What is colchicine?

Colchicine is a prescription medication indicated for prophylaxis and treatment of gout flares in adults, as well as familial Mediterranean fever (FMF) in adults and children four years or older. Colchicine also has off-label indications, such as acute and recurrent pericarditis, dermatitis herpetiformis, and hepatic cirrhosis.

How does colchicine work?

As colchicine is indicated to treat gout and FMF, it primarily has anti-inflammatory properties. Gout and acute gout flares are caused by too much uric acid building up in your joints. Colchicine works by inhibiting the inflammatory effects of the uric acid build-up. Specifically, it does this by binding to tubulin and preventing its polymerization into microtubules. It also stops the activation and migration of white blood cells (neutrophils) that are linked to gout symptoms.

For the treatment of familial Mediterranean fever, it is less known how colchicine helps. It is thought that it interferes with interleukin-1-beta, a protein related to inflammation.

What doses of colchicine are available?

Colchicine comes in 0.6 mg tablets.

The brand Gloperba also offers colchicine as a 0.6mg/5mL oral solution. It appears as a slightly hazy, red liquid indicated solely for prophylaxis of gout flares in adults.

Gout treatment and FMF are only treatable by tablets.

How do you use colchicine?

Follow all directions given by your doctor and read all prescribing information and FDA-approved product labeling and Medication Guide before using colchicine. You can take colchicine with or without food, but always by mouth. Dosing recommendations vary by condition and person, so ensure you follow the instructions given to you by your doctor. Make sure you do not take too much as fatal overdoses have occurred. However, general dosing follows:

For gout flares:
- Prophylaxis of gout flares:
  - 0.6 mg once or twice daily in patients 16 years or older. Do not exceed 1.2 mg per day.
- Treatment of gout flares:
  - 1.2 mg (two tablets) when you first suspect a gout flare, followed by 0.6mg (one tablet) an hour later.
  - The maximum recommended dose is 1.8 mg in a one-hour period. Ask your doctor how often you can repeat treatment if you have another gout attack.
For FMF, you can give the daily dose in either one or two divided doses. You most likely will start on a low dose and slowly increase it. Your doctor may decrease your dose if you experience side effects. However, the recommended doses for:
- Children 4 to 6 years is 0.3 – 1.8 mg
- Children 6 to 12 years is 0.9 – 1.8 mg
- Adults and children older than 12 years is 1.2 – 2.4 mg

If you miss a dose of colchicine, take the missed dose as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at its regular time.

What are the side effects of colchicine?

The most common adverse events of colchicine in clinical trials compared to placebo include:

Diarrhea
Pharyngolaryngeal pain
Cramping
Nausea
Abdominal pain
Vomiting

Rarely, the use of colchicine may cause some serious side effects. There have been reports of fatal overdoses. Usually, those life-threatening complications occur between 24 and 72 hours after you take the drug. Death is usually a result of respiratory depression and cardiovascular collapse. Acute colchicine toxicity is usually within 24 hours after you take colchicine, and begins with gastrointestinal symptoms. Other serious side effects of colchicine include:

Unusual bleeding
Myopathy, muscle weakness, muscle pain, or muscle damage (rhabdomyolysis)
Numbness/tingling in your fingers or toes
Infections (ex: sore throat, chills, fever)
Weakness or tiredness
Paleness or grayness of the tongue, lips, or palms
The possibility of decreased fertility in men. Speak to your doctor about what is best for you.

Contact your healthcare professional for medical advice about any possible adverse effects you experience while taking colchicine. You can report your adverse effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Colchicine drug interactions

When colchicine is taken with other prescription drugs, over-the-counter medications, vitamins, and supplements, it may change how they work or increase the frequency or severity of side effects. Some drug interactions that have been reported with colchicine include:

CYP3A4 inhibitors (ex: diltiazem, verapamil, or clarithromycin).
- This is the primary P450 enzyme associated with metabolizing colchicine too quickly.
- There is a potentially fatal drug interaction with CYP3A4 inhibitors.
- This would include grapefruit juice; avoid grapefruit juice.
Protease inhibitors
P-glycoprotein inhibitors such as cyclosporine and ranolazine
Digoxin

Colchicine precautions

You should be sure that your healthcare provider is aware of all your medical conditions, including if you have:

Any renal (kidney) or hepatic (liver) impairment.
Undergone or undergoing dialysis.
- Close monitoring should occur.
- The recommended doses would change:
  - Patients on dialysis being treated for prophylaxis of gout flares should be given 0.3 mg twice a week.
  - Treatment of gout flares would be 0.6 mg per dose, not more than once every two weeks.
  - FMF patients would have a starting dose of 0.3 mg/day and then slow progression with monitoring.
Have any allergies to colchicine, the inactive ingredients in it, or any other allergies.
Kidney issues.
Liver issues.
A pregnancy, plan to be pregnant, or are breastfeeding.
- Colchicine has been proven to show up in breast milk.
- It is unknown whether colchicine can harm your unborn baby. Talk to your healthcare provider about what is best for you.
- Some men may be infertile while using colchicine which has been found to resolve itself once finishing treatment. Talk to your healthcare provider about what might be best for you.
An infection or are taking antibiotics.
- Examples: azithromycin, clarithromycin, erythromycin, telithromycin
A fungal infection or are taking antifungals.
- Examples: fluconazole, itraconazole, ketoconazole
A condition that requires cholesterol-lowering medications.
- Examples: atorvastatin, pravastatin, simvastatin, gemfibrozil
HIV or AIDS and are taking medications.
- Examples: atazanavir, ritonavir