# Familial Mediterranean Fever - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: EULAR/PReS Recommendations for Familial Mediterranean Fever (FMF) 2024 · Colchicine 500 microgram tablets SmPC sections 4.1 and 4.2, Paediatric population - Familial Mediterranean fever (eMC product 100968): "Colchicine is indicated in Familial Mediterranean Fever for prophylaxis of attacks and prevention of amyloidosis", with starting doses "0.5 mg / day in children less than 5 years of age (1 tablet); 1 mg / day in children from 5 to 10 years of age (2 tablets); 1.5 mg / day in children over 10 years (3 tablets)" and "increased in a stepwise fashion (e.g., 0.25mg/step) up to a maximum of 2mg/day (four tablets a day)". This label carries the familial Mediterranean fever indication for children only and states no adult regimen; the adult 1 to 1.5 mg daily rising to 3 mg is from the EULAR/PReS 2024 recommendations, which are not held in this corpus. · Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020) - Verified date: 2026-08 ## Verified against - EULAR/PReS Recommendations for Familial Mediterranean Fever (FMF) 2024 - Colchicine 500 microgram tablets SmPC sections 4.1 and 4.2, Paediatric population - Familial Mediterranean fever (eMC product 100968): "Colchicine is indicated in Familial Mediterranean Fever for prophylaxis of attacks and prevention of amyloidosis", with starting doses "0.5 mg / day in children less than 5 years of age (1 tablet); 1 mg / day in children from 5 to 10 years of age (2 tablets); 1.5 mg / day in children over 10 years (3 tablets)" and "increased in a stepwise fashion (e.g., 0.25mg/step) up to a maximum of 2mg/day (four tablets a day)". This label carries the familial Mediterranean fever indication for children only and states no adult regimen; the adult 1 to 1.5 mg daily rising to 3 mg is from the EULAR/PReS 2024 recommendations, which are not held in this corpus. - Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020) ## Treatment metadata - Colchicine — 0.5 mg — oral.solid - Ibuprofen — 400 mg — oral.solid ## Complete treatment card ```text FAMILIAL MEDITERRANEAN FEVER Sources: EULAR/PReS Recommendations for Familial Mediterranean Fever (FMF) 2024 · Colchicine 500 microgram tablets SmPC sections 4.1 and 4.2, Paediatric population - Familial Mediterranean fever (eMC product 100968): "Colchicine is indicated in Familial Mediterranean Fever for prophylaxis of attacks and prevention of amyloidosis", with starting doses "0.5 mg / day in children less than 5 years of age (1 tablet); 1 mg / day in children from 5 to 10 years of age (2 tablets); 1.5 mg / day in children over 10 years (3 tablets)" and "increased in a stepwise fashion (e.g., 0.25mg/step) up to a maximum of 2mg/day (four tablets a day)". This label carries the familial Mediterranean fever indication for children only and states no adult regimen; the adult 1 to 1.5 mg daily rising to 3 mg is from the EULAR/PReS 2024 recommendations, which are not held in this corpus. · Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020) Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (9) - Recurrent fevers with severe chest, abdominal, or joint pain usually begin by age 20 [abdominal pain · chest pain · joint pain] - Episodes typically run 12 to 72 hours before the patient returns to full baseline health - A prodrome of irritability, anxiety, nausea, or muscle aching can precede an attack [anxiety · irritability · muscle pain · nausea] - Severe stress, cold, hard exercise, infection, surgery, or menstruation can set off an attack - Fever is the most frequent complaint and can reach 38 to 40 degrees C, sometimes with no other symptom, especially in children [fever] - Pleural involvement causes one-sided chest pain that gets worse with a deep breath or coughing [chest pain · cough] - A single large lower-limb joint - hip, knee, or ankle - is typically painful; more than one joint at once is rare - Tender, raised, erythema-like patches on the lower legs are seen more often in Jewish patients than in Arab patients [redness] - A one-sided, tender scrotal swelling from tunica vaginalis inflammation settles within a day [scrotal swelling] SIGNS - what you find (4) - Abdominal distension, guarding, rebound tenderness, and quiet bowel sounds from peritoneal irritation are found on exam during an attack [abdominal distension · guarding · peritoneal signs · rebound tenderness] - A pleural or pericardial friction rub may be heard when the chest is involved [friction rub] - The affected joint shows a limited range of motion, while overt swelling or redness is uncommon [redness · reduced range of movement] - Muscle tenderness on palpation accompanies the nonspecific myalgia [muscle pain] TESTS (7) - A raised white cell count with a predominance of neutrophils is seen during attacks - Acute-phase markers - fibrinogen, ESR, serum amyloid A, and CRP - rise but are not specific to this diagnosis - An ECG can show diffuse ST-segment elevation when pericarditis is present - Aspirated joint fluid is sterile but has a raised nucleated cell count - Abdominal CT is routinely obtained to rule out other causes of an acute abdomen - Genetic testing can support the diagnosis in atypical cases, though about a tenth of clinically-diagnosed patients carry no identifiable mutation - The Tel-Hashomer criteria require a rectal reading of 38C together with inflammatory pain, three or more repeat episodes, each lasting 12 to 72 hours IF NOT THIS - what else fits (8) - An acute abdomen from FMF peritonitis is easily confused with appendicitis or cholecystitis, sometimes leading to surgery before FMF is recognized - Children with recurring fever and arthritis attacks can be mistaken for juvenile idiopathic arthritis - Positive ANA with low complement points to lupus, while rheumatoid factor and anti-CCP antibodies point to rheumatoid arthritis - PFAPA syndrome attacks run longer than an FMF episode - PFAPA responds to steroids rather than to colchicine, unlike FMF - TRAPS features prominent rash, muscle pain, and swelling around the eyes - Muckle-Wells syndrome and familial cold urticaria feature hives more prominently than FMF does - Cellulitis can look like the erysipelas-like skin lesions of FMF, but a careful history and failure to respond to antibiotics point away from cellulitis Source StatPearls "Familial Mediterranean Fever" - disease-level clinical article Status traced to the source above 1. COLCHICINE [1st line] Adult 1-1.5 mg daily in 1-2 divided doses; increase in steps of 0.5 mg if attacks continue, to a maximum of 3 mg daily - continuous, lifelong prophylaxis - not just during attacks Peds Under 5 years: Up to 0.5 mg daily 5 to 10 years: 0.5 to 1 mg daily Over 10 years: 1 to 1.5 mg daily, as for an adult. Maximum 2 mg daily in a child. (EULAR/PReS 2024 age-band starting doses (not weight-based): under 5 years, up to 0.5 mg/day; 5-10 years, 0.5-1 mg/day; over 10 years, 1-1.5 mg/day (same as adult). Maximum 2 mg/day in children versus 3 mg/day in adults. Titrate under specialist guidance) Source Colchicine 500 microgram tablets SmPC sections 4.1 and 4.2, Paediatric population - Familial Mediterranean fever (eMC product 100968): "Colchicine is indicated in Familial Mediterranean Fever for prophylaxis of attacks and prevention of amyloidosis", with starting doses "0.5 mg / day in children less than 5 years of age (1 tablet); 1 mg / day in children from 5 to 10 years of age (2 tablets); 1.5 mg / day in children over 10 years (3 tablets)" and "increased in a stepwise fashion (e.g., 0.25mg/step) up to a maximum of 2mg/day (four tablets a day)". This label carries the familial Mediterranean fever indication for children only and states no adult regimen; the adult 1 to 1.5 mg daily rising to 3 mg is from the EULAR/PReS 2024 recommendations, which are not held in this corpus. Why Colchicine is the mainstay of FMF: daily continuous dosing prevents both attacks and the amyloidosis that untreated FMF can cause, unlike its short 3-day course use in gout. EULAR/PReS 2024 states colchicine should be continued through conception, pregnancy, and lactation - stopping risks a flare and amyloidosis, and current evidence does not show the fetal risk that older general drug-labelling contraindications assume for colchicine's other indications Caution Narrow therapeutic index - diarrhoea or vomiting is an early sign of toxicity; do not exceed the recommended dose. Reduce dose in renal or hepatic impairment; avoid combining with strong CYP3A4 or P-glycoprotein inhibitors (e.g. clarithromycin, ciclosporin) - risk of life-threatening toxicity. Do not stop colchicine in pregnancy without discussing with the treating specialist - see rationale. During an acute attack, keep the dose unchanged; do not increase colchicine to control attack pain. Numbers for the dose reductions: in mild to moderate renal or hepatic impairment an adult goes to 0.5 mg a day and a child's dose halves. A strong CYP3A4 or P-gp inhibitor needs a four-fold reduction and a moderate CYP3A4 inhibitor a two-fold one - and in renal or hepatic impairment those combinations are contraindicated outright, not merely reduced. Egypt COLCHICINE 500 MCG 100 TABS. EL NASR 190.00 EGP (1.90/unit) COLMEDITEN 0.5 MG 100 TABS. KAHIRA 190.00 EGP (1.90/unit) GOURYST 0.5 MG 100 TABS. PHAROPHARMA 190.00 EGP (1.90/unit) 2. IBUPROFEN [add-on - not a substitute] Adult 400-800 mg three times daily with food during an acute attack, alongside the usual unchanged colchicine dose - duration of the acute attack, typically 1-3 days Peds 15 to 17 years: 20 mg/kg daily, up to a maximum of 40 mg/kg daily (maximum 2400 mg daily), in 3 to 4 divided doses. Below 15 years the label gives weight bands for pain and fever only, not for rheumatic disease. (Specialist-guided in paediatric FMF attacks. No document held here gives a paediatric dose for FMF specifically. The ibuprofen label behind the adult dose above (Ibuprofen 400 mg SmPC, eMC 7020) gives, under the same Rheumatic diseases heading: "Adolescents from 15 to 17 years of age: The recommended dose should be adjusted by weight: 20 mg/kg to a maximum of 40 mg/kg body weight daily (max 2400 mg daily) in 3 to 4 divided doses." Below 15 years that label gives weight bands for pain and fever only, not for rheumatic disease, and it states: "Ibuprofen is contraindicated in children below 20 kg body weight or younger than 6 years of age.") Source Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020) Why EULAR/PReS 2024 recommends NSAIDs for symptomatic relief during attacks; glucocorticoids and opioids are advised against, and the colchicine dose itself should not be increased for an attack Caution Avoid in peptic ulcer disease, severe heart failure, or CKD. Take with food or gastroprotection. Do not use opioids or increase the colchicine dose to manage attack pain - EULAR/PReS 2024 recommends against both. Contraindicated in the third trimester of pregnancy. 2400 mg a day is the ceiling and the label allows it only as a temporary increase in acute severe conditions - which an FMF attack is. The usual range is 1200-1800 mg daily, no single dose above 800 mg, and it comes back down when the attack settles. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)