An anti-inflammatory alkaloid derived from the autumn crocus plant, used for the treatment and prevention of gout flares and for familial Mediterranean fever. Colchicine has also shown cardiovascular benefit in reducing recurrent cardiovascular events (COLCOT trial) and pericarditis. It has a narrow therapeutic index requiring careful dosing.
Prophylaxis against gout flares during urate-lowering therapy initiation9,10
Treatment of familial Mediterranean fever
Cardiovascular event reduction (post-MI, per COLCOT trial)3,1
Treatment and prevention of recurrent pericarditis1,4
What to watch for
Diarrhea (most common, dose-limiting)
Nausea and vomiting
Abdominal cramping
Concurrent use of strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin) in patients with renal or hepatic impairment
Severe renal impairment requiring dialysis
The bottom line
Evidence rating strong. Most-documented uses: treatment of acute gout flares, prophylaxis against gout flares during urate-lowering therapy initiation, treatment of familial mediterranean fever. 11 sources indexed (2020–2026), with 2 interaction records on file.
The science
How it works, mechanistically.
Core mechanism
Binds to tubulin and inhibits its polymerization into microtubules, disrupting multiple inflammatory processes. This inhibits neutrophil migration to sites of urate crystal deposition, impairs neutrophil phagocytosis and degranulation, reduces inflammasome (NLRP3) activation and IL-1 beta release, and decreases leukotriene B4 and prostaglandin production. The overall effect is a potent reduction in the inflammatory response to monosodium urate crystals.
Class
Anti-Gout / Anti-Inflammatory
Dosing
Dosing & protocol.
Common range
Acute gout flare: 1.2 mg at first sign, then 0.6 mg one hour later (max 1.8 mg per flare); Prophylaxis: 0.6 mg once or twice daily (as prescribed by your physician)
Recommended form
Tablet or capsule
Can be taken with or without food; reduce dose or avoid with strong CYP3A4 or P-glycoprotein inhibitors1,6
Safety
Full safety detail.
Side effects
Diarrhea (most common, dose-limiting)
Nausea and vomiting
Abdominal cramping
Myopathy and rhabdomyolysis (especially with statins or renal impairment)
Bone marrow suppression (with chronic high-dose use)
Peripheral neuropathy (rare, with chronic use)
Contraindications
Concurrent use of strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin) in patients with renal or hepatic impairment
Colchicine causes dose-dependent, reversible malabsorption of vitamin B12 by reducing the number of intrinsic factor-vitamin B12 receptors in the ileal mucosa. Chronic colchicine use can lead to clinically significant B12 deficiency, manifesting as megaloblastic anemia and potentially irreversible peripheral neuropathy or subacute combined degeneration of the spinal cord. The neuropathy from B12 deficiency may be difficult to distinguish from colchicine-induced neuropathy.
Recommendation: Monitor vitamin B12 levels annually in patients on chronic colchicine therapy. Consider prophylactic B12 supplementation (1000 mcg sublingual daily or monthly B12 injections) for long-term users. Sublingual or injectable B12 bypasses the intestinal absorption defect caused by colchicine. Report any numbness, tingling, or balance problems promptly.
Colchicine can impair intestinal absorption of multiple nutrients through its disruption of microtubule-dependent enterocyte function. While the effect on folate absorption is less well-documented than the B12 malabsorption, colchicine's general inhibition of intestinal brush border transport mechanisms may reduce folate uptake. Megaloblastic changes in chronic colchicine users may reflect combined B12 and folate deficiency.
Recommendation: Monitor folate levels periodically during chronic colchicine therapy, particularly if megaloblastic changes are observed. Methylfolate supplementation (400-800 mcg/day) may be considered for long-term colchicine users. Methylfolate is preferred over folic acid as it is directly bioactive and less dependent on intestinal processing.
Li HY, Cheriyan J, Chan TK et al.. Colchicine for the Secondary Prevention of Cardiovascular Diseases: A Cumulative-Dose Meta-analysis of Randomized Controlled Trials including 31,397 Subjects Worldwide. American journal of cardiovascular drugs : drugs, devices, and other interventions. 2026
Younas A, Awan Z, Khan T et al.. The effect of colchicine on myocardial infarction: An updated systematic review and meta-analysis of randomized controlled trials. Current problems in cardiology. 2025
Xie S, Galimberti F, Olmastroni E et al.. Colchicine and cardiovascular events: An updated meta-analysis of published randomized controlled trials. Journal of internal medicine. 2025
Akl E, Sahami N, Labos C et al.. Meta-Analysis of Randomized Trials: Efficacy and Safety of Colchicine for Secondary Prevention of Cardiovascular Disease. Journal of interventional cardiology. 2024
Schwier NC, Cornelio CK, Boylan PM. A systematic review of the drug-drug interaction between statins and colchicine: Patient characteristics, etiologies, and clinical management strategies. Pharmacotherapy. 2022
Fiolet ATL, Opstal TSJ, Mosterd A et al.. Efficacy and safety of low-dose colchicine in patients with coronary disease: a systematic review and meta-analysis of randomized trials. European heart journal. 2021
This page is educational. Do not start, stop, or change a supplement or medication based on it without checking with a qualified healthcare professional.
Use this with your stack
Colchicine in NutriStack.
Add it to your stack, see how it interacts with everything else you take, and get a Stack Score that updates the moment it does.
NutriStack is an informational and organizational tool, not a medical service, and not a substitute for professional advice. Always consult a qualified healthcare professional before starting, stopping, or changing any supplement or medication.
NutriStack