Colchicine
COLCRYS
Pronunciation: KOL-chi-seen (KOL-kris)
“Cold Chris, the Cold chicken”
What it isMicrotubule inhibitor that blocks neutrophil migration; acute gout, gout prophylaxis, and pericarditis.
Why this oneIts neutrophil-directed action treats gout and reduces pericarditis recurrence without corticosteroids.
What limits itStrong CYP3A4 or P-gp inhibitors can cause fatal toxicity in renal impairment; clarithromycin is the classic trap. Diarrhea limits use.
Colchicine prescription history
Animated chart of estimated U.S. prescriptions per year, Gout meds (1918–2026). Colchicine enters in 1918 (estimated).
FDA-approved for
- gout (2009)
- familial Mediterranean fever (2009)
Off-label
- pericarditis
- coronary risk reduction
Principal riskDiarrhea; fatal toxicity with strong CYP3A4 or P-gp inhibitors in renal impairment
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityNarrow safety margin with catastrophic multiorgan toxicity in overdose or with strong CYP3A/P-gp inhibitors.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Prophylaxis of gout flares | Adults and adolescents >16 yr | 0.6 mg QD or BID | 0.6 mg QD–BID | 1.2 mg/day |
| Treatment of gout flare | Adults | 1.2 mg at first sign of flare, then 0.6 mg 1 h later | Single course (1.8 mg total) | 1.8 mg over 1 h |
| Familial Mediterranean fever (FMF) | Adults | 1.2–2.4 mg/day, QD or divided BID | Adjust in 0.3 mg/day increments as needed/tolerated | 2.4 mg/day |
| FMF | Adolescents >12 yr | 1.2–2.4 mg/day, QD or divided BID | Adjust in 0.3 mg/day increments | 2.4 mg/day |
| FMF | Children 6–12 yr | 0.9–1.8 mg/day, QD or divided BID | Adjust in 0.3 mg/day increments | 1.8 mg/day |
| FMF | Children 4–6 yr | 0.3–1.8 mg/day, QD or divided BID | Adjust in 0.3 mg/day increments | 1.8 mg/day |
Renal Mild (CrCl 50–80)/moderate (30–50): no adjustment, monitor closely (FMF: dose reduction may be necessary). Severe: prophylaxis start 0.3 mg/day; flare treatment dose unchanged but repeat course no more than once every 2 weeks; FMF (CrCl <30) start 0.3 mg/day. Dialysis: prophylaxis 0.3 mg twice a week; flare treatment single 0.6 mg dose, repeat no more than once every 2 weeks; FMF start 0.3 mg/day. Contraindicated with P-gp or strong CYP3A4 inhibitors
Hepatic Mild–moderate: no adjustment, monitor closely. Severe: consider dose reduction (prophylaxis, FMF); flare treatment dose unchanged but repeat course no more than once every 2 weeks. Contraindicated with P-gp or strong CYP3A4 inhibitors
Not recommended for pediatric gout prophylaxis or treatment
Instructions
- Take orally without regard to meals; not an analgesic — do not use for other pain
- Flare during prophylaxis: max 1.2 mg then 0.6 mg 1 h later; wait 12 h, then resume prophylactic dose
- Strong CYP3A4 inhibitors (e.g., clarithromycin, ketoconazole, ritonavir, most protease inhibitors) or P-gp inhibitors (cyclosporine, ranolazine), incl. within prior 14 days: prophylaxis 0.3 mg QD (from 0.6 mg BID) or 0.3 mg every other day (from 0.6 mg QD); flare 0.6 mg ×1 then 0.3 mg 1 h later, repeat no earlier than 3 days; FMF max 0.6 mg/day
- Moderate CYP3A4 inhibitors (e.g., diltiazem, verapamil, erythromycin, fluconazole, aprepitant, grapefruit juice): prophylaxis 0.3 mg BID or 0.6 mg QD (from 0.6 mg BID) or 0.3 mg QD (from 0.6 mg QD); flare 1.2 mg ×1, repeat no earlier than 3 days; FMF max 1.2 mg/day
- Flare treatment not recommended in patients on prophylactic colchicine who take CYP3A4 inhibitors or have renal/hepatic impairment
Available strengths
- tab 0.6 mg
Contraindications
- Renal or hepatic impairment together with P-gp or strong CYP3A4 inhibitors (incl. all protease inhibitors except fosamprenavir) — life-threatening/fatal toxicity
Cautions
- Fatal overdose (adults and children) — keep out of reach of children
- Blood dyscrasias: myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, pancytopenia, aplastic anemia
- Drug interactions: P-gp and/or strong CYP3A4 inhibitors — life-threatening/fatal
- Neuromuscular toxicity/rhabdomyolysis (risk higher with renal dysfunction, elderly, statins, fibrates, cyclosporine)
Adverse reactions
- Diarrhea (23% in gout flare trial)
- Pharyngolaryngeal pain (3%)
- FMF: abdominal pain, cramping, diarrhea, nausea, vomiting (up to 20%)
Pregnancy Category C; crosses placenta; limited FMF data show no increased miscarriage/teratogenic risk; use only if benefit justifies risk
Lactation Excreted in human milk (infant receives <10% of maternal weight-adjusted dose); use caution and observe infant for adverse effects
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 0.6 mg | tab | 30 qd | $3.66 | offered |
Generic entry2016
Open Colchicine in the interactive console ↗
Memory aids: interaction avatars
Open Colchicine in the interactive console ↗
Self-check
- Which antibiotic is the classic fatal colchicine interaction in renal impairment?
Clarithromycin. - What cellular process does colchicine block to restrain neutrophils?
Microtubules, blocking migration.