What is Colchicine?

Colchicine is a plant-derived alkaloid originally extracted from the autumn crocus (Colchicum autumnale). In modern medicine, it is a prescription-only anti-inflammatory agent used primarily in the treatment and prevention of gout attacks.

Unlike NSAIDs, which reduce inflammation through cyclooxygenase inhibition, colchicine interferes with the migration of neutrophils (a type of white blood cell) to the site of inflammation. This selective suppression of cellular response helps decrease the joint swelling, redness, and pain associated with urate crystal deposition in gout.

In the UK, colchicine is licensed and regulated for adults with acute gout or as prophylaxis during initiation of urate-lowering therapy. It is also used in rare conditions like familial Mediterranean fever (FMF) under specialist supervision.

Each Colchicine 500 mcg tablet is precisely dosed for controlled administration and designed for oral use, typically once to three times daily depending on the stage and purpose of treatment.

What is Colchicine Used For?

1. Treatment of Acute Gout Attacks
During a gout flare, uric acid crystals trigger an inflammatory response within the affected joint. Colchicine reduces this inflammatory reaction by preventing neutrophils from travelling to and acting on the site of uric acid deposition.

Best results are observed when taken within 12–24 hours of symptom onset
Helps reduce swelling, pain, and joint stiffness
Often preferred in patients who cannot tolerate NSAIDs or corticosteroids

The typical regimen involves two tablets (1 mg) initially, followed by one tablet (500 mcg) after one hour. No more tablets should be taken for at least 12 hours, and total intake in one course should not exceed 6 mg.

2. Prevention of Gout Flare-Ups During Urate-Lowering Therapy

When urate-lowering medicines like allopurinol or febuxostat are initiated, serum urate levels begin to drop. This sudden change can destabilise existing urate crystals, increasing the risk of flares in the early months. Colchicine helps prevent such flares when given concurrently during the first 3–6 months of urate-lowering treatment.

Standard prophylactic dose: 500 mcg once or twice daily
Duration: 3 to 6 months, depending on flare history and GP assessment

How Does Colchicine Work?

Colchicine has a unique mechanism of action among anti-inflammatories. Instead of acting as a general painkiller or fever reducer, it specifically targets the cellular response to inflammation, making it well-suited for treating gout.

Mechanism of Action

Neutrophil Inhibition: Colchicine blocks microtubule formation in white blood cells (neutrophils), preventing their migration to joints.

Interrupts Inflammation Cascade: Reduces cytokine release and local joint inflammation caused by uric acid crystals.

Non-Analgesic: It does not relieve pain directly like NSAIDs but rather reduces the cause of pain, joint inflammation.

No Uric Acid Effect: Unlike allopurinol or febuxostat, colchicine does not lower uric acid. It purely treats or prevents inflammatory flares.

Its targeted effect and low-dose format allow for precision treatment of flares, with less systemic disruption compared to general anti-inflammatories.

Can Colchicine be Purchased Over the Counter?

No. In the UK, Colchicine 500 mcg Tablets are prescription-only medications (POM) and cannot be purchased over the counter.This classification ensures that a medical practitioner, typically a GP, assesses your symptoms, flare frequency, kidney function, and concurrent medications before initiating colchicine.

The potential for toxicity at high doses and interactions with medications like clarithromycin, cyclosporin, or statins make professional oversight essential. There are no non-prescription alternatives or lower-strength formulations of colchicine available OTC in the UK.

Alternative Medications

If Colchicine is not suitable, due to intolerance, contraindications, or side effects—there are several UK-prescribed alternatives for both treatment and prevention of gout attacks:

For Acute Gout Flares

NSAIDs (e.g., Naproxen, Diclofenac): Commonly prescribed for their potent anti-inflammatory effects

Oral Corticosteroids (e.g., Prednisolone): Used for patients who cannot tolerate NSAIDs or colchicine

Intra-articular Steroid Injections: Administered directly into affected joints under medical supervision

For Preventing Flares During Urate-Lowering Therapy

Low-dose NSAIDs: Given at lower doses for flare prevention when colchicine is unsuitable

Allopurinol or Febuxostat: Long-term urate-lowering therapy; not for flare treatment but reduce flare frequency over time

Note: Always consult your GP before switching to or combining therapies.

For Acute Gout Attacks

Initial Dose: Take 2 tablets (1 mg) at the first sign of symptoms
Follow-up Dose: Take 1 tablet (500 mcg) after 1 hour
Important: Do not take any further doses for at least 12 hours
Maximum Limit: Do not exceed 6 mg (12 tablets) over any one course; do not repeat a course within 3 days 

Administration Instructions

Swallow tablets whole with water
Can be taken with or after food to reduce stomach upset
Maintain a consistent schedule if taken regularly for prevention
Avoid grapefruit juice as it may increase the risk of side effects

If You Miss a Dose

Take it as soon as you remember unless your next dose is due soon
Do not double up to make up for a missed dose
Stick to the schedule prescribed by your GP

Storage Guidelines

Store tablets at room temperature (20–25 °C)
Keep away from direct light, moisture, and heat
Ensure tablets remain in the original container until use
Keep out of reach of children
Do not use after the expiry date printed on the label

Active Ingredient

Colchicine 500 micrograms (mcg) per tablet

A highly purified alkaloid that suppresses inflammatory response by disrupting white blood cell activity in joints.

Inactive Ingredients

(May vary slightly depending on the manufacturer)

Lactose Monohydrate – Filler and stabiliser

Maize Starch – Helps tablet disintegrate properly

Magnesium Stearate – Lubricant in tablet production

Microcrystalline Cellulose – Binder to hold the tablet together

Povidone – Aids in the even dispersion of ingredients

Sodium Starch Glycolate – Helps the tablet break down quickly after swallowing

Film Coating Ingredients – Includes hypromellose, titanium dioxide (E171), and macrogol

Always read the patient information leaflet (PIL) in your pack for the complete list of ingredients, and to check for any you might be allergic to.

Colchicine is effective, but like all medicines, it can cause side effects in some patients. These are more likely when higher doses are taken or when kidney or liver function is impaired.

Common Side Effects (≥1%)

Nausea and Vomiting: Often dose-related and may improve with food

Diarrhoea: May occur shortly after the first few doses; inform your GP if it becomes severe

Stomach Pain or Discomfort: Usually mild but should be monitored

Loss of Appetite: Generally temporary and reversible

Uncommon or Rare Side Effects (<1%)

Allergic Reactions: Rash, itching, or swelling of the face/throat, seek immediate medical attention

Muscle Weakness or Pain: May indicate muscle toxicity, especially if you're on statins

Peripheral Neuropathy: Tingling, numbness, or burning sensations in hands or feet

Blood Disorders: Low white cells, anaemia, or thrombocytopenia—especially with long-term or high-dose use

Liver Dysfunction: Jaundice or elevated liver enzymes in rare cases

Signs You Need Urgent Help

Seek immediate medical help from your GP, NHS 111, or A&E to avoid complications if you experience:

Difficulty breathing

Severe diarrhoea or vomiting

Blood in stools

Unexplained bruising or bleeding

Yellowing of skin or eyes (jaundice)

Severe fatigue or muscle pain

Routine check-ups and blood tests may be recommended by your GP if colchicine is used long-term.