Editor—Morris et al discussed the use of low dose colchicine in gout.1 The treatment dose of colchicine, which has remained at 1 mg initially, followed by 500 μg every 2-3 hours for many years, should be reviewed. However, they are incorrect to say that the current BNF (British National Formulary) recommends a regimen for colchicine that is unchanged since the 1966 edition.
In September 1999 the BNF reduced the total dose of a course of colchicine from 10 mg to 6 mg.2 Before 1981 the BNF did not even state the higher limit of 10 mg.
The decision to reduce the total dose of colchichine to 6 mg was taken because of expert advice given to the BNF.3 The formulary committee reported that it found little evidence to support the use of the total dose of 10 mg and that a total dose of 6 mg has been recommended in the United States.4
After nearly 2000 years of recorded use of colchicine we are still struggling to find its optimal dose. Recent history seems to be one of a gradual reduction in the total dose. Morris et al, by suggesting a reduction in dose frequency, may reduce further the unpleasant adverse effects of this useful agent.
Competing interests: None declared.
References
- 1.Morris I, Varughese G, Mattingly P, Colchicine in acute gout, BMJ 2003;327: 1275-6. (29 November.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Joint Formulary Committee. British national formulary. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 1999. (No 38.)
- 3.British National Formulary FAQ. www.bnf.org/AboutBNFFrameFAQ.htm (accessed 4 Dec 2003).
- 4.Martindale: The complete drug reference. 32nd ed. London: Pharmaceutical Press, 1999.