- Discussion: (see GoutPal.com)
- colchicine is used to treat acute gout;
- mechanism of action involves inhibition of MSU-induced chemotactic factor release by PMNs;
- in addition to treatment of acute gout, prophylactic administration of low doses of colchicine is effective in reducing the frequency of multiple attacks;
- disadvantages: its onset of action is slow (typically 18 hours is required to improve symptoms) and it invariably causes diarrhea;
- w/ acute gout, begin w/ 0.5 mg q2 hours until pain decreases or until GI symptoms appear, or until a maximum of 6 mg has been given;
- another option is starting dose of 1 mg, followed by 0.5 mg every two hours until abdominal discomfort or diarrhea
develops or a total dose of 8 mg has been administered;
- alternatively: 1-2 tab PO initially, then 1 tab q1-2hr until GI side effects appear;
- max dose = 16 tab/day ... or 1-2mg IV, then 0.5gm q6-12hr upto 4mg/day;
- cautions: with elderly and renal railure;
- even low-dose daily colchicine can cause severe adverse effects, including myopathy and myelosuppression;
- IV dosing:
- risk of systemic toxic effects is higher with IV dosing;
- complications include marrow suppression and renal, hepatic, and CNS toxicity;
- with IV dosing, give 1 mg IV q6 hr with max dosage of 4 mg
Colchicine: its mechanism of action and efficacy in crystal-induced inflammation
A randomized controlled trial to evaluate the modifying effects of a regimen containing colchicine in a subset of patients with osteoarthritis of the knee.
A randomized controlled trial to evaluate the slow-acting symptom-modifying effects of colchicine in osteoarthritis of the knee: a preliminary report.
Original Text by Clifford R. Wheeless, III, MD.
Last updated by Data Trace Staff on Wednesday, August 14, 2013 9:26 am