What You Should Know About Colchicine

Indications, Dosages, and Common Side Effects

Foot pain from gout.
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Colchicine is a prescription medication available under the brand name Colcrys or in generic form. Colchicine is a preferred treatment for gouty arthritis and is derived from the dried seeds of Colchicum autumnale (also known as the autumn crocus or meadow saffron).

Indications

The use of C. autumnale alkaloids for the treatment of gout dates back to 1810. The medicinal value of colchicum was reported back in the first century A.D. Colchicine can be used to manage conditions other than gout, including:

  • Amyloidosis
  • Behcet's disease
  • Dermatitis herpetiformis
  • Familial Mediterranean fever
  • Paget's disease
  • Pericarditis
  • Pseudogout
  • Biliary and hepatic cirrhosis

Mechanism of Action

While colchicine has potent anti-inflammatory properties, its efficacy in treating pain other than gout is limited. Colchicine is not considered analgesic (pain relieving) and does nothing to alter high uric acid levels associated with gout.

Colchicine works by binding to a type of white blood cell called a neutrophil. By doing so, the cells are unable to migrate to areas where uric acid crystals have accumulated. This tempers the inflammatory response and, with it, much of the pain.

Colchicine also has a suppressive effect that helps to decrease acute gout attacks, thereby relieving pain and discomfort associated with gout.

Dosages

Colchicine is available in two oral strengths: 0.5 (milligram) mg and 0.6 mg tablets. For the treatment of acute gout, the recommended dosage for adults is 1.2 mg taken at first sign of an attack followed by 0.6 mg one hour later. You can continue with additional 0.6 doses every two to three hours, taking care never to exceed 1.8 mg per hour.

The drug should be stopped if there is gastrointestinal discomfort or diarrhea.

Gout Prevention

Colchicine is also recommended for regular use between attacks for prophylactic (preventive) therapy.

In people who have less than one gout attack per year, the usual dose is 0.5 or 0.6 mg per day, three or four days a week. For those who have more than one attack per year, the usual dose is 0.5 or 0.6 mg daily. Severe cases may require two or three 0.5 mg or 0.6 mg tablets daily.

While colchicine is reserved for use in adults with acute gout flares, it can be used prophylactically in adolescents 16 and over. Its only approved use in children is for the treatment of familial Mediterranean fever (FMF).

Side Effects

Adverse reactions can occur with colchicine use and it's important for you to be aware of that potential. Bone marrow depression, with aplastic anemia, with agranulocytosis, or with thrombocytopenia may occur in people receiving long-term therapy.

Other possible adverse reactions include:

  • Peripheral neuritis
  • Purpura
  • Myopathy
  • Hair loss
  • Reversible azoospermia (complete absence of sperm)

Vomiting, diarrhea, and nausea are side effects that may occur with colchicine therapy, especially when the maximum doses are prescribed. To decrease side effects, colchicine may be taken with food.

Considerations and Contraindications

Pregnant women must weigh the risks and benefits of colchicine use. Colchicine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Colchicine can arrest cell division, so it may be a significant risk to take the drug while pregnant. Caution should also be exercised when colchicine is administered to a woman who is nursing.

Colchicine should also not be used by a person with a known hypersensitivity to the drug, or by anyone with a serious gastrointestinal, renal, hepatic, or cardiac disorder. Also, people with blood disorders should not use colchicine.

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