different manifestations of colchicine toxicity and identify patients most at risk
Risk factors for toxicity include: old age, renal impairment, hepatic impairment, chronic use, and concomitant interacting medications. Most adverse effects are related to dose and duration.
- • Common: gastrointestinal (GI) effects (nausea, vomiting, & especially diarrhea) can occur even at recommended doses.
- • Acute toxicity: renal failure, circulatory collapse, marrow failure, rhabdomyolysis, and respiratory failure.
- • Chronic toxicity: most common in elderly, renal insufficiency, and interacting medications. Bone marrow suppression (thrombocytopenia, leukopenia), neuromyopathy (elevated creatinine kinase, proximal weakness, peripheral neuropathy, lysosomal vacuoles on biopsy).
- • Rare (<1%) but notable effects: alopecia, azoospermia, oligospermia, amenorrhea, dysgeusia, central nervous system dysfunction, malabsorption syndrome (especially of vitamin B12), hemorrhagic gastritis.