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Brand names: Colcrys • Drug class: Antigout (microtubule inhibitor)
Colchicine is the standard treatment for gout flares — but it is eliminated by the kidneys and has a narrow safety window. In CKD, doses must drop sharply: down to 0.3 mg twice weekly on dialysis. Getting this wrong causes severe myopathy and marrow toxicity.
Colchicine is cleared largely by the kidney (up to 80% of its metabolism is renal-dependent in some pathways). At eGFR <30, standard doses accumulate and cause toxic effects — muscle pain, weakness, diarrhea, and blood count drops. The FDA label provides renal-specific dosing tables.
FDA label: CrCl 30-59 → 0.3 mg BID; CrCl 10-29 → 0.3 mg daily; CrCl <10/dialysis → 0.3 mg twice weekly (gout flare dosing)
FDA Colcrys prescribing information, 2023
Toxicity (myoneuropathy, cytopenias) well documented at unadjusted doses in CKD
Clinical toxicology case literature, 2021
Effective for gout flares and for cardiovascular prevention at low dose (LoDoCo2)
LoDoCo2 trial (Nidorf SM et al., NEJM 2020), 2020
Gout flare: 1.2 mg then 0.6 mg one hour later in normal kidney function. CrCl 30-59: 0.3 mg BID. CrCl 10-29: 0.3 mg daily. Dialysis/CrCl <10: 0.3 mg twice weekly. Do not escalate for prophylaxis in CKD. Check blood counts and CK with long-term use in CKD.
Check your kidney functionThis page is educational. Medication decisions — especially dosing changes — must be made by your prescribing clinician.
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This content is a general reference, not medical advice, a diagnosis, or a treatment plan. Do not change your diet, fluids, medicines, or dialysis plan without your nephrologist or renal dietitian. Individual recommendations depend on your labs, medications, conditions, and care plan.