Colchicine: Targeted Relief for Gout and Familial Mediterranean Fever
| Product dosage: 0.5mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 60 | $0.95 | $57.29 (0%) | 🛒 Add to cart |
| 90 | $0.79 | $85.93 $71.36 (17%) | 🛒 Add to cart |
| 120 | $0.70 | $114.58 $84.43 (26%) | 🛒 Add to cart |
| 180 | $0.63 | $171.87 $112.57 (35%) | 🛒 Add to cart |
| 270 | $0.57 | $257.80 $152.77 (41%) | 🛒 Add to cart |
| 360 | $0.54
Best per pill | $343.73 $193.98 (44%) | 🛒 Add to cart |
Synonyms | |||
Colchicine is a time-tested, orally administered medication derived from the autumn crocus (Colchicum autumnale). It is a first-line therapeutic agent primarily indicated for the treatment and prophylaxis of acute gout flares and for the management of Familial Mediterranean Fever (FMF). Its mechanism of action is distinct from NSAIDs and corticosteroids, functioning as a microtubule polymerization inhibitor, which disrupts inflammatory pathways mediated by neutrophils. This profile provides a comprehensive, evidence-based overview for healthcare professionals to ensure safe and effective clinical application.
Features
- Active Ingredient: Colchicine.
- Standard Formulations: Oral tablets (typically 0.6 mg).
- Pharmacologic Class: Anti-gout agent, microtubule inhibitor.
- Mechanism of Action: Binds to tubulin, inhibiting microtubule assembly, which subsequently reduces neutrophil chemotaxis, phagocytosis, and inflammatory cytokine release.
- Bioavailability: Approximately 45%; significant first-pass metabolism.
- Half-life: ~27-31 hours in healthy adults; prolonged in patients with hepatic or renal impairment.
- Primary Excretion: Biliary and fecal; renal excretion accounts for 10-20% of unchanged drug.
Benefits
- Rapid Onset for Acute Gout: Effectively reduces the pain, swelling, and duration of acute gouty arthritis attacks when administered promptly.
- Prophylactic Efficacy: Low-dose regimens significantly reduce the frequency and severity of future gout flares, particularly during the initial months of urate-lowering therapy.
- Disease Modification in FMF: Provides critical symptomatic control and helps prevent damaging amyloidosis in patients diagnosed with Familial Mediterranean Fever.
- Specific Anti-inflammatory Action: Targets neutrophil-driven inflammation without the gastrointestinal risks commonly associated with high-dose NSAIDs or the metabolic side effects of corticosteroids.
- Well-Established Safety Profile: When used at appropriate, weight- and function-adjusted doses, it is a predictable and reliable therapeutic option.
Common use
Colchicine is FDA-approved for the treatment of acute gout flares and for the prophylaxis of gout flares. It is also approved for the treatment of Familial Mediterranean Fever (FMF). Its use in acute gout is most effective when initiated within 36 hours of symptom onset. Off-label, it is sometimes used in the management of other inflammatory conditions, such as pericarditis, Behçet’s disease, and pseudogout (calcium pyrophosphate deposition disease), though evidence and dosing regimens for these indications can vary.
Dosage and direction
Dosing is critically dependent on the indication, patient’s renal and hepatic function, and concomitant medications. Always consult official prescribing information.
- Acute Gout Flare: A loading dose of 1.2 mg (two 0.6 mg tablets) at the first sign of a flare, followed by 0.6 mg one hour later. The total course for an acute flare is 1.8 mg over one hour. This regimen should not be repeated for at least three days.
- Gout Flare Prophylaxis: 0.6 mg once or twice daily. Maximum prophylactic dose is typically 0.6 mg twice daily. Dose reduction is required in patients with renal or hepatic impairment.
- Familial Mediterranean Fever (FMF): 1.2 to 2.4 mg daily. The dose may be increased by 0.3 mg per day to a maximum of 2.4 mg daily (1.2 mg twice daily). Dosing is highly individualized based on efficacy and tolerability.
- Administration: Can be taken with or without food. If gastrointestinal upset occurs, administration with food may be beneficial.
Precautions
- Organ Impairment: Use with extreme caution and at reduced doses in patients with renal impairment (CrCl <30 mL/min) or hepatic impairment. Dose adjustment or avoidance is mandatory.
- Elderly Patients: Increased susceptibility to neuromyotoxicity and bone marrow suppression. Initiate therapy at the lower end of the dosing spectrum and monitor closely.
- Blood Monitoring: Periodic complete blood counts (CBC) should be considered in patients on long-term therapy to monitor for myelosuppression (e.g., leukopenia, granulocytopenia, thrombocytopenia, aplastic anemia).
- Neuromuscular Toxicity: Monitor for symptoms of myotoxicity (muscle pain, weakness, tenderness) and peripheral neuropathy, especially in elderly and debilitated patients or those with renal/hepatic dysfunction. This may necessitate discontinuation.
- P-Glycoprotein (P-gp) and CYP3A4 Inhibitors: Concomitant use is a major risk factor for toxicity (see Drug Interactions).
Contraindications
- Patients with severe renal impairment (e.g., end-stage renal disease on dialysis) or severe hepatic impairment.
- Concomitant administration of strong P-glycoprotein (P-gp) or strong CYP3A4 inhibitors (e.g., clarithromycin, ketoconazole, cyclosporine) in patients with renal or hepatic impairment. This combination is contraindicated due to the high risk of life-threatening colchicine toxicity.
- Known hypersensitivity to colchicine or any component of the formulation.
Possible side effect
Side effects are often dose-related and more common with acute dosing.
- Very Common (>10%): Gastrointestinal disturbances including diarrhea, nausea, vomiting, and abdominal pain.
- Common (1-10%): Pharyngolaryngeal pain.
- Uncommon (<1%): Myelosuppression (leukopenia, neutropenia, thrombocytopenia, aplastic anemia), myopathy (muscle pain, weakness, rhabdomyolysis), peripheral neuropathy, alopecia.
- Rare: Dermatological reactions (e.g., rash), hepatotoxicity.
Drug interaction
Colchicine is a substrate for both CYP3A4 and P-glycoprotein (P-gp). Interactions can be severe and fatal.
- Strong CYP3A4/P-gp Inhibitors (CONTRAINDICATED or requires major dose adjustment): Clarithromycin, ketoconazole, itraconazole, ritonavir, cyclosporine. Concomitant use dramatically increases colchicine plasma levels, leading to toxicity.
- Moderate/Weak CYP3A4/P-gp Inhibitors: Use with caution. Examples include erythromycin, verapamil, diltiazem, dronedarone.
- Statins (HMG-CoA Reductase Inhibitors) and Fibrates: Increased risk of myopathy and rhabdomyolysis. Monitor for muscle pain or weakness.
- Digoxin: Colchicine may increase digoxin concentrations.
- CNS Depressants: May potentiate their effects.
Missed dose
- If a dose is missed for prophylaxis or FMF, it should be taken as soon as it is remembered.
- However, if it is almost time for the next scheduled dose, the missed dose should be skipped. The patient should not double the dose to make up for the missed one.
Overdose
Colchicine overdose is a MEDICAL EMERGENCY and can be FATAL. Symptoms are delayed 2-24 hours and manifest in three phases:
- Gastrointestinal Phase (10-24h): Nausea, vomiting, diarrhea, abdominal pain, fluid losses leading to hypovolemic shock.
- Multi-Organ Failure Phase (24-72h): Myelosuppression (pancytopenia), metabolic acidosis, arrhythmias, rhabdomyolysis, acute renal failure, adult respiratory distress syndrome (ARDS), and progressive multisystem organ failure.
- Recovery Phase ( survivors): Rebound leukocytosis, alopecia. Treatment is supportive: Gastric lavage (if very early), aggressive fluid and electrolyte replacement, hemodynamic support, and use of granulocyte colony-stimulating factor (G-CSF) for marrow aplasia. There is no specific antidote.
Storage
- Store at room temperature (20°C to 25°C or 68°F to 77°F).
- Keep the container tightly closed.
- Protect from light and moisture.
- Keep out of reach of children and pets.
Disclaimer
This information is for educational purposes and is intended for healthcare professionals. It is not exhaustive and does not replace the official prescribing information or professional medical advice, diagnosis, or treatment. Always consult the full FDA-approved prescribing information and exercise your own professional judgment when treating patients. Dosage must be individualized based on the patient’s specific clinical status, organ function, and concomitant medications.
Reviews
- “Colchicine remains a cornerstone of gout management. Its efficacy in aborting acute flares is excellent if used early. The key to safety is strict adherence to modern low-dose regimens and vigilant management of drug interactions.” – Rheumatologist, 15 years experience
- “In my FMF patients, colchicine is a life-changing and often life-saving therapy. It prevents debilitating attacks and the development of renal amyloidosis. Monitoring for GI side effects initially is crucial for adherence.” – Clinical Immunologist
- “While highly effective, colchicine’s narrow therapeutic index demands respect. I have seen several cases of severe toxicity from inappropriate dosing in renal impairment or from drug interactions. Education is paramount.” – Clinical Pharmacist, Nephrology unit