colchicine

colchicine /col·chi·cine/ (kol´chĭ-sēn) an alkaloid from the tree Colchicum autumnale (meadow saffron), used as a suppressant for gout.

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Colchicine

A compound that blocks the assembly of microtubules-protein fibers necessary for cell division and some kinds of cell movements, including neutrophil migration. Side effects may include diarrhea, abdominal bloating, and gas.

Mentioned in: Familial Mediterranean Fever, Gout

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colchicine

[kol′chəsēn]

Etymology: Gk, kolchikon

a gout suppressant that suppresses leukocyte mobility and phagocytosis in joints.

indications It may be prescribed in the treatment of acute gout and prophylaxis of recurrent gouty arthritis.

contraindications Ulcer, ulcerative colitis, or known hypersensitivity to this drug prohibits its use. The drug is highly toxic and is not given to elderly, debilitated patients or to those who have chronic renal, hepatic, cardiovascular, or GI disease.

adverse effects Among the most serious adverse reactions are severe GI distress including diarrhea with blood, bone marrow depression, peripheral neuritis, liver dysfunction, and alopecia. It is in pregnancy category D.

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colchicine (kälˑ·ch·sēn),

n an alkaloid derived from the toxic plant
Colchicum autumnale and used to treat the pain and inflammation of gout. Contraindicated for pregnant and lactating women; children; geriatric patients; and those taking antineoplastics, antithyroid medications, azathioprine, chloramphenicol, cyclophosphamide, flucytosine, gancyclovir, interferon, mercaptopurine, methotrexate, phenylbutazone, plicamycin, or zidovudine.

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colchicine (kol´chsēn´),

n generic colchicine;
drug class: antigout agent;
action: inhibits deposition of ureate crystals in soft tissues;
uses: gout, gouty arthritis, to arrest progression of neurologic disability in multiple sclerosis.

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colchicine

a water-soluble antimitotic drug that blocks the addition of tubulin subunits to the ends of existing microtubules, preventing spindle formation. It is a poisonous alkaloid from colchicum autumnale which causes violent purgation, abdominal pain and is often fatal. In research it is used to induce polyploidy by delaying mitosis. In humans it is used in the treatment of gout. See also colchiceine.

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colchicine Warning - Hazardous drug!

Pharmacologic class: Colchicum alkaloid

Therapeutic class: Antigout drug

Pregnancy risk category C

Action

Unclear. Antigout action may occur through white blood cell (WBC) migration and reduced lactic acid production by WBCs. This action in turn decreases uric acid deposition, kinetin formation, and phagocytosis, leading to reduction in inflammatory response.

Availability

Injection: 0.5 mg/ml

Tablets: 0.5 mg, 0.6 mg

⊘Indications and dosages

➣ Acute gouty arthritis

Adults: Initially, 0.6 to 1.2 mg P.O.; then 0.6 to 1.2 mg P.O. q 1 to 2 hours or until relief occurs, adverse GI reactions occur, or patient has received a total cumulative dosage of 8 mg. Or 2 mg I.V., followed by 0.5 mg I.V. q 6 hours p.r.n., not to exceed 4 mg daily.

➣ Prophylaxis for recurrent gouty arthritis

Adults: In patients who have one yearly attack or less, 0.6 mg P.O. daily 3 days per week. In patients who have more than one yearly attack, 0.6 mg P.O. daily; in severe cases, 1 to 1.8 mg P.O. daily.

Dosage adjustment

• Mild hepatic or renal impairment

Off-label uses

• Hepatic cirrhosis
• Chronic progressive multiple sclerosis
• Pyoderma gangrenosum associated with Crohn's disease
• Psoriasis
• Dermatitis herpetiformis

Contraindications

• Hypersensitivity to drug
• Blood dyscrasias
• Serious GI, renal, hepatic, or cardiac disorders

Precautions

Use cautiously in:
• renal impairment
• elderly or debilitated patients
• pregnant or breastfeeding patients
• children (safety not established).

Administration

☞ Know that I.V. colchicine is a high-alert drug.
• Initiate therapy at first sign of acute gout attack.
☞ Don't administer I.M. or subcutaneously, because severe local irritation may occur.
☞ Don't dilute with 5% dextrose in water. If dilution is required, use normal saline solution injection.
• For I.V. injection, give by slow I.V. push over 2 to 5 minutes.
• Know that GI reactions may be troublesome in patients with peptic ulcer or irritable bowel.

Route	Onset	Peak	Duration
P.O.	12 hr	24-72 hr	Unknown
I.V.	Rapid	Rapid	Rapid

Adverse reactions

CNS: peripheral neuritis, neuropathy

GI: nausea, vomiting, diarrhea, abdominal pain

GU: anuria, hematuria, reversible azoospermia, renal impairment

Hematologic: purpura, agranulocytosis, aplastic anemia, thrombocytopenia

Metabolic: vitamin B₁₂ malabsorption

Musculoskeletal: myopathy

Skin: dermatosis, alopecia

Other: hypersensitivity reactions

Interactions

Drug-drug. Cyclosporine: colchicine-induced myopathy

Vitamin B₁₂: reversible vitamin malabsorption

Drug-diagnostic tests. Alkaline phosphatase, aspartate aminotransferase: increased levels

Hematocrit, hemoglobin, platelets: decreased values

Urine hemoglobin, urinary red blood cells: false-positive results

Drug-food. Caffeine-containing foods and beverages: decreased colchicine effect

Drug-herbs. Herbal teas, St. John's wort: decreased drug effect

Drug-behaviors. Alcohol use: increased uric acid level

Patient monitoring

☞ Monitor patient for signs and symptoms of toxicity (nausea, vomiting, abdominal pain, bloody diarrhea, burning sensation, muscle weakness, oliguria, hematuria, ascending paralysis, delirium, and seizures). Discontinue drug if these occur.
• Monitor CBC and renal function test results regularly.
• Be aware that patient may need opioids to control drug-induced diarrhea (especially if he's receiving maximum colchicine dosage).

Patient teaching

• Instruct patient to report rash, sore throat, fever, tiredness, weakness, numbness, or tingling.
☞ Tell patient to immediately report muscle tremors, weakness, fatigue, bruising, bleeding, yellowing of eyes or skin, pale stools, dark urine, severe vomiting, watery or bloody diarrhea, or abdominal pain.
• Advise patient to increase fluid intake to prevent renal calculi (unless prescriber wants him to restrict fluids).
• Instruct patient to avoid alcohol, herbal teas, and caffeine during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.

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colchicine

An alkaloid isolated from autumn crocus-Colchicum autumnale used for long term control of gout Mechanism Colchicine blocks mitosis at metaphase by binding to the tubulin heterodimer, interfering with microtubule assembly Indications Management of gouty arthritis; used in research to arrest cells during mitosis–by disrupting the spindle, to visualize chromosomes