Colchicine

Dosage Forms

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Tablet

500 micrograms

Uses

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Acute gout
Short-term prophylaxis during initial therapy with allopurinol and uricosuric drugs

Dose and Duration

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Acute gout

Adult:1 mg initially, then 500 micrograms every 2–3 hours until pain relief is obtained or vomiting or diarrhoea occurs (max 6 mg). Do not repeat course within 3 days

Short-term prophylaxis during initial therapy with allopurinol or uricosuric drugs

Adult: 500 micrograms every 8–12 hours

Contraindications

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Blood disorders
Patients on dialysis
Severe renal impairment
Patients with renal or hepatic impairment taking P-glycoprotein or a strong CYP3A4 inhibitor

Side Effects

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Nausea, vomiting, abdominal pain, profuse diarrhoea, gastrointestinal haemorrhage
Skin rash
Renal and hepatic damage
Bone marrow suppression on prolonged treatment
In overdose: burning in mouth and throat, difficulty in swallowing, nausea, vomiting, abdominal pain, and diarrhoea
Delayed signs of overdose: confusion, reduced cardiac output, arrhythmias, respiratory distress, hyperpyrexia, bone marrow suppression, renal and hepatic impairment

Interactions

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Amiodarone, azithromycin, clarithromycin, erythromycin, itraconazole, atazanavir, indinavir, ritonavir, diltiazem, verapamil, grapefruit juice (increased risk of colchicine toxicity)
Digoxin, fenofibrate, gemfibrozil, simvastatin, atorvastatin, rosuvastatin (possible increased risk of myopathy)
Ciclosporin (increased risk of nephro- and myotoxicity)

Pregnancy

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Do not use

Breastfeeding

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Can be used

⚠️ Caution

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Use with caution in hepatic impairment, elderly and debilitated patients due to higher risk of cumulative toxicity
Reduce dose or increase dosage interval if eGFR is 10–50 ml/minute/1.73 m²
Colchicine may be teratogenic in humans
Colchicine has a narrow therapeutic window and is very toxic in overdose. Symptoms of toxicity may be delayed for up to 6 hours or 1 week or longer for some features