Published: 15 December 2014

Publications

Keeping Patients Informed about Colchicine Use

This article is more than five years old. Some content may no longer be current.

Prescriber Update 35(4): 49
December 2014

Earlier this year, the Centre for Adverse Reactions Monitoring (CARM) received a report of a patient who had died due to colchicine toxicity. The patient, who had a history of gout, had incorrectly self-administered colchicine to relieve acute severe pain.

Colchicine is indicated for the treatment of acute gout when non-steroidal anti-inflammatory drugs are contraindicated or have previously been unsuccessful.

While in this reported case the patient had been previously warned of the risk of taking more medication than was prescribed, it is an important reminder that incorrect use of colchicine can be fatal. Patients need to be informed that colchicine has a narrow therapeutic index and must understand that they must not take any more medicine than instructed.

Colchicine toxicity may also occur as a result of interactions. In particular, interactions occur with medicines that inhibit CYP3A4 (such as protease inhibitors, imidazoles and clarithromycin) and P-gp (such as ciclosporin, ketoconazole, protease inhibitors, and tacrolimus).

Early symptoms of colchicine toxicity include nausea, vomiting, diarrhoea and abdominal pain. Delayed signs and symptoms include seizures, cardiac dysrhythmias, hypotension and pancytopenia as well as respiratory, renal, and hepatic failure. Patients prescribed colchicine should be advised that if they experience these early symptoms they should stop the medicine and see a doctor immediately.

There is no specific antidote for colchicine toxicity; treatment is supportive.