Colchicine

Familial Mediterranean fever (FMF): Oral: Tablet (eg, Colcrys): 1.2 to 2.4 mg daily in 1 to 2 divided doses. Titration: Increase or decrease dose in 0.3 mg daily increments based on efficacy or adverse effects. Maximum dose: 2.4 mg/day Gout: Oral: Note: Colcrys is approved for prophylaxis and flare treatment; Mitigare is approved only for prophylaxis. Flare treatment: Manufacturer's labeling: Initial: 1.2 mg at the first sign of flare, followed in 1 hour with a single dose of 0.6 mg (maximum: 1.8 mg within 1 hour). Patients receiving prophylaxis therapy may receive treatment dosing; wait 12 hours before resuming prophylaxis dose. Note: Current FDA-approved dose for gout flare is substantially lower than what has been used historically; however, doses larger than FDA-recommended dose for gout flare have not been proven more effective (EULAR [Richette 2017]). Guideline recommendations: EULAR guidelines state that the initial colchicine dose may be given within 12 hours of flare onset (EULAR [Richette 2017]). Prophylaxis: Manufacturer’s labeling: 0.6 mg once or twice daily; maximum: 1.2 mg daily. Guideline recommendations: ACR guidelines: Duration of prophylaxis is 6 months or 3 months (patients without tophi) to 6 months (≥1 tophi) after achieving target serum uric acid levels (ACR guidelines [Khanna 2012]). EULAR guidelines: Duration of prophylaxis is the first 6 months of urate lowering therapy (EULAR [Richette 2017]). Behçet syndrome (off-label use): 1 to 2 mg/day in divided doses (eg, 0.5 or 0.6 mg 3 times daily) using the lower end of the dosage range for lower body weight patients (eg, Pericarditis, acute (off-label use): Note: The 0.5 mg tablets are not available in the US or Canada. However, the 0.6 mg tablets are used empirically in place of 0.5 mg tablets in countries where they are not available: Patients >70 kg: 0.5 mg twice daily for 3 months (Imazio 2013) Patients ≤70 kg or unable to tolerate higher dosing regimen: 0.5 mg once daily for 3 months (Imazio 2013) Note: Loading doses of colchicine used in earlier studies may not be necessary in the treatment of acute pericarditis according to newer data; lower doses are proposed to improve patient compliance and reduce adverse effects (Adler 2015; Imazio 2010b; Imazio 2013). Concomitant therapy: Use in combination with high-dose aspirin or ibuprofen for 7 to 14 days, followed by a gradual tapering of the dose over 3 to 4 weeks (ESC [Adler 2015]). In patients with contraindications to NSAIDS/aspirin, glucocorticoid therapy has been used (eg, prednisone for 2 weeks with gradual tapering) (Imazio 2013). Concurrent gastroduodenal prophylaxis with a proton pump inhibitor has been used and is recommended (ESC [Adler 2015]; Imazio 2005a; Imazio 2013) Pericarditis, recurrent (off-label use): Note: The 0.5 mg or 1 mg tablets are not available in the US or Canada. However, the 0.6 mg tablets are used empirically in place of 0.5 mg tablets in countries where they are not available: Regimens with load