Colchicine
COLCRYS
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.
FDA-approved for
- gout (2009)
- familial Mediterranean fever (2009)
Off-label
- pericarditis
- coronary risk reduction
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Established atherosclerotic disease (MACE risk reduction) | Adults | 0.5 mg QD | 0.5 mg QD | 0.5 mg QD |
Renal Contraindicated in renal failure (CrCl <15 mL/min); monitor for colchicine toxicity at any degree of renal impairment
Hepatic Contraindicated in severe hepatic impairment; monitor for colchicine toxicity at any degree of hepatic impairment
Instructions
- Take missed dose ASAP then resume normal schedule; do not double the next dose
- Avoid moderate CYP3A4 inhibitors in patients with risk factors for increased colchicine exposure
Contraindications
- Concurrent use of strong CYP3A4 inhibitors or P-glycoprotein inhibitors (life-threatening/fatal colchicine toxicity)
- Renal failure (CrCl <15 mL/min)
- Severe hepatic impairment
- Pre-existing blood dyscrasias
Cautions
- Blood dyscrasias: myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, pancytopenia, aplastic anemia (can be fatal)
- Neuromuscular toxicity and rhabdomyolysis
- GI symptoms are often the first sign of colchicine toxicity
- Risk potentiated by concomitant HMG-CoA reductase inhibitors, gemfibrozil, fenofibric acid, or cyclosporine
Adverse reactions
- Myalgia
- Diarrhea, vomiting, abdominal cramping/pain
- Rhabdomyolysis, weakness, paresthesia
- Thrombocytopenia, leukopenia, pancytopenia
Pregnancy Published human data do not indicate drug-associated risk; colchicine crosses the placenta
Lactation Present in human milk; no adverse effects reported in breastfed infants; reconsider if infant has diarrhea
NO BOXED WARNINGS
Principal riskDiarrhea; fatal toxicity with strong CYP3A4 or P-gp inhibitors in renal impairment
Cost, est. cash$5–$150/month
Generic entry2016
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.
Mechanism of action: Colchicine ballicule
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