Colchicine for the treatment of gout

Importance of the field: Colchicine, used for a long period in gout, was approved for the first time in 2009 by the FDA for the prophylaxis and the treatment of acute attack, on the basis of a pivotal trial that showed the efficacy in the very short term – that is 24 h of a well-tolerated, low-dose regimen of Colcrys (colchicine, URL Pharma, Philadelphia, USA) to reduce pain in patients with acute gout – when given early. Areas covered in this review: We searched the Cochrane Library and Medline for articles published in English from January 2000 to August 2010 using the following search terms: colchicine, gout, efficacy, toxicity, drug interaction. Some information from the FDA was also included because it provides comprehensive overviews that are within the scope of this review. What the reader will gain: Colchicine is a drug with a narrow therapeutic-toxicity window and with an important variability in tolerance between subjects. This paper reviews recent important findings on its pharmacology and efficacy which will allow a better use of this drug for the treatment of acute attack of gout. Also, pharmacokinetic, drug interaction and toxicity of colchicine are discussed. Take home message: Low-dose colchicine (1.8 mg over 1 h) taken as early as possible ('pills in the pocket') is effective in reducing pain and is well tolerated in patients with acute gout.