For gout flares where anti-inflammatories are unsafe — at a much lower dose than older regimens used.
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Colchicine is an anti-inflammatory that works quite differently from NSAIDs and steroids. It interferes with the microtubules that white cells need in order to migrate to the joint, so the inflammatory response to urate crystals is blunted at source.
It is derived from the autumn crocus and has been used for gout for centuries.
The important modern change is the dose. Older regimens used colchicine until diarrhoea developed, which was unpleasant and unnecessary. Current guidance uses much lower doses, which work nearly as well with far fewer side effects.
500 micrograms two to four times a day, started as early in the attack as possible, until the flare settles — and stopped once it has. Maximum 6mg per course, and no repeat course within three days.
Earlier is much better. Colchicine started within the first 12 to 24 hours works considerably better than colchicine started on day three.
500 micrograms once or twice daily for up to six months, alongside the allopurinol, to prevent the flares that urate-lowering treatment provokes.
Diarrhoea is the signal that you have had enough, not a side effect to push through. Older practice deliberately dosed to that point; modern practice stops before it.
Kidney function is the single most important thing to check before prescribing colchicine, because it is cleared by the kidneys and accumulates when they are impaired.
This interaction list is unusually important because colchicine's therapeutic window is narrow. Always declare every medicine before taking it.
Kidney function before prescribing. Full blood count with prolonged use. Urate level once the flare has settled, to guide long-term prevention.
Yes, for a gout flare where gout is already an established diagnosis and anti-inflammatories are unsuitable. Gout assesses reasonably well remotely — a rapid onset of severe pain in a single joint, often the base of the big toe, with the joint red, hot and exquisitely tender.
What we will not do is treat that picture as gout without care. A single hot swollen joint can be septic arthritis, which destroys a joint within days and is a surgical emergency. Fever, feeling systemically unwell, or a joint that is difficult to move at all means urgent assessment, not a gout prescription.
We will also raise long-term prevention, because treating flares one at a time while the urate stays high is treating the symptom rather than the disease.
Colchicine is a generic, though its price in the UK has been unstable in recent years. It generally remains modest.
Because a flare course is short, the cost per attack is low.
Anyone with recurrent gout should have a supply at home — the drug works far better started within hours than after a wait for an appointment, and that is a legitimate reason to hold a rescue supply.
Stop it when the flare settles, or at the first sign of diarrhoea. It is not a long-term treatment for gout.
Treating flares does nothing to prevent the next one. Gout is caused by a high urate level, and the only way to stop attacks is to lower it — with allopurinol or febuxostat, taken every day, long term, to a target urate level.
People are often treated for flare after flare over years without anyone offering urate-lowering treatment. That is a genuine gap in care, and joint damage accumulates in the meantime.
Rest and ice the joint. Keep taking allopurinol if you are already on it — do not stop it during a flare, which is a common misunderstanding. Reducing alcohol, particularly beer, and sugary drinks helps prevent recurrence.
As soon as the attack starts — within hours, not days. Late colchicine works much less well, which is why having a supply at home is sensible for recurrent gout.
Because modern guidance uses much lower doses. The old approach of dosing until diarrhoea was unnecessary and unpleasant.
No — keep taking it. Stopping and restarting makes things worse. If you are not on it and you get repeated flares, ask about starting it.
That is expected in the first months, as urate is mobilised from the joints. It is precisely why colchicine is often prescribed alongside for cover. It is not a reason to stop.
Not with clarithromycin or erythromycin — that combination is dangerous. Always mention colchicine when any new medicine is prescribed.
No. Diet contributes modestly; genetics and kidney handling of urate matter far more. Gout is not a moral failing and dietary change alone rarely controls it — which is why urate-lowering medication exists.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 30, 2026
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