Rheumatology Book

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Colchicine

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  1. Indications
    1. Acute Gouty Arthritis (adjunct to NSAIDs)
    2. Gout prophylaxis (started with Allopurinol to prevent triggering acute attack)
  2. Contraindications
    1. Severe renal or liver disease (see adverse effects below)
  3. Dosing: Gout in normal Renal Function
    1. Tolerable Protocol (as adjunct to NSAIDs)
      1. Colchicine 0.6 mg orally twice daily started within 24 hours of attack
    2. Old Protocol (poorly tolerated due to Diarrhea)
      1. Start: 1.0 mg given within 24 hours of attack
      2. Then: 0.5 mg each hour or 1.0 mg every 2 hours prn
    3. Endpoints
      1. Joint pain improves
      2. Diarrhea
      3. Maximum Dose: 6 mg in 24 hours
  4. Dosing: Renal dose adjustment
    1. GFR >50 ml/minute: 0.6 mg orally twice daily
    2. GFR 35-50 ml/minute: 0.6 mg orally once daily
    3. GFR 10-34 ml/minute: 0.6 mg orally every 2-3 days
    4. GFR <10 ml/minute: Do NOT use
  5. Adverse Effects
    1. Gastrointestinal toxicity (limits dosing)
      1. Nausea or Vomiting
      2. Diarrhea
    2. Bone Marrow suppression (esp. if severe liver or renal disease)
    3. Myopathy (esp. if severe liver or renal disease)
    4. Alopecia
  6. References
    1. Borstad (2004) J Rheumatol 31:2429

Colchicine (C0009262)

Definition (MSH)A major alkaloid from Colchicum autumnale L. and found also in other Colchicum species. Its primary therapeutic use is in the treatment of gout, but it has been used also in the therapy of familial Mediterranean fever (PERIODIC DISEASE).
Definition (CSP)inhibits tubulin-tubulin binding and thus destabilizes microtubules; used to block mitosis, axonal transport, and other microtubule dependent cellular functions in vitro, and clinically to treat gout.
Definition (SPN)A general purpose reagent is a chemical reagent that has general laboratory application, that is used to collect, prepare, and examine specimens from the human body for diagnostic histopathology, cytology, and hematology, and that is not labeled or otherwise intended for a specific diagnostic application. General purpose reagents include cytological preservatives, decalcifying reagents, fixatives and adhesives, tissue processing reagents, isotonic solutions, and pH buffers.
Definition (PDQ)An alkaloid isolated from Colchicum autumnale with anti-gout and anti-inflammatory activity. The exact mechanism of action by which colchicines exerts its effect has not been completely established. Colchicine binds to tubulin, thereby interfering with the polymerization of tubulin, interrupting microtubule dynamics, and disrupting mitosis. This leads to an inhibition of migration of leukocytes and other inflammatory cells, thereby reducing the inflammatory response to deposited urate crystals. Colchicine may also interrupt the cycle of monosodium urate crystal deposition in joint tissues, thereby also preventing the resultant inflammatory response. Overall, colchicine decreases leukocyte chemotaxis/migration and phagocytosis to inflamed areas, and inhibits the formation and release of a chemotactic glycoprotein that is produced during phagocytosis of urate crystals. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39188&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39188&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C385" NCI Thesaurus)
Definition (NCI)An alkaloid isolated from Colchicum autumnale with anti-gout and anti-inflammatory activity. The exact mechanism of action by which colchicines exerts its effect has not been completely established. Colchicine binds to tubulin, thereby interfering with the polymerization of tubulin, interrupting microtubule dynamics, and disrupting mitosis. This leads to an inhibition of migration of leukocytes and other inflammatory cells, thereby reducing the inflammatory response to deposited urate crystals. Colchicine may also interrupt the cycle of monosodium urate crystal deposition in joint tissues, thereby also preventing the resultant inflammatory response. Overall, colchicine decreases leukocyte chemotaxis/migration and phagocytosis to inflamed areas, and inhibits the formation and release of a chemotactic glycoprotein that is produced during phagocytosis of urate crystals.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD003078
EnglishCOLCHCINE, Colchicine, COLCHICINE PREPARATION
Spanishcolchicina
Parent ConceptsAlkaloids (C0002062), Antimitotic Agents (C0003379), Gout Suppressants (C0018100), cycloheptane (C0178579), Colchicine-Site Binding Agent (C1880116), Colchicum alkaloid (C0360273), Drug allergen (C1320237), Antigout Agents (Non-renal Tubular Blocking Agents and Non-xanthine Inhibitors) (C1579371)
SourcesAOD, CSP, LNC, MSH, MTHSPL, NCI, NDFRT, PDQ, RXNORM, SCTSPA, SNOMEDCT, SPN, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)



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