1. About colchicine
Colchicine is a medicine for treating inflammation and pain.
It can be used to:
- treat flare-ups (attacks) of gout
- prevent increased flare-ups of gout when you first start on a medicine like allopurinol – taken to manage your condition long term
- prevent flare-ups of symptoms of familial Mediterranean fever (FMF) – an inherited inflammatory condition
Colchicine is available on prescription. It comes as tablets.
2. Key facts
- It's important to stick to your prescribed dose. Taking even a little bit more can be very serious.
- Avoid grapefruit and grapefruit juice while taking colchicine.
- Some people find it's gentler on their stomach if they take their medicine with or after food.
- Colchicine is not usually recommended in pregnancy or when breastfeeding.
3. Who can and can't take colchicine
Colchicine can be taken by most adults aged 18 and over.
It can sometimes be prescribed for children by a specialist doctor.
Colchicine is not suitable for some people. To make sure it's safe for you, tell your doctor if you:
- have ever had an allergic reaction to colchicine or any other medicines
- have a severe blood disorder (such as blood dyscrasia, low amounts of white or red blood cells, a low blood platelet count or problems with your bone marrow function)
- have severe kidney or liver problems
- have problems with your heart or digestive system
- are pregnant, think you might be pregnant or are trying for a baby
Women who could become pregnant will usually only be prescribed colchicine if they are using suitable contraception.
4. How and when to take it
Follow your doctor's instructions about how many tablets to take, and how many times a day.
It's important to stick to your prescribed dose. This is because there is only a small difference between a correct dose and an overdose.
Colchicine comes as 500 microgram tablets. The word microgram is sometimes written with the Greek symbol μ followed by the letter g (μg). A microgram is 1,000 times smaller than a milligram (mg).
If you have kidney or liver disease, your doctor may prescribe a lower dose. You will also have regular blood and urine tests.
Swallow your tablet whole, with a glass of water.
How much will I take?
For gout
The usual dose is 1 tablet (500 micrograms), taken 2 to 4 times a day.
You'll usually take colchicine for just a few days. Your doctor will tell you how long to take it for.
For familial Mediterranean fever (FMF)
Doses can vary between 1 and 4 tablets (500 micrograms to 2mg), taken once a day.
Your doctor will probably recommend taking this medicine long-term.
What if I forget to take it?
If you forget to take your colchicine, take it as soon as you remember. Unless it's nearly time for your next dose. In which case, skip the missed dose and take the next one at the usual time.
Never have 2 doses at the same time. Never have an extra dose to make up for a forgotten one.
If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember your medicines.
What if I take too much?
Taking too many colchicine tablets can be very dangerous. It could be fatal.
Symptoms of taking too much colchicine can include:
- feeling or being sick (nausea or vomiting)
- stomach ache
- bloody diarrhoea
- signs of low blood pressure (such as feeling dizzy or lightheaded)
Immediate action required: Call 999 or go to A&E right away if:
- you take too much colchicine (even if you do not have any symptoms)
5. Side effects
Like all medicines, colchicine can cause side effects, although not everyone gets them.
However, even mild side effects can be very serious.
If you have any side effects when taking colchicine, stop taking the medicine and get medical help straight away.
Immediate action required: Call 999 or go to A&E now if you:
- are feeling or being sick
- have stomach pain
- have diarrhoea
- have a high temperature, swollen mouth, sore throat, bleeding that does not stop, unusual bruising or skin problems – these can be signs of a serious problem with your blood
Serious allergic reaction
In rare cases, it's possible to have a serious allergic (anaphylaxis) to colchicine.
Immediate action required: Call 999 or go to A&E if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of colchicine. For a full list, see the leaflet inside your medicines packet.
You can report any suspected side effect to the UK safety scheme.
6. Pregnancy and breastfeeding
Colchicine is not usually recommended in pregnancy.
Women who could become pregnant will usually only be prescribed colchicine if they are using a suitable contraception.
If you become pregnant while taking colchicine for gout or familial Mediterranean fever (FMF), contact your doctor.
Your doctor will be able to explain the risks and the benefits, and will help you decide what's best for you and your baby.
Colchicine and breastfeeding
Colchicine is not usually recommended while you're breastfeeding.
If you have gout, your doctor may recommend a non-steroidal anti-inflammatory drug (NSAID) like ibuprofen instead.
For FMF, a doctor will only prescribe colchicine while you're breastfeeding if the benefits outweigh the risks.
If your baby is not feeding as well as usual, seems unusually sleepy or is vomiting or has diarrhoea, talk to a health visitor or doctor.
Non-urgent advice: Tell your doctor if you are:
- trying to get pregnant
- pregnant
- breastfeeding
7. Cautions with other medicines
Certain medicines can interfere with the way colchicine works. Some can make you more likely to get serious or life-threatening side effects.
Speak to your doctor before starting on colchicine if you take:
- medicines that can affect your kidneys, your liver or your blood (check with your doctor if you're not sure)
- clarithromycin or erythromycin (antibiotics used to treat infections)
- ritonavir or atazanavir (antiviral medicines used to treat HIV infection)
- ciclosporin (medicines for psoriasis, rheumatoid arthritis, and after an organ transplant)
- ketoconazole, itraconazole or voriconazole (antifungal medicines)
- verapamil or diltiazem (medicines for the heart)
- disulfram (medicine used to treat alcohol dependence)
Your doctor may need to adjust your dose if you are taking any of these medicines.
Mixing colchicine with herbal remedies and supplements
There's very little information about taking herbal medicines and supplements with colchicine.
Important
Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.
8. Common questions
How does colchicine work?
For gout, colchicine works by reducing the inflammation caused by crystals of uric acid in your joints. This also helps to reduce pain.
The way that colchicine works for familial Mediterranean fever (FMF) is complicated. Colchicine can affect the way your white blood cells work. This helps to reduce the inflammation that can cause symptoms.
How long does it take to work?
Colchicine starts to work after around 30 minutes to 2 hours. However, it may take a day or two before you notice your inflammation and pain starts to get better.
If you're taking it to prevent flare-ups of FMF, you may not feel any different.
How long will I take it for?
Depending on why you're taking colchicine, you may only need to take it for a short time.
For gout attacks – treatment is usually only for a few days.
For FMF – treatment is usually long term. You may need to take it for the rest of your life.
Talk to your doctor if you're not sure how long you need to take this medicine for.
Is it safe to take for a long time?
It's generally a safe medicine, as long as you follow your doctor's instructions.
However, if you are taking a high dose for a long time, there is a small risk of getting kidney or liver problems.
Talk to your doctor if you're worried. They will be able to explain the benefits and risks of taking colchicine.
Are there other medicines for treating gout?
There are a few types of medicine that can help with gout and its symptoms.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help symptoms such as inflammation and pain during a gout attack.
Allopurinol can help prevent your gout from coming back. It does this by lowering the levels of uric acid in your body. This stops urate crystals (that cause inflammation and pain) from forming in and around your joints.
Talk to your doctor or pharmacist if you have any questions about your treatment.
Can I drink alcohol with it?
Yes, you can drink alcohol with colchicine. Alcohol does not affect how this medicine works.
However, drinking alcohol increases the level of uric acid in your blood. This could make your gout worse.
It's best to stick to the national guidelines of no more than 14 units a week. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.
Is there any food or drink I need to avoid?
Generally you can eat and drink as normal while taking colchicine.
The only thing you need to avoid is grapefruit and grapefruit juice. This is because grapefruit can increase the amount of colchicine in your blood.
However, reducing certain food and drink may help to stop gout coming back. It's a good idea not to have too much:
- red meat, kidneys, liver, or seafood
- sugary drinks and snacks
- fatty foods
- alcohol
Will it affect my contraception?
Colchicine will not affect any contraceptives, including the combined pill or emergency contraception.
Will it affect my fertility?
There have been some reports that colchicine can cause reduced sperm count in men if taken long-term. This is usually reversible when you stop treatment.
There's no firm evidence to suggest that taking colchicine reduces fertility in women.
However, talk to a doctor if you think you may be pregnant, or you're trying for a baby. This is because this medicine is not usually recommended in pregnancy.
Women who could get pregnant will usually only be prescribed this medicine if they are taking a recommended contraceptive.
Can I drive or ride a bike?
Generally, colchicine will not affect your ability to drive or ride a bike.
However, if you feel sleepy or dizzy after taking your medicine, do not drive, cycle or use any machinery or tools until you feel OK again.
Can lifestyle changes help to stop gout coming back?
Making lifestyle changes might mean you can stop or reduce further attacks.
Do
- get to a healthy weight, but avoid crash diets – you could try the NHS weight loss plan
- aim for a healthy, balanced diet, with plenty of vegetables and some low-fat dairy foods
- have at least 2 alcohol-free days a week
- drink plenty of fluids to avoid getting dehydrated
- exercise regularly – but avoid intense exercise or putting lots of pressure on joints
- stop smoking
Don't
- do not eat a lot of red meat, kidneys, liver, or seafood
- do not have lots of sugary drinks and snacks
- do not have lots of fatty foods
- do not drink more than 14 units of alcohol a week