What diseases are treated with colchicine?

October 13, 2025 •

5 min read

The use of colchicine dates back centuries, with ancient civilizations employing extracts from the autumn crocus plant for its anti-inflammatory properties. Today, it is a prescription medication used to manage several inflammatory conditions, making the answer to the question "What diseases are treated with colchicine?" more diverse than many might expect.

Quick Summary

Colchicine is an anti-inflammatory medication used for several conditions, including gout, familial Mediterranean fever (FMF), and cardiovascular disease risk reduction. It is also used off-label for conditions like Behçet's disease and pericarditis, working by disrupting microtubule assembly to inhibit the inflammatory process. Dosage is individualized and depends on the specific condition being treated.

Key Points

Approved for Gout Treatment: Colchicine is used to both relieve acute gout attacks and provide long-term prevention of flares.
Essential for Familial Mediterranean Fever (FMF): It is the standard treatment for FMF, helping to reduce the frequency and severity of attacks and prevent life-threatening complications like amyloidosis.
Reduces Cardiovascular Risk: A specific low-dose formulation is FDA-approved to lower the risk of heart attack and stroke in patients with cardiovascular disease.
Used Off-Label for Pericarditis: It is effective in treating and preventing recurrent pericarditis, often as an add-on to conventional therapy.
Addresses Behçet's Disease Symptoms: Colchicine can be prescribed for Behçet's disease to manage painful mucocutaneous ulcers and joint inflammation.
Works by Inhibiting Inflammation: Its primary mechanism is disrupting microtubules within white blood cells, thereby inhibiting their movement and the release of inflammatory mediators.
Requires Careful Monitoring: Due to its narrow therapeutic index, close medical supervision is necessary, especially for patients with liver or kidney issues or those taking certain interacting medications.

Colchicine, an ancient drug derived from the Colchicum autumnale plant, has evolved into a modern treatment for a variety of inflammatory and cardiovascular diseases. While its mechanism of action is multifaceted, its core function is disrupting the inflammatory process by interfering with microtubule assembly in white blood cells. This article explores the primary FDA-approved indications for colchicine, along with other off-label and investigational uses.

FDA-Approved Indications for Colchicine

Gout Flares

Colchicine is a cornerstone of treatment for managing and preventing gout, a painful form of inflammatory arthritis caused by the accumulation of uric acid crystals in the joints.

Acute Gout Flares: At the first sign of a flare, a low-dose regimen of oral colchicine can be administered to relieve pain and swelling. Its anti-inflammatory effect helps halt the inflammatory cascade triggered by the urate crystals.
Gout Flare Prophylaxis: For patients starting a urate-lowering therapy (like allopurinol), colchicine is often prescribed for several months to prevent initial flares that can occur during treatment. Long-term use can help prevent recurrent attacks.

Familial Mediterranean Fever (FMF)

FMF is a hereditary autoinflammatory disorder that causes recurrent episodes of fever and inflammation, typically affecting the abdomen, chest, and joints.

Preventing Attacks: For FMF, colchicine is often prescribed for lifelong, daily use to prevent or significantly reduce the frequency and severity of inflammatory attacks.
Preventing Complications: It is highly effective in preventing amyloidosis, a serious complication that can lead to kidney failure in FMF patients.

Cardiovascular Disease Risk Reduction

Certain low-dose colchicine formulations (e.g., Lodoco®) have been approved to reduce the risk of major adverse cardiovascular events in patients with established atherosclerotic cardiovascular disease (ASCVD) or multiple risk factors.

Stabilizing Plaques: The anti-inflammatory action of colchicine is believed to reduce inflammation within atherosclerotic plaques, helping to stabilize them and lower the risk of rupture, which can cause a heart attack or stroke.

Off-Label and Investigational Uses

Colchicine's potent anti-inflammatory effects have led to its use and study in several other conditions, including:

Acute and Recurrent Pericarditis: This condition involves inflammation of the pericardium, the sac surrounding the heart. Colchicine, often used in conjunction with conventional therapy, has been shown to reduce recurrence rates in both first and subsequent episodes of pericarditis.
Behçet's Disease: This is a rare, multi-systemic inflammatory disease. Colchicine can be effective in treating mucocutaneous symptoms, such as mouth and genital sores, and may also improve joint swelling.
Pseudogout: Also known as calcium pyrophosphate crystal deposition (CPPD), this condition is caused by calcium pyrophosphate crystals. Colchicine can help manage the inflammation and pain during flares.
Dermatitis Herpetiformis: A chronic, itchy, blistering skin condition, dermatitis herpetiformis has shown some responsiveness to colchicine in certain cases.
Atrial Fibrillation (AF): Research has shown colchicine can reduce the recurrence of AF after procedures like cardiac surgery or ablation, likely by targeting the inflammatory pathways involved.
COVID-19: During the pandemic, clinical trials investigated colchicine's potential to combat the cytokine storm driving severe COVID-19 complications. Some studies showed a modest reduction in hospitalizations and death.

How Colchicine Works

Colchicine's anti-inflammatory mechanism is distinct from common pain relievers and is primarily based on its interaction with cellular microtubules. Here's a simplified overview:

Microtubule Disruption: Colchicine binds to tubulin, a protein that forms microtubules. This disrupts the assembly and function of these crucial cellular structures.
Inhibiting Neutrophil Activity: Neutrophils are a type of white blood cell central to inflammation. By disrupting microtubules, colchicine prevents neutrophils from migrating to sites of inflammation and from releasing pro-inflammatory cytokines and signaling molecules.
Targeting the Inflammasome: For conditions like FMF and gout, colchicine interferes with the NLRP3 inflammasome, a protein complex that mediates the activation of the inflammatory cytokine IL-1β.

Colchicine vs. Other Inflammatory Treatments

Understanding how colchicine compares to other common anti-inflammatory medications used for conditions like gout is crucial.


Feature	Colchicine	Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)	Corticosteroids
Mechanism	Inhibits microtubule assembly, disrupting neutrophil function and the NLRP3 inflammasome.	Blocks cyclooxygenase (COX) enzymes, which produce inflammatory prostaglandins.	Suppresses immune system activity by affecting gene transcription and cytokine production.
Primary Use (Gout)	Treating acute flares, long-term prophylaxis.	Treating acute flares.	Treating acute flares, especially if other treatments are contraindicated.
Speed of Action	Most effective when started at the first sign of a flare.	Rapid onset of action.	Rapid onset of action.
Long-Term Use	Common for chronic conditions like FMF and prophylaxis.	Potential for increased cardiovascular and gastrointestinal risks.	Risk of numerous side effects with long-term use (osteoporosis, diabetes, etc.).
Common Side Effects	Gastrointestinal distress (nausea, diarrhea, stomach cramps).	Gastrointestinal upset, bleeding risk, cardiovascular risks.	Weight gain, mood changes, increased blood sugar, fluid retention.
Key Drug Interactions	Strong CYP3A4 inhibitors (e.g., clarithromycin, ketoconazole), P-gp inhibitors (e.g., cyclosporine).	Various, including anticoagulants and blood pressure medications.	Various, including diuretics and anticoagulants.

Key Considerations and Safety

While beneficial for many, colchicine has a narrow therapeutic index, meaning the dose that is effective is close to the dose that is toxic. It is essential to follow a doctor's instructions carefully.

Potential Risks:

Gastrointestinal Distress: Nausea, vomiting, and diarrhea are common, especially with higher doses.
Serious Side Effects: Rare but serious risks include muscle pain or weakness (myopathy), bone marrow suppression (leading to blood disorders), and nerve problems.
Overdose: Colchicine overdose is a life-threatening medical emergency.
Renal and Hepatic Impairment: Dosing adjustments are often necessary for patients with kidney or liver disease, as impairment can increase toxicity risk. Concomitant use with specific drugs is contraindicated in these patients.

Conclusion

Colchicine is a powerful anti-inflammatory medication with a long history of use, particularly for conditions like gout and Familial Mediterranean Fever. Its ability to target the inflammatory process at a cellular level has led to a growing list of applications, including reducing cardiovascular risk and managing other systemic inflammatory disorders. However, its narrow therapeutic window and potential for serious side effects necessitate careful prescription and monitoring by a healthcare professional. Understanding what diseases are treated with colchicine and its specific mechanisms is key for both patients and clinicians in optimizing treatment outcomes while managing risks effectively. For more information, consult the American College of Rheumatology.

Frequently Asked Questions

Colchicine treats gout by inhibiting the movement of neutrophils, a type of white blood cell, to the joints where uric acid crystals have accumulated. By tempering this inflammatory response, it reduces the pain and swelling associated with an acute gout attack.

For FMF, colchicine is the standard treatment because it helps prevent the recurring attacks of fever and inflammation. By interfering with the inflammasome complex, it controls the chronic inflammation associated with the condition and prevents long-term complications, such as kidney damage from amyloidosis.

No, colchicine is not a general pain reliever. It specifically targets the inflammatory processes characteristic of conditions like gout and FMF. It will not relieve most other kinds of pain.

Caution is required for patients with kidney or liver impairment. Doses often need to be adjusted, and some combinations with interacting medications are strictly contraindicated due to the risk of toxicity. Always inform your doctor about any kidney or liver issues.

The most common side effects include gastrointestinal issues such as nausea, vomiting, diarrhea, and stomach cramps. These side effects are more likely with higher doses.

Colchicine has significant drug-drug interactions, particularly with inhibitors of the CYP3A4 enzyme and P-glycoprotein transporter. It is crucial to inform your doctor or pharmacist of all medications, vitamins, and supplements you take to avoid potentially fatal interactions.

If you miss a dose for FMF or gout prophylaxis, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose. Do not take a double dose. Specific instructions may vary based on your condition and dosage, so follow your doctor's orders.

The duration of colchicine therapy depends on the condition being treated. For FMF, it is often a lifelong treatment. For gout prophylaxis, it may be used for several months. Your doctor will determine the appropriate length of therapy for your specific case.