II. Indications

  1. Acute Gouty Arthritis (adjunct to NSAIDs)
  2. Gout prophylaxis (started with Allopurinol to prevent triggering acute attack)
  3. Acute Pericarditis

III. Disadvantages

  1. Less viable option (too expensive) now that generic preparations were removed from the market
    1. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm227796.htm
    2. Use NSAIDs instead

IV. Contraindications

  1. Severe renal or liver disease (see adverse effects below)
    1. If used, limit to the 3 dose protocol below and do not repeat for 2 weeks
    2. Do not use with Cyclosporine or Cytochrome P450 3A4 Inhibitor if severe liver or renal disease (lethal interaction)

V. Dosing: Gout in normal Renal Function

  1. See Gout for prophylaxis protocol when starting allopurinal
  2. Tolerable Protocol (as adjunct to NSAIDs)
    1. Start within 24 hours of attack
    2. Option 1: Colchicine 0.6 mg orally twice daily
    3. Option 2: Colchicine 0.6 mg two taken immediately, then a third one hour later
      1. New protocol (2010) - recommended dosing for Colcrys
  3. Old Protocol (Not recommended - poorly tolerated due to Diarrhea, serious toxicity)
    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
  4. Endpoints
    1. Joint Pain improves
    2. Diarrhea
    3. Maximum Dose: 6 mg in 24 hours

VI. 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

VII. 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. Reversible Axonal Neuromyopathy (1% of cases)
    1. Increased risk if severe liver or renal disease
  4. Alopecia

VIII. Monitoring: Baseline and repeated at 1 month

IX. Drug Interactions

  1. Cyclosporine
  2. Cytochrome P450 3A4 inhibitors (e.g. Clarithromycin, Verapamil)
    1. Do not use with with Macrolides (e.g. Clarithromycin, Azithromycin, Erythromycin)
  3. Drug Interactions also occur with P-Glycoprotein Inhibitors
  4. Avoid Grapefruit
  5. Rhabdomyolysis risk
    1. Increased risk when combined with Statins or Clarithromycin
    2. Increased risk with older patients and those with Chronic Kidney Disease

X. References

  1. (2011) Presc Lett 18(12): 70
  2. Borstad (2004) J Rheumatol 31:2429-32 [PubMed]

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Cost: Medications

colchicine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
COLCHICINE 0.6 MG CAPSULE Generic $4.15 each
COLCHICINE 0.6 MG TABLET Generic $0.37 each
colcrys (on 4/20/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
COLCRYS 0.6 MG TABLET Generic $0.37 each