Colchicine for Acute Gout

[...]the price increased 50-fold from about $0.10 to $5.00 per pill.1 This Cochrane review updates a 2006 meta-analysis of a single study of 43 people. The high-dose regimens in the two studies-which included a 1- to 1.2-mg loading dose, followed by either 0.6 mg every hour for six hours or 0.5 mg every two hours until therapeutic response or intolerance (i.e., nausea, vomiting, or diarrhea)-caused significantly more adverse effects (number needed to treat to harm = 2). There is a 1% risk of reversible axonal neuromyopathy in patients taking colchicine; colchicine can cause rhabdomyolysis when used with statins or clarithromycin (Biaxin); and colchicine has multiple drug-drug interactions with cytochrome P3A4 inhibitors, including certain antiviral agents, antifungal agents, calcium channel blockers, and grapefruit.3,4 Comparative studies among the different treatments for acute gout and for flare-up prophylaxis are needed.