Colchicine Side Effects And How To Avoid Them - SingleCare

Key takeaways

• Diarrhea is the most commonly reported adverse event of colchicine (16% of cases), and toxicity is the second most commonly reported adverse event (11%), according to the FDA Adverse Event Reporting System (FAERS).

• Gastrointestinal side effects can start as early as two hours after taking colchicine and can last for a few days to a couple of weeks.

• The key to the safe use of colchicine is to be aware of its side effects and report them to your healthcare provider right away.

In this article:

• Common side effects
• Serious side effects
• How long do colchicine side effects last?
• Warnings
• How to avoid side effects
• Expert takeaway

In this article

• Common side effects
• Serious side effects
• How long do colchicine side effects last?
• Warnings
• How to avoid side effects
• Expert takeaway

If you are one of the 12.1 million Americans living with gout, your healthcare provider may have prescribed an anti-gout medication named colchicine to help ease your symptoms.

Colchicine is an FDA-approved drug that is safe for use in both adults and children aged 4 and older. Colchicine side effects most commonly involve gastrointestinal symptoms like diarrhea, nausea, vomiting, and abdominal pain, which usually go away within a couple of weeks. However, serious side effects like toxicity and kidney injury are also possible.

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Common side effects of colchicine

There are quite a number of side effects associated with the use of colchicine. Most are related to gastrointestinal symptoms, but all are usually short-lived. The most common symptoms to be aware of when using colchicine include: 

• Diarrhea
• Nausea
• Vomiting
• Cramping
• Abdominal pain
• Fatigue
• Headache
• Sore throat

Colchicine and diarrhea

Diarrhea is the most prevalent complication seen with its use. A systematic review was performed in 2017 that found diarrhea could be seen in as many as 3 out of 4 patients prescribed the original recommended dosage for colchicine. This dosage has since been studied and adjusted. Because of the potential gastrointestinal concerns associated with colchicine, the lowest effective dose is always recommended.

“Due to the common side effect of diarrhea with the use of colchicine, providers need to be especially careful when prescribing this medication in certain patient populations,” says Jesse Houghton, MD, FACG, a senior medical director of Gastroenterology at Southern Ohio Medical Center. “Using this medication in patients with ulcerative colitis, Crohn’s disease, or even in those with IBS-D, may result in severe diarrhea, dehydration, or a flare of their GI condition.”

Serious side effects of colchicine

Although colchicine is considered a safe drug, serious adverse effects are associated with its use. If any of the following symptoms occur while using colchicine, contact your medical provider immediately for further medical attention. 

• Myelosuppression (decreased bone marrow activity)
• Leukopenia (reduced white blood cells)
• Thrombocytopenia (reduced platelets)
• Granulocytopenia (reduced granulocytes)
• Pancytopenia (all three  blood cell lines are reduced)
• Aplastic anemia
• Severe diarrhea
• Myopathy (disease of muscle tissue)
• Rhabdomyolysis (a serious condition of muscle fibers being broken down)
• Neuropathy (nerve damage)
• Hepatotoxicity (liver damage)
• Nephrotoxicity (kidney damage)
• Multiple organ failure
• Disseminated intravascular coagulation (abnormal blood clotting in the body)
• Hypersensitivity reaction
• Reversible azoospermia (absence of viable sperm in semen)

Colchicine toxicity

Since there is minimal room for error when dosing colchicine safely, you must be aware of certain symptoms that may represent signs of toxicity. Gastrointestinal symptoms, the most common side effects with the use of colchicine, are usually the first symptoms of toxicity. When these symptoms (usually diarrhea and vomiting) occur, the medication is frequently stopped, as continuing the medication could result in more serious adverse effects occurring. Rare but extremely dangerous symptoms may involve multiorgan failure, which frequently leads to death.  

Colchicine toxicity is commonly divided into three stages: 

1. Stage one involves the common and initial symptoms of diarrhea, nausea, and vomiting. These symptoms may cause severe dehydration, leading to low blood pressure and an abnormal number of blood cells. This stage typically lasts anywhere from 1-12 hours. 
2. Stage two usually lingers for 1-7 days and involves more catastrophic complications such as bone marrow suppression, multi-organ failure, kidney failure, altered mental status, and heart attack. 
3. Finally, for those individuals who survive stage two, there is stage three, which includes hair loss and rebound elevated blood counts that will last 1-2 weeks.

Because the stages of colchicine toxicity may overlap, close monitoring is vital if any symptoms begin to occur, even minor ones. Early intervention may be required to prevent fatalities associated with its use.

Kidney injury

Acute kidney injury accounts for about 9% of adverse events reported in FAERS. Studies show kidney damage as well as the potential for kidney failure from the direct toxic effect of colchicine on the kidney tubules. Most studies show that acute kidney damage from colchicine use is reversible. Typically, kidney damage related to colchicine is a direct result of chronic use of the medication at high doses. Because kidney damage is always a concern with any medication, colchicine management should be monitored closely by a medical professional.

How long do colchicine side effects last?
Category	Examples	Typical timeline
Common side effects	Diarrhea, nausea, vomiting, cramping, abdominal pain, fatigue, headache	Usually short-lived; may start within 2 hours and last days to weeks
Serious side effects	Myelosuppression, rhabdomyolysis, neuropathy, liver or kidney damage, multiorgan failure	Require immediate medical attention; may begin 8-72 hours after exposure

Long-term side effects like numbness are less common with colchicine. 

Quicker onset of symptoms appears to be found more with the use of intravenous colchicine versus the oral formulation. 

While colchicine can help manage gout symptoms, it is not intended to cure gout and is not recommended for long-term use for pain management.

Colchicine contraindications and warnings

There is a wide range of medications that should be monitored closely or avoided when someone is prescribed colchicine.

Contraindications

Colchicine is absolutely contraindicated with certain HIV/antivirals, macrolide antibiotics, cancer medications, antifungals, and heart prescription drugs. These have the potential to increase the amount of colchicine levels in the body, which can result in colchicine toxicity and other serious side effects. This is especially true if liver or kidney disease is present. 

Some of these medications include:

• Atazanavir
• Clarithromycin
• Cyclosporine
• Itraconazole
• Ketoconazole
• Lopinavir/Ritonavir
• Ribociclib
• Ritonavir
• Saquinavir
• Voriconazole
• Voxilaprevir

Other drug interactions:

• Statins. This includes popular cholesterol medications such as atorvastatin, fluvastatin, lovastatin, pravastatin, and simvastatin.
• Antibiotics. Antibiotics such as ciprofloxacin and erythromycin should be avoided as they pose a risk of muscle pain and damage when combined with colchicine.
• NSAIDs. Certain anti-inflammatories should also be closely monitored. Examples include indomethacin and naproxen.

Vitamin and food interactions

Supplements such as vitamin B12, turmeric, milk thistle, or ginkgo should always be disclosed to your healthcare provider due to potential interactions when added with colchicine. 

Additionally, any products containing grapefruit should be avoided as they may cause unwanted side effects with colchicine use.

Abuse and dependence

Colchicine is not a habit-forming drug and does not pose any risk of dependency. Additionally, there are no withdrawal symptoms documented with the discontinuation of the medicine.

Overdose

It is recommended that no more than 0.5 mg/kg body weight of colchicine be prescribed per day, in order to prevent a fatal overdose of the medication. 

Understanding how to properly use this medication is important, as there is no antidote to reverse its effects. Currently, activated charcoal and saline flushing are the traditional treatments for an overdose and should be started as quickly as possible.

Restrictions

 Do not use colchicine if you have:

• Known allergic reaction to the medication
• Liver disease 
• Kidney disease 

Pregnancy and breastfeeding

Colchicine has been shown to be safe for use during pregnancy with no adverse effects noted to the fetus or mother. 

No adverse effects in breastfed infants have been reported in studies of colchicine, and many experts consider it safe during breastfeeding; however, according to the Drugs and Lactation Database (LactMed), the highest levels of colchicine in breastmilk occur 2-4 hours after a dose, so avoid breastfeeding during this time to minimize infant exposure. 

Children

Colchicine has been approved for use in pediatric patients as young as 4 years old. This is only for the treatment of the genetic condition Familial Mediterranean Fever (FMF). Gout prophylaxis can be used only for those aged 16 or older.

Seniors

Close monitoring is needed when prescribing colchicine to seniors. Kidney function in older patients may be decreased, leading to inadequate processing of colchicine in the body. This increases the risk of colchicine side effects. To counteract this possibility, a lower dose of colchicine or a different medication altogether may be considered.  

RELATED: Compare other gout medications

How to avoid colchicine side effects

1. Provide your healthcare provider with a current list of all medications. Include all prescription and over-the-counter medications, vitamins, and herbal supplements.
2. Discuss your complete medical history with your provider. Because colchicine toxicity poses a higher risk for those with certain medical conditions, a complete history should be provided so that it can be determined if you are a good candidate to take this medication. Disclosure of liver disease, kidney disease, pregnancy, or breastfeeding is important.
3. Always take colchicine on time. Keep a record of when you should take your medication. If you miss a dose, take it as soon as you remember. If the missed dose is close to your next scheduled dose, take that one instead.
4. Take colchicine as directed by your healthcare professional. Do not take more or less of this medication without the guidance of your physician. Even small increases in colchicine can be life-threatening and may not improve symptoms. Colchicine dosing will vary based on your age, the medical condition being treated, your medical history, and how you react to the medication. If your symptoms are not improving, do not take more medication or for longer than recommended.  
   • Acute gout: When taking colchicine for an acute gout flare, usually larger doses are prescribed at first. The medication should be discontinued as soon as the pain goes away. If any acute symptoms of diarrhea, vomiting, nausea, or stomach pain occur, the medication should be discontinued immediately.
   • Gout prevention: When taking colchicine for an extended time for gout prevention, smaller dosages will be given, but for longer periods of time. This medication may be given in addition to other gout medications like allopurinol. Depending on other medical conditions that may need treatment, colchicine may be prescribed for the rest of someone’s life. Close monitoring may be required in this scenario, along with laboratory testing. 
5. Monitor symptoms closely. An overdose of colchicine can be fatal. Contact your healthcare provider immediately if you notice any of the following:

1. • Diarrhea
   • Vomiting
   • Stomach pain
   • Muscle weakness
   • Little or no urinating
   • Numbness or tingling
   • Weak pulse
   • Slow heart rate
   • Weak or shallow breathing
   • Fainting

Expert takeaway

Clinical perspective: Jesse Houghton, MD, FACG

“When I see colchicine on my patient’s medication list, I spend a little extra time reviewing their other medications, including herbals and supplements, since this medication is one that is known to have multiple potential interactions. That said, it is a tried and true effective medication for gout flares and gout prevention. With proper monitoring, it can significantly improve the lives of my patients who suffer from gout.”

Expert bio: Dr. Houghton is a board-certified gastroenterologist and Senior Medical Director of Gastroenterology at Southern Ohio Medical Center and member of the SingleCare Medical Review Board

Sources

• Colchicine adverse events, FDA Adverse Event Reporting System (FAERS) Public Dashboard (2026)
• Trends in prevalence of gout among U.S. Asian adults, Rheumatology (2023)
• Colchicine, Epocrates
• Colchicine overdose-induced acute renal failure and electrolyte imbalance, Renal Failure (2009)
• Diarrhea in adults, Merck Manual
• Colchicine poisoning: the dark side of an ancient drug, Clinical Toxicology (2010)
• Gout and hyperuricaemia in the USA: prevalence and trends, Rheumatology (2019)
• Hepatotoxicity and nephrotoxicity of colchicine prolonged use in the rats, International Journal of Advanced Research (2014)
• Lessons from the courtroom: Colchicine toxicity, Emergency Medicine News (2009)
• Management of gout: A systematic review in support of an American College of Physicians Clinical Practice Guideline, Annals of Internal Medicine (2016)
• The ugly side of colchicine,  Journal of Investigative Medicine High Impact Case Reports (2021)
• Use of colchicine in pregnancy: a systematic review and meta-analysis, Rheumatology (2018)
• Colchicine, LactMed (2025)

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