdose |
An acute gout attack occurs when uric acid crystals build up in a joint. The immune system attacks these crystals, leading to intense inflammation with severe joint pain, redness and swelling – often in the base joint of the big toe.
Colchicine intervenes exactly here: it slows the migration and activation of certain immune cells (the neutrophil granulocytes) that drive the inflammation. As a result, the attack subsides more quickly. Important to understand: colchicine does not dissolve the crystals and does not lower uric acid. It works against the inflammation in an acute attack and – at a low dose – as protection against new attacks, while at the start of uric-acid-lowering therapy the risk of an attack temporarily rises.
The modern dosage is deliberately low. The high dose common in the past, where the amount was increased until diarrhoea set in, is now considered outdated – it produced no better effect, but clearly more signs of poisoning.
| Situation | Usual dosage |
|---|---|
| Acute gout attack | 1 mg at the start, 0.5 mg after 1 hour; max. 1.5 mg on the first day |
| Attack prophylaxis (start of uric-acid lowering) | 0.5 mg 1–2× daily, for a few weeks to months |
| Impaired kidney/liver function | Reduce the dose – only on medical instruction |
| Older people | Use a lower dose, monitor closely |
A missed dose is not made up for by taking a double amount. Take the next dose as planned. What generally applies to a missed dose is explained in the guide Missed medication.
brite reminds you to take your colchicine and helps you stick to the low dosage.
Colchicine and allopurinol are both used for gout, but they have completely different jobs and must not be confused. Colchicine works against the inflammation in an acute attack and temporarily protects against new attacks. Allopurinol, by contrast, permanently lowers uric acid and treats the cause – but does not work against an acute attack.
| Property | Colchicine | Allopurinol |
|---|---|---|
| Job | Acute attack + attack prophylaxis | Long-term uric-acid therapy |
| Effect | Anti-inflammatory | Lowers uric acid production |
| When used | During an attack & at the start of uric-acid lowering | Long-term, ongoing |
| Works in an acute attack? | Yes | No |
| Typical alternative | NSAIDs such as ibuprofen, prednisolone | Febuxostat |
In an acute attack, besides colchicine, anti-inflammatory painkillers such as ibuprofen or the corticosteroid prednisolone are also possible. Which option fits best depends on comorbidities, kidney function and tolerability – that is decided by the doctor.
The most common side effects affect the gastrointestinal tract. They are at the same time the most important early warning sign: if they occur, the dose is usually too high.
| Side effect | Frequency | What to do? |
|---|---|---|
| Diarrhoea, nausea, vomiting, abdominal cramps | Common | Early sign of overdose – stop taking it, ask your GP practice |
| Abdominal pain | Common | Observe; if it persists, have it checked |
| Muscle weakness, muscle pain | Uncommon | Have it checked by a doctor |
| Tingling/numbness in the hands and feet | Rare | Have it checked by a doctor promptly |
| Blood count changes | Rare | Medical monitoring required |
Colchicine is broken down and transported out of the body by certain enzymes and transporters. Medicines that inhibit these cause the colchicine level to rise dangerously. Check combinations in the interaction check.
| Substance / medicine | Interaction | Recommendation |
|---|---|---|
| Macrolide antibiotics (clarithromycin, erythromycin) | Colchicine level rises strongly | Avoid or only under medical supervision, adjust dose |
| Antifungals (ketoconazole), ciclosporin | Markedly increased level, risk of poisoning | Avoid the combination |
| Certain statins (e.g. simvastatin) | Increased risk of muscle damage | Watch for muscle pain, coordinate with a doctor |
| Grapefruit juice | Inhibits breakdown, level rises | Avoid while taking it |
With brite you can check in seconds whether a new medicine goes together with colchicine.
