Colchicine

Indications
 Oral
Acute gout
Adult: Initial dose: 1 mg, reduce to 0.5 mg every 2-3 hr until pain relief is achieved or GI toxicity occurs. Course may be repeated after at least 3 drug-free days. Max dose: 6 mg/course.
Renal impairment: Not exceeding 600 mcg daily in patients with CrCl ≤50 ml/min.
Oral
Prophylaxis of recurrent gouty arthritis
Adult: 0.5-0.6 mg once daily. Up to 1.8 mg daily may be required in some patients. Dosage range: 0.6 mg every other day to 0.6 mg tid.
Renal impairment: Not exceeding 600 mcg daily in patients with CrCl ≤50 ml/min.
Hepatic impairment: Severe: Contra-indicated.
Intravenous
Acute gout
Adult: 1 or 2 mg over 2-5 minutes. May give additional doses of 0.5-1 mg every 6 hr up to a total of not more than 4 mg/24 hr. Once the max dose has been reached, further doses should not be given via any route for at least 7 days.
Renal impairment: Not to be given to patients undergoing haemodialysis.
CrCl (ml/min)Dosage Recommendation
10-50Reduce dose by 50%.
<10Avoid use.
Hepatic impairment: IV dose should be reduced by at least 50%.

Incompatibility: 5% dextrose injection, bacteriostatic 0.9% sodium chloride injection.
Contraindications
 Hypersensitivity; blood dyscrasias, severe renal impairment, pregnancy, debilitated patients; SC/IM admin.
Warnings / Precautions
 Elderly; GI disease. Cardiac, renal and hepatic impairment; prolonged therapy not recommended; lactation.
Adverse Reactions
 Nausea, vomiting and abdominal pain; diarrhoea, GI haemorrhage, rashes, renal and hepatic damage in excessive doses. Rarely peripheral neuritis, myopathy, alopecia and with chronic therapy blood disorders like agranulocytosis, aplastic anaemia.
Overdose Reactions
 Symptoms include nausea, anorexia, abdominal pain, vomiting, dehydration, paralytic ileus, muscular weakness, severe bloody diarrhoea, stomatitis, arthralgia, malaise, hypocalcaemia, fever, rashes, renal damage, hepatomegaly and liver tenderness with elevated liver enzymes, shock and CV collapse (due to extreme vascular damage), bone marrow depression, respiratory depression. Mental confusion, delirium, and seizures may occur. No specific antidote for colchicine poisoning although colchicine-specific Fab fragments prepared from goat antiserum (not commercially available) have been used in the potentially life-threatening colchicine toxicity to increase urinary excretion. Gastric lavage or emesis followed by activated charcoal if orally ingested. Treatment is symptomatic and supportive. Abdominal pain may be relieved by atropine or morphine. Filgrastim has been used in the treatment of pancytopenia resulting from colchicine toxicity.
Drug 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.
See Below for More colchicine Drug Interactions
Mechanism of Actions
 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.
Absorption: Peak plasma concentrations after 2 hr (oral).
Distribution: Leucocytes, kidneys, liver and spleen (high concentrations). Protein-binding: 10-31%.
Metabolism: Partially hepatic via deacetylation.
Excretion: Faeces and urine. Elimination half-life: 12-30 min (adult), 45 min (renal disease).
Administration
 Should be taken with food.
Storage Conditions
 Intravenous: Store below 30°C. Oral: Store below 30°C.
ATC Classification
 M04AC01 - colchicine ; Belongs to the class of preparations with no effect on uric acid metabolism. Used in the treatment of gout.
Storage
 Intravenous: Store below 30°C. Oral: Store below 30°C.
Available As
  • Colchicine 0.5 mg

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