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Pharmacologic class: Colchicum alkaloid
Therapeutic class: Antigout drug
Pregnancy risk category C
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.
Tablets: 0.6 mg
Indications and dosages
➣ Prophylaxis of gout flares
Adults and adolescents age 16 and older: 0.6 mg P.O. daily or b.i.d. Maximum dosage, 1.2 mg/day.
➣ Treatment of gout flares
Adults and adolescents age 16 and older: 1.2 mg P.O. at first sign of a gout flare, followed by 0.6 mg 1 hour later. Wait 12 hours; then resume prophylactic dose.
➣ Familial Mediterranean fever
Adults and adolescents age 12 and older: 1.2 to 2.4 mg P.O. in one or two divided doses. Increase or decrease dosage as indicated and as tolerated in increments of 0.3 mg/day; not to exceed the maximum recommended daily dosage.
Children ages 6 to 12: 0.9 to 1.8 mg P.O. as a single dose or as divided doses b.i.d.
Children ages 4 to 6: 0.3 to 1.8 mg P.O. as a single dose or as divided doses b.i.d.
• Mild hepatic or renal impairment
• Hepatic cirrhosis
• Chronic progressive multiple sclerosis
• Pyoderma gangrenosum associated with Crohn's disease
• Dermatitis herpetiformis
• Hypersensitivity to drug
• Blood dyscrasias
• Serious GI, renal, hepatic, or cardiac disorders
• Concurrent use of P-glycoprotein or strong CYP3A4 inhibitors (including all protease inhibitors except fosamprenavir)
Use cautiously in:
• renal impairment
• elderly or debilitated patients
• pregnant or breastfeeding patients
• children (safety not established).
• Give tablets without regard to meals.
• Know that GI reactions may be troublesome in patients with peptic ulcer or irritable bowel.
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
Skin: dermatosis, alopecia
Other: hypersensitivity reactions
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
☞ 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).
• Tell patient to take tablets with or without food.
• 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.