II. Indications

  1. Acute Gouty Arthritis (adjunct to NSAIDs)
  2. Gout prophylaxis (started with Allopurinol to prevent triggering acute attack)

III. Disadvantages

  1. Less viable option (too expensive) now that generic preparations were removed from the market
    1. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm227796.htm
    2. Use NSAIDs instead

IV. Contraindications

  1. Severe renal or liver disease (see adverse effects below)
    1. If used, limit to the 3 dose protocol below and do not repeat for 2 weeks
    2. Do not use with Cyclosporine or Cytochrome P450 3A4 Inhibitor if severe liver or renal disease (lethal interaction)

V. Dosing: Gout in normal Renal Function

  1. See Gout for prophylaxis protocol when starting allopurinal
  2. Tolerable Protocol (as adjunct to NSAIDs)
    1. Start within 24 hours of attack
    2. Option 1: Colchicine 0.6 mg orally twice daily
    3. Option 2: Colchicine 0.6 mg two taken immediately, then a third one hour later
      1. New protocol (2010) - recommended dosing for Colcrys
  3. Old Protocol (Not recommended - poorly tolerated due to Diarrhea, serious toxicity)
    1. Start: 1.0 mg given within 24 hours of attack
    2. Then: 0.5 mg each hour or 1.0 mg every 2 hours prn
  4. Endpoints
    1. Joint Pain improves
    2. Diarrhea
    3. Maximum Dose: 6 mg in 24 hours

VI. Dosing: Renal dose adjustment

  1. GFR >50 ml/minute: 0.6 mg orally twice daily
  2. GFR 35-50 ml/minute: 0.6 mg orally once daily
  3. GFR 10-34 ml/minute: 0.6 mg orally every 2-3 days
  4. GFR <10 ml/minute: Do NOT use

VII. Adverse Effects

  1. Gastrointestinal toxicity (limits dosing)
    1. Nausea or Vomiting
    2. Diarrhea
  2. Bone Marrow suppression (esp. if severe liver or renal disease)
  3. Reversible Axonal Neuromyopathy (1% of cases)
    1. Increased risk if severe liver or renal disease
  4. Alopecia

VIII. Monitoring: Baseline and repeated at 1 month

IX. Drug Interactions

  1. Cyclosporine
  2. Cytochrome P450 3A4 inhibitors (e.g. Clarithromycin, Verapamil)
    1. Do not use with with Macrolides (e.g. Clarithromycin, Azithromycin, Erythromycin)
  3. Rhabdomyolysis risk
    1. Increased risk when combined with Statins or Clarithromycin
    2. Increased risk with older patients and those with Chronic Kidney Disease

X. References

  1. (2011) Presc Lett 18(12): 70
  2. Borstad (2004) J Rheumatol 31:2429-32 [PubMed]

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Cost: Medications

colchicine (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
COLCHICINE 0.6 MG CAPSULE Generic $4.26 each
COLCHICINE 0.6 MG TABLET Generic $5.63 each
colcrys (on 1/5/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
COLCRYS 0.6 MG TABLET Generic $5.63 each

Ontology: Colchicine (C0009262)

Definition (CHV) a drug used to prevent or treat attacks of gout
Definition (CHV) a drug used to prevent or treat attacks of gout
Definition (NCI_NCI-GLOSS) A drug used to treat gout (inflamed joints caused by a buildup of uric acid). It comes from the crocus plant Colchicum autumnale. Colchicine blocks cell division and the movement of certain immune cells to areas that are inflamed. It is a type of alkaloid and a type of mitotic inhibitor.
Definition (NCI) An alkaloid isolated from Colchicum autumnale with anti-gout and anti-inflammatory activities. The exact mechanism of action by which colchicines exerts its effect has not been completely established. Colchicine binds to tubulin, thereby interfering with the polymerization of tubulin, interrupting microtubule dynamics, and disrupting mitosis. This leads to an inhibition of migration of leukocytes and other inflammatory cells, thereby reducing the inflammatory response to deposited urate crystals. Colchicine may also interrupt the cycle of monosodium urate crystal deposition in joint tissues, thereby also preventing the resultant inflammatory response. Overall, colchicine decreases leukocyte chemotaxis/migration and phagocytosis to inflamed areas, and inhibits the formation and release of a chemotactic glycoprotein that is produced during phagocytosis of urate crystals.
Definition (SPN) A general purpose reagent is a chemical reagent that has general laboratory application, that is used to collect, prepare, and examine specimens from the human body for diagnostic histopathology, cytology, and hematology, and that is not labeled or otherwise intended for a specific diagnostic application. General purpose reagents include cytological preservatives, decalcifying reagents, fixatives and adhesives, tissue processing reagents, isotonic solutions, and pH buffers.
Definition (MSH) A major alkaloid from Colchicum autumnale L. and found also in other Colchicum species. Its primary therapeutic use is in the treatment of gout, but it has been used also in the therapy of familial Mediterranean fever (PERIODIC DISEASE).
Definition (CSP) inhibits tubulin-tubulin binding and thus destabilizes microtubules; used to block mitosis, axonal transport, and other microtubule dependent cellular functions in vitro, and clinically to treat gout.
Definition (PDQ) An alkaloid isolated from Colchicum autumnale with anti-gout and anti-inflammatory activity. The exact mechanism of action by which colchicines exerts its effect has not been completely established. Colchicine binds to tubulin, thereby interfering with the polymerization of tubulin, interrupting microtubule dynamics, and disrupting mitosis. This leads to an inhibition of migration of leukocytes and other inflammatory cells, thereby reducing the inflammatory response to deposited urate crystals. Colchicine may also interrupt the cycle of monosodium urate crystal deposition in joint tissues, thereby also preventing the resultant inflammatory response. Overall, colchicine decreases leukocyte chemotaxis/migration and phagocytosis to inflamed areas, and inhibits the formation and release of a chemotactic glycoprotein that is produced during phagocytosis of urate crystals. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39188&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39188&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C385" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D003078
SnomedCT 387413002, 73133000
LNC LP18089-0, MTHU003371
English Colchicine, colchicine, Acetamide, N-(5,6,7,9-tetrahydro-1,2,3,10-tetramethoxy-9-oxobenzo(a)heptalen-7-yl)-, (S)-, (S)-N-(5,6,7,9-Tetrahydro-1,2,3,10-tetramethoxy-9-oxobenzo[a]heptalen-7-yl)acetamide, colchicine (medication), Colchicine [Chemical/Ingredient], COLCHICINE, colchicines, Colchicine (product), Colchicine (substance), COLCHCINE
Swedish Kolkicin
Czech kolchicin
Finnish Kolkisiini
Russian KOLKHITSIN, КОЛХИЦИН
Japanese コルヒチン
Polish Kolchicyna
Spanish colchicina (producto), colchicina (sustancia), colchicina, Colchicina
French Colchicine
German Colchicinum, Colchicin
Italian Colchicina
Portuguese Colchicina