Colchicine in acute gout

If colchicine in doses 1 g + 0.5 g is partly ineffective in a patient with acute gout, should it be continued at the same daily dose or is it better to switch to or add a nonsteroidal anti-inflammatory drug or a corticosteroid?

George Nuki: The one small trial by R.A. Terkeltaub, which suggested that you should just use 2 doses of colchicine and no more, is not sufficient to overgo the wide range of clinical experience, which suggests that using colchicine in small doses for a longer period of time can be very effective and is recommended if there are no contraindications.

It is certainly not a good idea to use very high doses. There is the old adage in medicine that the patients often run before they can walk, because they develop the gastrointestinal side effects with diarrhea if you use very large doses of colchicine.

So everybody is agreed that smaller doses are effective, but whether it should just be those 2 doses or whether it should be 0.5 mg 3 times a day, for example, is not [established].