Colchicine

Sounds like 'KOL-chi-seen'

Overview
Clinicians

Easy-to-read medicine information about colchicine – what it is, how to take colchicine safely and possible side effects.

Type of medicine	Also called
Anti-gout medication (used to treat gout)	Colgout®

What is colchicine?

Colchicine is used for the treatment of gout flares to relieve pain and swelling. It is also used for the prevention of gout attacks while starting on urate-lowering therapy such as allopurinol, febuxostat or benzbromarone. In New Zealand, colchicine is available as tablets (0.5 mg).

How does colchicine work?

Colchicine works by reducing the buildup of uric acid crystals in the affected joints and in this way reduces pain and swelling from gout. It is usually used when other medicines for gout like non-steroidal anti-inflammatories cannot be used or don’t work well enough. Read more about gout.

Watch a video about colchicine for gout.

Dose

Colchicine is considered a high-risk medication because it can cause serious side effects. There isn’t a big difference between a safe dose of colchicine and a harmful dose. Always take colchicine exactly as your doctor has told you to.

The pharmacy label on your medicine will tell you how much colchicine to take, how often to take it, and any special instructions.
Never take more than the prescribed dose.
Taking too much colchicine can cause serious problems.

Dosing information
Dose for the treatment of a gout attack or gout flare Colchicine works best if you take it at the first sign (within 12 hours) of an acute gout attack. Take 2 tablets at the same time, followed by 1 tablet one hour later. Wait 12 hours before taking another tablet. If you get nausea and diarrhoea (runny poos), stop taking colchicine.
Colchicine for the prevention of gout attacks (prophylactic colchicine) Colchicine can be used for the prevention of gout attacks while starting on urate-lowering therapy such as allopurinol, febuxostat or benzbromarone. The prophylactic dose is 1 tablet twice daily for 6 months while urate-lowering therapy is introduced, or for 3–6 months after target serum urate has been achieved. Your doctor may reduce your dose to 1 tablet once daily if you get runny poos (diarrhoea), or your dose may be further reduced to 1 tablet on alternate days if necessary. It is generally recommended that colchicine is continued for 3–6 months after target serum urate has been achieved with these medicines.

Dosing information

Dose for the treatment of a gout attack or gout flare

Colchicine works best if you take it at the first sign (within 12 hours) of an acute gout attack.

Take 2 tablets at the same time, followed by 1 tablet one hour later.
Wait 12 hours before taking another tablet.
If you get nausea and diarrhoea (runny poos), stop taking colchicine.

Colchicine for the prevention of gout attacks (prophylactic colchicine)

Colchicine can be used for the prevention of gout attacks while starting on urate-lowering therapy such as allopurinol, febuxostat or benzbromarone.

The prophylactic dose is 1 tablet twice daily for 6 months while urate-lowering therapy is introduced, or for 3–6 months after target serum urate has been achieved.
Your doctor may reduce your dose to 1 tablet once daily if you get runny poos (diarrhoea), or your dose may be further reduced to 1 tablet on alternate days if necessary.

It is generally recommended that colchicine is continued for 3–6 months after target serum urate has been achieved with these medicines.

How to take colchicine

Swallow your colchicine tablet whole with a full glass of water.
Take colchicine with food to reduce stomach upset.
Avoid drinking alcohol while you are taking colchicine – it can cause stomach problems.
Do not drink grapefruit juice while you are on colchicine. This is because grapefruit juice increases the risk that you will experience side-effects from the colchicine.

Precautions – while taking colchicine

Colchicine can cause serious side effects. Here are a few precautions to reduce the risk of harmful effects.

Never take more than the dose prescribed by your doctor.
Stop taking colchicine immediately if you develop tummy pain, diarrhoea (runny poos), nausea or vomiting, even if you still have gout pain.
Tell your doctor or pharmacist about all other medications you are taking – colchicine can be harmful when taken with some other medicines like antibiotics and medicines for pain relief.
Always store colchicine out of reach of children – even a couple of tablets may be fatal for children.

Precautions – before taking colchicine

Do you have problems with your kidneys, heart or liver?
Do you have problems with your stomach or indigestion?
Do you have any blood disorders?
Are you pregnant, trying for a baby or breastfeeding?
Are you taking any other medicines? This includes any medicines you buy without a prescription, such as herbal and complementary medicines.

If so, it’s important that you tell your doctor or pharmacist before you start colchicine. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

Possible side effects

Colchicine can cause serious side effects, although not everyone gets them.

Signs of taking too much colchicine

There isn’t a big difference between a safe dose of colchicine and a harmful dose. People who are over 65 years of age are especially at risk. Signs that you may be taking too much colchicine include tummy pain, runny poos, vomiting or not feeling well (nausea) or a burning feeling in your throat, stomach or on your skin. If you get any of these symptoms, stop taking colchicine immediately and contact your doctor immediately or ring HealthLine 0800 611 116.

Side effects	What should I do?
Stomach pain Diarrhoea, vomiting or not feeling well (nausea) A burning feeling in your throat or on your skin	Stop taking colchicine immediately Tell your doctor immediately or ring HealthLine
Unusual bleeding or easy bruising Fever, sore throat Tiredness, muscle weakness, muscle cramps	Tell your doctor immediately or ring HealthLine
Loss of appetite Hair loss or thinning	Tell your doctor if troublesome

Interactions

Colchicine interacts with a few medications and herbal supplements, so check with your doctor or pharmacist.

Learn more

The following links have more information on colchicine:

Colchicine (Māori) New Zealand Formulary Patient Information
Colchicine SafeRx
Colgout Medsafe Consumer Information Sheet

References

Spotlight on colchicine Medsafe 2018
Keeping patients informed about colchicine use Medsafe 2014
Managing gout in primary care BPAC, 2018
Colchicine New Zealand Formulary

Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 30 Apr 2018

Information for clinicians

This section will be of most interest to clinicians (eg, nurses, doctors, pharmacists and specialists).

Medicines for gout flares

Medicines for gout flares are determined by the patient’s characteristics Patients with gout often initially present due to a flare, which will be the treatment priority. Patients should rest and elevate the affected joint during a gout flare and some may find the use of a ice pack beneficial. A NSAID, corticosteroids or colchicine may be prescribed to treat gout flares. Options for the treatment of gout flares are:

Naproxen 750 mg initially, 500 mg eight hours later, then 250 mg every eight hours until the flare has settled
Prednisone 20 – 40 mg, once daily, for five days; tapering the dose over ten days can reduce the likelihood of a rebound flare, but tapering is not always necessary
Colchicine 1 mg immediately , followed by 500 micrograms after one hour on day one, and then twice daily dosing of 500 micrograms
(Note: this is an alternative dose to the traditional regimen, which is now recommended by many experts. In patients with an estimated glomerular filtration rate (eGFR) < 50 mL/minute/1.73m2 the initial dose should not exceed 1 mg in the first 24 hours, with a total maximum of 3 mg over 4 days)
Triamcinolone acetonide intra-articular injection , 2.5 – 40 mg, determined by the size of the affected joint.

There is insufficient evidence to directly compare the efficacy of medicines for the treatment of gout flares. Medicine selection is therefore based on the patient’s preference, renal function, the presence of co-morbidities, e.g. prednisone may be preferred over a NSAID or colchicine in a patient with reduced renal function, and the concurrent use of medicines that may interact with colchicine.

Read more Managing gout in primary care 2018

Contra-indications

severe renal impairment
severe hepatic impairment
combined hepatic and renal impairment
serious cardiac or gastrointestinal disorders
blood disorders (including thrombocytopenia and leucopenia)
children

Cautions

elderly
gastro-intestinal disease
cardiac disease
concomitant use of medicines that cause blood dyscrasias or bone marrow depressants
concomitant use of P-glycoprotein and/or CYP3A4 inhibitors e.g. erythromycin, clarithromycin and verapamil (fatalities reported)

Resources

Resources	Links
BPAC	Managing gout in primary care 2018 An update on the management of gout March, 2013
Medsafe	Key Messages Colchicine is approved for the treatment of acute gout. Patients should be counselled on the appropriate use of this medicine and the signs of toxicity to ensure its safe and effective use. Serious adverse effects and toxicity may be potentiated by pharmacokinetic drug interactions. Adverse effects predominantly affect the gastrointestinal tract, skin, and blood. Read more: spotlight on colchicine March 2018
SafeRx	Key messages Assess if colchicine is appropriate as a first-line treatment Consider renal function and interactions with other medicines Ensure patients understand the risks associated with colchicine Read more colchicine
New Zealand Formulary	Colchicine