What is colchicine used for?

October 8, 2025 •

4 min read

Dating back to ancient Greece and Rome, colchicine is one of the oldest remedies still used in modern medicine, primarily for its potent anti-inflammatory effects. The FDA has approved it for specific inflammatory conditions, most notably for the treatment and prevention of gout attacks and the management of Familial Mediterranean Fever (FMF). However, its applications extend beyond these well-known uses, with new research exploring its benefits for cardiovascular diseases and other inflammatory disorders.

Quick Summary

Colchicine is an anti-inflammatory medication with a long history of therapeutic use. It is primarily used to treat and prevent gout attacks and manage Familial Mediterranean Fever, but it also has applications in treating pericarditis and certain cardiovascular conditions.

Key Points

Gout Flares: Colchicine effectively treats acute gout attacks and prevents future flares, particularly when starting other uric acid-lowering therapies.
Familial Mediterranean Fever (FMF): It is the standard long-term treatment for FMF, a genetic inflammatory disorder, to prevent episodes of fever and inflammation.
Pericarditis: Colchicine is used in conjunction with other anti-inflammatory drugs to treat acute pericarditis and prevent recurrent episodes.
Cardiovascular Disease: Emerging evidence shows that colchicine can help prevent major cardiovascular events like heart attack and stroke in certain patients.
Mechanism of Action: It works by inhibiting microtubule formation, which disrupts the migration of neutrophils and reduces the body's overall inflammatory response.
Side Effects and Toxicity: The medication has a narrow therapeutic index, with common gastrointestinal side effects and a risk of more serious issues with incorrect administration or drug interactions.
Important Drug Interactions: Grapefruit juice and many common medications, including some antibiotics and cholesterol drugs, can increase colchicine levels and risk toxicity.

What is Colchicine and how does it work?

Colchicine is an anti-inflammatory medication derived from the autumn crocus plant, Colchicum autumnale. Its primary mechanism of action involves binding to tubulin, a protein that is crucial for the formation of microtubules. Microtubules are a key component of the cytoskeleton, involved in cell division, shape, and mobility. By inhibiting microtubule polymerization, colchicine disrupts the function of neutrophils and other inflammatory cells, preventing their migration to sites of inflammation.

This disruption also affects other inflammatory processes, such as the inhibition of the NLRP3 inflammasome, which is implicated in a broad range of inflammatory conditions. By interfering with these core inflammatory pathways, colchicine effectively reduces swelling and pain in specific diseases.

Primary applications of colchicine

Colchicine is most well-known for its role in managing two main inflammatory conditions: gout and Familial Mediterranean Fever (FMF).

Gout: A painful arthritic condition

Gout is a form of inflammatory arthritis characterized by sudden, severe attacks of pain, swelling, and redness in one or more joints, often in the big toe. These flares are caused by an accumulation of uric acid crystals in the joints. Colchicine plays a crucial role in treating and preventing these attacks.

Acute Gout Flares: For the treatment of an active gout flare, colchicine is typically administered as soon as symptoms begin. This approach is effective and has a lower risk of serious side effects compared to older, high-dose regimens.
Gout Flare Prevention: Colchicine is also prescribed to prevent recurrent gout attacks. This is especially common when a patient begins a uric acid-lowering therapy (ULT), such as allopurinol, as starting ULT can temporarily increase the frequency of flares. The preventive regimen is typically taken for several months.

Familial Mediterranean Fever (FMF)

FMF is a hereditary autoinflammatory disorder that causes recurring episodes of fever and inflammation in the abdomen, chest, and joints. Colchicine is the standard and most effective treatment for FMF, helping to prevent or reduce the frequency of these attacks. For most people with FMF, colchicine must be taken daily for life. In FMF, colchicine likely works by interfering with the assembly of the inflammasome, a complex of proteins involved in the body's inflammatory response.

Expanding uses of colchicine

Beyond gout and FMF, research has revealed several other therapeutic applications for this medication, demonstrating its broader anti-inflammatory potential.

Pericarditis: Inflammation of the heart sac

Pericarditis is the inflammation of the pericardium, the sac-like membrane surrounding the heart. This condition can be acute or recurrent. Studies have shown that colchicine, used in combination with conventional therapy like NSAIDs, can significantly reduce the rate of recurrent pericarditis and improve symptoms. Its anti-inflammatory properties disrupt the autoimmune inflammatory process believed to cause recurrent pericarditis.

Cardiovascular disease prevention

Growing evidence suggests a cardioprotective role for colchicine, particularly in patients with atherosclerosis or who have experienced a recent myocardial infarction (heart attack). By inhibiting inflammatory processes, colchicine can help stabilize atherosclerotic plaques and reduce cardiovascular events. Trials like COLCOT and LoDoCo2 have shown that colchicine can significantly reduce the risk of heart attack, stroke, and other cardiovascular events in certain patient populations.

Colchicine comparisons for common uses


Feature	Colchicine for Gout Flares	Colchicine for FMF	Colchicine for Pericarditis
Primary Goal	Stop or prevent acute inflammatory episodes.	Prevent recurrent episodes of fever and inflammation.	Reduce risk of recurrence and aid in symptom relief.
Treatment Regimen	Short-term approach for acute attacks; longer for prophylaxis.	Long-term daily therapy, adjustable based on patient response.	Extended treatment, often alongside NSAIDs.
Mechanism Focus	Inhibiting neutrophil migration in response to urate crystals.	Disrupting inflammasome complex and inflammatory pathways.	Interrupting the autoimmune inflammatory cycle.
Side Effects	Gastrointestinal side effects like diarrhea are common.	Gastrointestinal side effects generally less frequent due to chronic dosing.	Gastrointestinal side effects, generally well-tolerated at typical doses.

Important considerations and precautions

Despite its benefits, colchicine has a narrow therapeutic index, meaning the dose that is effective is close to the dose that is toxic. Patients must be carefully monitored, especially those with pre-existing conditions.

Side Effects: The most common side effects are gastrointestinal, including diarrhea, nausea, and stomach cramps. More serious, but rare, side effects include muscle pain or weakness, nerve problems, and blood disorders.
Drug Interactions: Colchicine interacts with a variety of medications, as well as grapefruit juice. Combining colchicine with certain drugs, particularly potent inhibitors of CYP3A4 and P-glycoprotein, can lead to dangerously high levels of colchicine in the body and fatal toxicity.
Organ Function: Patients with liver or kidney problems are at a higher risk of colchicine toxicity and may require a modified regimen or be advised against using the medication.
Overdose Risk: Fatal overdoses have been reported. It is crucial to store colchicine securely away from children.

Conclusion

Colchicine has evolved from an ancient remedy into a versatile and effective modern medication used for treating a variety of inflammatory diseases. While its traditional uses for gout and FMF remain vital, emerging evidence has expanded its application to conditions like pericarditis and cardiovascular disease prevention. Despite its clear benefits, patients must use colchicine with caution due to its narrow therapeutic window and potential for significant side effects and drug interactions. Proper administration, careful monitoring, and patient education are essential to safely and effectively utilize this powerful anti-inflammatory drug. As research continues to unfold, the therapeutic potential of colchicine may expand even further, highlighting the enduring relevance of this ancient compound in modern pharmacology.

Frequently Asked Questions

For an acute gout attack, a regimen is typically followed as soon as symptoms begin to quickly reduce inflammation. For prevention, a regimen is taken on a long-term basis to keep flares from occurring. It is important not to mix these approaches without medical supervision.

No, colchicine does not cure gout. While it is very effective at treating and preventing the inflammatory attacks associated with gout, it does not address the underlying high uric acid levels that cause the condition. Other medications, known as urate-lowering therapies, are used for long-term management of uric acid levels.

Colchicine is an anti-inflammatory medication, not a typical pain reliever. It specifically targets the inflammatory processes that cause the pain associated with conditions like gout and FMF, but it is not used to treat general pain.

The most common side effects of colchicine are gastrointestinal, including diarrhea, nausea, vomiting, and abdominal pain. These effects are more likely to occur with certain regimens. A modification in the regimen can often resolve these symptoms.

Patients with severe kidney or liver impairment should not take colchicine, especially if also using medications that inhibit CYP3A4 and P-glycoprotein. The drug is also contraindicated for those with certain blood disorders and should be used with caution in elderly patients.

No, you should avoid eating grapefruit or drinking grapefruit juice while taking colchicine. Grapefruit can increase the level of colchicine in your body, significantly raising the risk of serious side effects and toxicity.

For an acute gout attack, colchicine can begin to provide relief within 12 to 14 hours of the first oral administration. Joint inflammation often starts to subside within 48 hours for 75% to 80% of patients.