Colchicine

Colchicine is a medicine used in the treatment and prevention of gout. It reduces inflammation which causes pain, swelling, and other symptoms of gout. Colchicine can be taken with or without food. You should take it regularly and at the same time each day to get the maximum benefit from it. Keep taking it as recommended by your doctor and complete the dose even if you feel better. If you stop, your symptoms may get worse.

In gout, crystals of uric acid are deposited in certain joints. White blood cells migrate to the areas of the body where uric acid has been deposited. They attempt to engulf the crystals, and as a result, lactic acid and pro-inflammatory enzymes are released. These substances give rise to the characteristic pain and swelling of gout. Colchicine inhibits the migration of the white blood cells into the inflamed area, causing a reduction in pain and inflammation.

• Treatment of acute gout flares
• Prophylaxis of gout (intercritical periods)
• Prevention of gout attacks during surgery
• Familial Mediterranean Fever (FMF) - patients 4 years and older

An acute attack of gout apparently occurs as a result of an inflammatory reaction to crystals of monosodium urate that are deposited in the joint tissue from hyperuric body fluids; the reaction is aggravated as more urate crystals accumulate. Leukocytes migrate to the sites where urate crystals have been deposited and try to engulf the crystals by phagocytosis. As a result lactic acid and proinflammatory enzymes are released which cause inflammation with severe pain, redness, and swelling of the affected joint. Lactic acid favors a local decrease in pH that enhances uric acid deposition. Colchicine inhibits the phagocytosis of uric acid by leukocytes & also diminishes the lactic acid production directly. Thus interrupts the cycle of urate crystal deposition and inflammatory response that sustains the acute attack of gout.

Colchicine reduces the inflammatory response to deposited urate crystals and diminishes phagocytosis in joints. It inhibits lactic acid production by leukocytes, thereby interrupting urate deposition and the inflammatory response that sustains the acute gout attack.

Acute Gout Flare (Adult): 1.2 mg at first sign, then 0.6 mg 1 hour later; not to exceed 1.8 mg in 1 hour. Alternative: 1-1.2 mg first dose, then 0.6 mg every 2 hours until pain and inflammation subside.

Gout Prophylaxis (Adult): 0.6 mg once daily or every 12 hours; not to exceed 1.2 mg/day.

FMF (Adult): 1.2-2.4 mg/day (single dose or divided every 12 hours); increase by 0.3 mg/day as needed; max 2.4 mg/day.

Pediatric Dose (FMF - 12 years): 1.2-2.4 mg/day.

Surgical Prophylaxis: 0.6 mg three times daily for 3 days before and 3 days after surgery.

Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Colchicine may be taken with or without food, but it is better to take it at a fixed time.

If you miss a dose of Colchicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.

Common Side Effects:

• Nausea
• Vomiting
• Abdominal pain
• Diarrhea
• Pharyngolaryngeal pain

Serious Side Effects: Myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, aplastic anemia.

• [UNSAFE] Colchicine may decrease alertness, affect your vision or make you feel sleepy and dizzy. Do not drive if these symptoms occur.
• Inform your doctor if you have serious nausea, vomiting, diarrhea, or tingling in your fingers or toes.
• It can lower your body's ability to make new blood cells. Inform your doctor if you have frequent bleeding, bruising, fevers, or if you are always tired.
• Do not take Colchicine if you have severe liver disease, kidney disease, or if you are pregnant or breastfeeding.

• Hypersensitivity
• Blood dyscrasias
• Severe renal impairment
• Pregnancy
• Debilitated patients
• SC/IM administration

Reversible malabsorption of vitamin B12 may occur due to ileal mucosal function alteration. Response to CNS depressants and sympathomimetics may increase. Increased risk of myopathy with simvastatin. With ciclosporin, increased risk of nephrotoxicity and myotoxicity. Risk of colchicine toxicity with macrolides.

[CAUTION] Caution is advised when consuming alcohol with Colchicine. Please consult your doctor.

[CONSULT YOUR DOCTOR] Colchicine may be unsafe to use during pregnancy. Pregnancy Category C.

[SAFE IF PRESCRIBED] Colchicine is probably safe to use during breastfeeding. Limited human data suggests that the drug does not represent any significant risk to the baby. Colchicine is excreted into human milk.

Gout is rare in pediatric patients. Safety and effectiveness of Colchicine in pediatric patients have not been established. For FMF, children 4 years and older may be treated.

Limited information is available regarding dose adjustment for elderly patients.

[CAUTION] Use with caution in patients with kidney disease. Dose adjustment may be needed. Use should preferably be avoided in serious kidney disease.

[CAUTION] Use with caution in patients with severe liver disease. Dose adjustment may be needed. Close monitoring is recommended for patients with mild to moderate liver disease but dose adjustment is not necessary.

The exact dose that produces significant toxicity is unknown. Ingestion of less than 0.5 mg/kg typically results in milder toxicities (gastrointestinal symptoms), while 0.5-0.8 mg/kg may cause severe reactions (myelosuppression).

Store below 30°C temperature. Protect from light and moisture. Keep out of reach of children.

Colchicine