Colchicine

Colchicine Brand Names

ColciGel | Colcrys | GLOPERBA | MITIGARE

What is Colchicine

Colchicine is an ancient antiinflammatory remedy; use of Colchicum alkaloid for the treatment of acute gout occurred as early as 1810, and reports of its medicinal value exist from the first century A.D.

Colchicine, an alkaloid derivative from the plant Colchicum autumnale, has been used in the treatment of acute gout for nearly two centuries and for joint pain since the 6th century.

It was long believed that the clinical response of acute arthritis to colchicine was diagnostic for gout, though this is not correct as other inflammatory arthropathies such as familial Mediterranean fever (FMF) and pseudogout also respond.

Colchicine is primarily used in the treatment and prevention of acute gout flares to reduce pain and inflammation.

The drug is also used for familial Mediterranean fever, a genetic autoinflammatory disease. Colchicine is a preferred agent to treat acute gout flares.

Additionally, low-dose colchicine may be continued as an antiinflammatory to reduce pain during the early phase of management (e.g., 8 weeks to 6 months, depending on clinical signs and symptoms such as tophi) following an acute flare while uric acid lowering treatment (ULT) is initiated; the NSAIDs or corticosteroids are also options according to the American College of Rheumatology (ACR), European League Against Rheumatism (EULAR), and American college of Physician (ACP) guidelines.

The ACR and EULAR guidelines recommend patients with gout receive ULT (e.g., allopurinol, febuxostat) prophylactically for management; ULT is essential at preventing the formation and deposition of crystals, thereby dissolving the tophi that create pain and joint inflammation.

Care must be used in the prescription of colchicine, regardless of acute or limited long-term use. Use of colchicine carries a significant risk of toxicity, which may be higher in those with significant renal or hepatic impairment.

Patients taking P-glycoprotein (P-gp) inhibitors or strong CYP3A4 inhibitors concurrently with colchicine are also at risk for toxicity and fatal drug-drug interactions have been reported.

Although used for centuries and marketed in the U.S. for decades, colchicine finally attained formal FDA approval in 2009.

Indications

  1. familial mediterranean fever
  2. gout
  3. gouty arthritis
  4. pseudogout

For the prevention and treatment of gout flares (gouty arthritis)

for the prevention of gout flares (gout prophylaxis)

Side Effects

  1. abdominal pain
  2. agranulocytosis
  3. alopecia
  4. anorexia
  5. aplastic anemia
  6. azoospermia
  7. diarrhea
  8. disseminated intravascular coagulation (DIC)
  9. elevated hepatic enzymes
  10. fatigue
  11. headache
  12. hematuria
  13. lactose intolerance
  14. leukopenia
  15. maculopapular rash
  16. myalgia
  17. myasthenia
  18. myopathy
  19. nausea
  20. neutropenia
  21. oligospermia
  22. oliguria
  23. pancytopenia
  24. paresthesias
  25. peripheral neuropathy
  26. purpura
  27. rash
  28. rhabdomyolysis
  29. spermatogenesis inhibition
  30. thrombocytopenia
  31. urticaria
  32. vitamin B12 deficiency
  33. vomiting
  34. weakness

Monitoring Parameters

  • CBC
  • LFTs
  • serum creatinine

Contraindications

  • accidental exposure
  • aplastic anemia
  • biliary obstruction
  • bone marrow suppression
  • breast-feeding
  • children
  • dialysis
  • geriatric
  • hepatic disease
  • infants
  • infertility
  • myopathy
  • neonates
  • potential for overdose or poisoning
  • pregnancy
  • renal disease
  • renal failure
  • renal impairment
  • reproductive risk
  • rhabdomyolysis

Interactions

  • Acidifying Agents
  • Aliskiren; Amlodipine
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Alkalinizing Agents
  • Amiodarone
  • Amlodipine
  • Amlodipine; Atorvastatin
  • Amlodipine; Benazepril
  • Amlodipine; Celecoxib
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amlodipine; Olmesartan
  • Amlodipine; Telmisartan
  • Amlodipine; Valsartan
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Amprenavir
  • Aprepitant, Fosaprepitant
  • Aspirin, ASA; Pravastatin
  • Atazanavir
  • Atazanavir; Cobicistat
  • Atorvastatin
  • Atorvastatin; Ezetimibe
  • Azithromycin
  • Boceprevir
  • Bortezomib
  • Brigatinib
  • Cabozantinib
  • Carvedilol
  • Ceritinib
  • Chloramphenicol
  • Ciprofloxacin
  • Citric Acid; Potassium Citrate
  • Citric Acid; Potassium Citrate; Sodium Citrate
  • Clarithromycin
  • Cobicistat
  • Conivaptan
  • Crizotinib
  • Cyanocobalamin, Vitamin B12
  • Cyclosporine
  • Daclatasvir
  • Darunavir
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Delavirdine
  • Dextromethorphan; Quinidine
  • Diazoxide
  • Digoxin
  • Diltiazem
  • Doravirine; Lamivudine; Tenofovir disoproxil fumarate
  • Dronedarone
  • Drospirenone; Ethinyl Estradiol; Levomefolate
  • Duvelisib
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elagolix
  • Elbasvir; Grazoprevir
  • Elexacaftor; tezacaftor; ivacaftor
  • Eliglustat
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Emtricitabine; Tenofovir disoproxil fumarate
  • Erythromycin
  • Erythromycin; Sulfisoxazole
  • Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
  • Etravirine
  • Everolimus
  • Ezetimibe; Simvastatin
  • Fedratinib
  • Fenofibrate
  • Fenofibric Acid
  • Fibric acid derivatives
  • Fluconazole
  • Fluvastatin
  • Fluvoxamine
  • Fosamprenavir
  • Fostamatinib
  • Gemfibrozil
  • Glecaprevir; Pibrentasvir
  • grapefruit juice
  • HMG-CoA reductase inhibitors
  • Ibrutinib
  • Idelalisib
  • Imatinib
  • Indinavir
  • Isavuconazonium
  • Isoniazid, INH
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Istradefylline
  • Itraconazole
  • Ivacaftor
  • Ixabepilone
  • Ketoconazole
  • Lamivudine; Tenofovir Disoproxil Fumarate
  • Lapatinib
  • Larotrectinib
  • Ledipasvir; Sofosbuvir
  • Lefamulin
  • Letermovir
  • Levomefolate
  • Lomitapide
  • Lopinavir; Ritonavir
  • Lovastatin
  • Lovastatin; Niacin
  • Lumacaftor; Ivacaftor
  • Lumacaftor; Ivacaftor
  • Mifepristone
  • Mitotane
  • Nefazodone
  • Nelfinavir
  • Neratinib
  • Netupitant, Fosnetupitant; Palonosetron
  • Niacin; Simvastatin
  • Nicardipine
  • Nilotinib
  • Ombitasvir; Paritaprevir; Ritonavir
  • Oritavancin
  • Osimertinib
  • Palbociclib
  • Pazopanib
  • Perindopril; Amlodipine
  • Pitavastatin
  • Ponatinib
  • Posaconazole
  • Potassium Bicarbonate
  • Potassium Chloride
  • Potassium Citrate
  • Pravastatin
  • Propafenone
  • Pyrazinamide, PZA
  • Quinidine
  • Quinine
  • Ranolazine
  • Ribociclib
  • Ribociclib; Letrozole
  • Ritonavir
  • Rosuvastatin
  • Rucaparib
  • Sapropterin
  • Saquinavir
  • Sarecycline
  • Simeprevir
  • Simvastatin
  • Simvastatin; Sitagliptin
  • Sofosbuvir; Velpatasvir; Voxilaprevir
  • Sorafenib
  • Sulfinpyrazone
  • Sympathomimetics
  • Tacrolimus
  • Telaprevir
  • Telithromycin
  • Telotristat Ethyl
  • Temsirolimus
  • Tenofovir, PMPA
  • Tetrahydrozoline
  • Tezacaftor; Ivacaftor
  • Tipranavir
  • Trandolapril; Verapamil
  • Ulipristal
  • Vemurafenib
  • Venetoclax
  • Verapamil
  • Voriconazole
  • Zonisamide
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