For a gout flare, two is where the label starts. The colchicine tablet label (brand name Colcrys) gives two 0.6 mg tablets (1.2 mg) at the first sign of the flare, then one more tablet an hour later. That 1.8 mg is the whole flare dose. The label adds: "Higher doses have not been found to be more effective." On a day without a flare, the prevention cap is 1.2 mg, or two tablets.
Those numbers belong to colchicine tablets. Mitigare capsules and Gloperba liquid are labeled for preventing flares, and Lodoco is a 0.5 mg heart medicine. Your own prescription may be lower, or the label may rule colchicine out, if you have kidney or liver problems or take certain other drugs. Took more than your prescription says? The tablet label says to "go to the nearest hospital emergency room right away." You can call Poison Help at 1-800-222-1222 on the way (1-844-764-7669 in Canada).
Important: This article explains what the colchicine labels say. It is general information, not a substitute for professional medical advice. Consult your doctor or pharmacist for advice specific to your medications.
How Many Colchicine Can You Take in a Day?
The tablet label splits colchicine use into three situations. The brand Colcrys is no longer on the market, but the current generic tablet label carries the same instructions.
| Your situation | What the tablet label gives | Spacing | If a dose is missed (label) |
|---|---|---|---|
| Treating a flare, not on daily colchicine | 2 tablets (1.2 mg) at the first sign, then 1 tablet (0.6 mg). Flare maximum: 1.8 mg over one hour | One hour between the two steps | "take the missed dose as soon as possible" |
| A flare while you already take colchicine daily | The same two steps, "not to exceed" 1.2 mg then 0.6 mg | "Wait 12 hours and then resume the prophylactic dose" | "take the missed dose immediately, wait 12 hours, then resume the previous dosing schedule" |
| Daily prevention, no flare | 0.6 mg once or twice daily. "Maximum dose 1.2 mg/day" | Once or twice a day | "take the dose as soon as possible ... the patient should not double the next dose" |
So the label's flare course is three tablets within one hour, and a prevention day is one or two. Flare while on daily colchicine? The patient guide says to "report this to your healthcare provider." The right dose "depends on the patient's age, renal function, hepatic function and use of coadministered drugs," per the label. It also says flare treatment "is not recommended" for people on daily colchicine who have kidney or liver problems or take certain interacting drugs. Unsure what "twice daily" means? See what twice a day means on a label.
Can You Take Colchicine Every Hour or Every 2 Hours?
That was the old way. A 2024 review in Rheumatology says the older regimen, "1.2 mg stat followed by 0.6 mg hourly until the flare resolves or diarrhoea occurs, is no longer recommended."
The change came from a 2010 trial of 184 people with an early gout flare, known as the AGREE trial. People took a low dose (1.8 mg over one hour), a high dose (4.8 mg over six hours) or a placebo. At 24 hours, the trial counted who had at least half their pain gone without rescue medicine. That was 37.8% on the low dose, 32.7% on the high dose and 15.5% on placebo.
More colchicine did not bring more relief. It brought more side effects: on the high dose, 76.9% had diarrhea and 17.3% vomited. On the low dose, 23.0% had diarrhea and nobody vomited. The 2020 American College of Rheumatology gout guideline "strongly recommended" the low dose.
Can You Take Colchicine Two Days in a Row?
On repeating a flare dose, the label says "the safety and efficacy of repeat treatment for gout flares has not been evaluated." It sets firm limits for two groups:
- If you take one of the interacting drugs in its table: "Dose to be repeated no earlier than 3 days."
- If you have severe kidney or liver impairment, "a treatment course should be repeated no more than once every two weeks."
Day two is your prescriber's call. The ACR guideline backs the FDA dose "with ongoing antiinflammatory therapy until the flare resolves." MedlinePlus says: "If you do not experience relief or have another attack within several days after treatment, talk to your doctor before taking additional doses of medication."
The label's overdose section explains the caution: "The exact dose of colchicine that produces significant toxicity is unknown. Fatalities have occurred after ingestion of a dose as low as 7 mg over a four-day period, while other patients have survived after ingesting more than 60 mg." Four flare doses of 1.8 mg add up to 7.2 mg. That is not a prediction for any one person. It shows how thin the margin is.
New Zealand's National Poisons Centre logged 56 colchicine poisonings from 2016 to early 2021. Children aged 1 to 4 who got into the medicine made up 43%, and the next most common cause was adults taking too much. Medsafe, New Zealand's medicines regulator, says these "may be due to patients misunderstanding how to take colchicine appropriately or trying to get further therapeutic effect to ease symptoms of gout."
How Long After Taking Colchicine Should Pain Relief Occur?
In the AGREE trial, only 37.8% on the low dose met its 24-hour bar. Still hurting a day later is common.
Colchicine is not a painkiller: the label says it "is not an analgesic medication and should not be used to treat pain from other causes." The ACR guideline lists colchicine, NSAIDs and steroids as first-line flare options. Ask your prescriber about a flare that is not settling. For home remedies, see tart cherry juice with allopurinol.
Can You Take Colchicine Twice a Day?
For daily prevention, yes, on the label: 0.6 mg "once or twice daily," with a "Maximum dose 1.2 mg/day." The tablet label recommends colchicine "upon initiation of gout flare prophylaxis with uric acid-lowering therapy," such as allopurinol, and says it "may be beneficial for at least the first six months." See a flare right after starting allopurinol and allopurinol and alcohol for those months.
| Product | Form | Labeled use | Daily dose on its label |
|---|---|---|---|
| Colchicine tablets (Colcrys) | 0.6 mg tablet | Prevent and treat gout flares, and familial Mediterranean fever (FMF) | Prevention: 0.6 mg once or twice daily, max 1.2 mg/day |
| Mitigare and generic capsules | 0.6 mg capsule | "prophylaxis of gout flares in adults" | 0.6 mg once or twice daily, max 1.2 mg per day |
| Gloperba | 0.6 mg per 5 mL liquid | "prophylaxis of gout flares in adults" | 0.6 mg (5 mL) once or twice daily, max 1.2 mg/day |
| Lodoco | 0.5 mg tablet | Lowering heart attack and stroke risk | 0.5 mg once daily |
The Mitigare label and the Gloperba label both say treating a flare with them during prevention "has not been studied." The Lodoco label is written for heart risk. Your prescription may be lower.
What Happens If You Miss a Dose of Colchicine?
The first table shows the label's rule for each situation. Its patient guide, for daily use: "If you take COLCRYS daily and you miss a dose, then take it as soon as you remember. If it is almost time for your next dose, just skip the missed dose. Take the next dose at your regular time. Do not take two doses at the same time."
The capsule, liquid and Lodoco labels say: take it as soon as possible, and do not double the next dose. Not sure whether you are mid-flare course or on a daily schedule? Ask your pharmacist which rule fits.
What Not to Take With Colchicine
The tablet label has a dose-change table for drugs that raise colchicine levels, including any taken "within the prior 14 days." Examples include:
- Some antibiotics and antifungals, such as clarithromycin, erythromycin, ketoconazole, itraconazole and fluconazole
- HIV medicines such as ritonavir
- Heart drugs including diltiazem, verapamil and ranolazine
- Cyclosporine, a transplant drug
- Grapefruit juice (the patient guide says to avoid grapefruit and grapefruit juice)
The patient guide adds: "Do not take COLCRYS if you have liver or kidney problems and you take certain other medicines."
The label says "fatal colchicine toxicity has been reported with clarithromycin." In a Hong Kong hospital study of 116 patients, 10.2% of those given clarithromycin and colchicine together died, compared with 3.6% given them one after the other. Paxlovid contains ritonavir, and its label rules out colchicine for people with kidney or liver impairment (our Paxlovid guide).
Statins such as atorvastatin and simvastatin have a separate warning: they "may potentiate the development of myopathy" (muscle problems). The patient guide also warns that "medicines that you take for a short period of time, such as antibiotics, can interact with COLCRYS and cause serious side effects or death." Tell every prescriber and pharmacist you take colchicine.
What Happens If You Take Too Much Colchicine?
If you took more than your prescription says, the label says to "go to the nearest hospital emergency room right away." On the way, Poison Help can guide you at 1-800-222-1222. In Canada, call 1-844-764-7669, or 1-800-463-5060 in Quebec (Health Canada). Call 911 if the person "collapses, has a seizure, has trouble breathing or can't be awakened," as Poison Control puts it.
Feeling fine now proves nothing. Per the label, the first stage of colchicine poisoning "typically begins within 24 hours" with stomach symptoms, and life-threatening problems come in a second stage "24 to 72 hours after." It also says "No specific antidote is known." The patient guide says to get medical help right away for the signs below. For all but the last, MedlinePlus says to "stop taking colchicine and call your doctor immediately":
- Muscle weakness or pain
- Numbness or tingling in your fingers or toes
- Unusual bleeding or bruising
- Increased infections
- Feeling weak or tired
- Pale or gray color to your lips, tongue or palms of your hands
- Severe diarrhea or vomiting
Bring the packet and your other medicines, as the UK's NHS suggests. Keep colchicine away from children. If the extra pill was allopurinol, that drug has its own answer in our separate allopurinol guide. For other drugs, see taking medication twice by mistake.
How Pillo Helps
On a flare day it is easy to lose track. Pillo's Dose Notes let you attach a note to a dose, like "flare dose, two tablets at 9:10," and Adherence Reporting keeps the history of what you marked as taken.
For daily prevention, Pillo's persistent alarm keeps going until you deal with it. If you manage a parent's gout medicines, Dependents Management is free for up to two dependents.
FAQ
Can you take a third colchicine for a flare?
On the tablet label, the third tablet is the one taken an hour after the first two, and those three tablets (1.8 mg) are the whole flare dose. If you took more than your prescription says, follow the overdose steps above.
Can you just stop taking colchicine?
The patient guide says, "Do not stop taking COLCRYS even if you start to feel better, unless your healthcare provider tells you." The exception: with muscle pain or weakness, or tingling or numbness in fingers or toes, the label says patients "must discontinue COLCRYS and seek medical evaluation immediately." Ask your prescriber when your prevention course ends.
What if my colchicine is 0.5 mg, or for pericarditis?
Lodoco is a 0.5 mg colchicine tablet labeled for heart risk, taken once daily. If your colchicine is for another condition, such as pericarditis or familial Mediterranean fever, your prescriber set that dose and the gout flare numbers here do not apply.
This article is for informational purposes only and does not constitute medical advice. If someone took too much colchicine, go to the nearest hospital emergency room right away; Poison Help (1-800-222-1222, or 1-844-764-7669 in Canada) can guide you on the way.
Sources
- Colcrys (colchicine) tablets prescribing information, DailyMed
- Colchicine tablets USP prescribing information (Macleods, 2026), DailyMed
- Mitigare (colchicine) capsules prescribing information, FDA
- Gloperba (colchicine) oral solution prescribing information, DailyMed
- Lodoco (colchicine) tablets prescribing information, DailyMed
- Paxlovid prescribing information, DailyMed
- Terkeltaub RA et al. High versus low dosing of oral colchicine for early acute gout flare. Arthritis Rheum. 2010
- FitzGerald JD et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res. 2020
- Stamp LK et al. Colchicine: the good, the bad, the ugly and how to minimize the risks. Rheumatology. 2024
- Effect of increasing doses of colchicine on the treatment of 333 COVID-19 inpatients (refers to the 2010 gout trial as AGREE), PMC
- Hung IF et al. Fatal interaction between clarithromycin and colchicine in patients with renal insufficiency. Clin Infect Dis. 2005
- Medsafe (New Zealand). Colchicine: painful insights from recent poisoning data in New Zealand. Prescriber Update 42(2), June 2021
- MedlinePlus: Colchicine
- MedlinePlus: Poisoning
- Health Canada: 1-844 POISON-X
- NHS: Colchicine
- Poison Control (poison.org)
