Colchicine

Indications

Colchicine is used for: Acute gout, Familial Mediterranean Fever, Behcet's disease, Gouty arthritis

Adult Dose

Gout Treatment of acute gout flares (Colcrys): 1.2 mg PO at first sign of flare, then 0.6 mg 1 hr later; not to exceed 1.8 mg in 1-hr period Prophylaxis (Colcrys, Mitigare): 0.6 mg PO once daily or q12hr; not to exceed 1.2 mg/day; after gout flare, wait 12 hr to continue prophylaxis Familial Mediterranean Fever Colcrys: 1.2-2.4 mg/day PO in single daily dose or divided q12hr; increased in 0.3 mg/day increments as necessary to control disease; decreased in 0.3 mg/day increments if intolerable side effects develop; not to exceed 2.4 mg/day Hepatic impairment (gout) Mild to moderate: Dosage adjustment not necessary; monitor patients for adverse effects Severe: Dosage adjustment not necessary; do not repeat more frequently than every 2 weeks; consider alternative therapy if repeated courses are required Hepatic impairment (familial Mediterranean fever) Mild to moderate: Monitor patients for adverse effects Severe: Consider dosage reduction; do not repeat more frequently than every 2 weeks

Child Dose

Gout <16 years Not recommended >16 years Treatment of acute gout flares: 1.2 mg PO at first sign of flare, then 0.6 mg 1 hr later; not to exceed 1.8 mg in 1-hr period Prophylaxis: 0.6 mg PO once daily or q12hr; not to exceed 1.2 mg/day; after gout flare, wait 12 hr to continue prophylaxis Familial Mediterranean Fever <4 years: Safety and efficacy not established 4-6 years: 0.3-1.8 mg/day PO in single daily dose or divided q12hr 6-12 years: 0.9-1.8 mg/day PO in single daily dose or divided q12hr >12 years: 1.2-2.4 mg/day PO in single daily dose or divided q12hr

Renal Dose

Renal impairment (gout) Mild (CrCl 50-80 mL/min) and moderate (CrCl 30-50 mL/min): Dosage adjustment not necessary; monitor patients for adverse effects Severe (CrCl <30 mL/min): Dosage adjustment not necessary; do not repeat more frequently than every 2 weeks Hemodialysis: 0.6 mg once; do not repeat more frequently than every 2 weeks Renal impairment (familial Mediterranean fever) Mild (CrCl 50-80 mL/min) and moderate (CrCl 30-50 mL/min): Monitor patients for adverse effects; dosage adjustment may be required Severe (CrCl <30 mL/min): 0.3 mg/day initially; dosage increases should be done with adequate monitoring for adverse effects Hemodialysis: 0.3 mg PO once; dosage increases should be done with adequate monitoring for adverse effects

Administration

Should be taken with food.

Contra Indications

Hypersensitivity; blood dyscrasias, severe renal impairment, pregnancy, debilitated patients; SC/IM admin.

Precautions

Elderly; GI disease. Cardiac, renal and hepatic impairment; prolonged therapy not recommended; lactation. Lactation: Drug enters breast milk; use with caution (American Academy of Pediatrics Committee states that drug is "compatible" with nursing)

Pregnancy-Lactation

Interactions

Reversible malabsorption of vitamin B12 may occur because of ileal mucosal function alteration. Response to CNS depressants and sympathomimetics may increase when used concurrently with colchicine. Increased risk of myopathy when used concurrently with simvastatin. Potentially Fatal: With ciclosporin, increased risk of nephrotoxicity and myotoxicity. Risk of colchicine toxicity when used with macrolides.

Adverse Effects

Side effects of Colchicine : >10% Gastrointestinal (GI) effects (eg, diarrhea, nausea, cramping, abdominal pain, vomiting) (26-77%) 1-10% Fatigue (1-4%),Gout (0-4%),Pharyngolaryngeal pain (2-3%),Headache (1-2%)

Mechanism of Action

Colchicine, a phenanthrene derivative, exerts its effect by reducing the inflammatory response to the deposited urate crystals and also by diminishing phagocytosis in joints. It inhibits lactic acid production by leucocytes, thereby interrupting urate deposition and inflammatory response that sustains the acute gout attack.