Adult: 1.2-2.4 mg daily given as a single dose or in 2 divided doses, may be increased or decreased as necessary in increments of 0.3 mg daily. Child: 4-6 years 0.3 mg-1.8 mg daily; 6-12 years 0.9-1.8 mg daily; ≥12 years Same as adult dose. All doses may be given as a single dose or in 2 divided doses.
Oral Acute gout
Adult: Treatment: Initially, 1 mg followed by 0.5 mg after 1 hour, given within 12 hours of flare onset. Treatment may resume after 12 hours, if necessary, with a max dose of 0.5 mg 8 hourly. Treatment course ends when symptoms are relieved or when a total of 6 mg has been given. Another course may be repeated after at least 3 days. Prophylaxis: 0.5 mg bid.
Special Patient Group
Patients taking P-gp inhibitors and moderate or strong CYP3A4 inhibitors (with normal renal and hepatic function): Dose reduction or interruption is recommended.
Moderate: Reduce dose or increase dosing interval. Severe or patients on haemodialysis: Contraindicated.
Familial Mediterranean fever
Patients on haemodialysis: Initially, 0.3 mg daily, increase if necessary, according to individual safety and tolerability.
Dose reduction may be necessary with close monitoring.
Initially, 0.3 mg daily, increase if necessary, according to individual safety and tolerability.
Familial Mediterranean fever
Severe: Dose reduction may be necessary.
May be taken with or without food.
Blood dyscrasias. Severe renal (including haemodialysis patients), and hepatic impairment (except in familial Mediterranean fever). Concomitant use with P-glycoprotein (P-gp) inhibitors or strong CYP3A4 inhibitors in patients with renal or hepatic impairment.
Patient with CV disease, gastrointestinal disorders, corneal wounds or ulcers; abnormalities in blood counts. Mild to moderate renal and hepatic impairment. Elderly, children. Pregnancy and lactation. Debilitated patients. Not indicated as an analgesic to treat pain from other causes.
Significant: Myelosuppression (e.g. thrombocytopenia, leucopenia, granulocytopenia, agranulocytosis, aplastic anaemia, thrombocytopenia), neuromuscular toxicity including rhabdomyolysis, gastrointestinal symptoms (e.g. anorexia, nausea, vomiting, diarrhoea). Eye disorders: Delayed corneal wound healing. Gastrointestinal disorders: Abdominal pain, gastrointestinal haemorrhage. General disorders and administration site conditions: Fatigue. Investigations: Increased ALT/AST, elevated creatine phosphokinase. Musculoskeletal and connective tissue disorders: Myotonia, muscle weakness, myopathy. Nervous system disorders: Headache, neuropathy, peripheral neuritis. Reproductive system and breast disorders: Amenorrhoea, oligospermia, azoospermia. Respiratory, thoracic and mediastinal disorders: Pharyngolaryngeal pain. Skin and subcutaneous tissue disorders: Rash, alopecia.
This drug may cause dizziness and drowsiness, if affected, do not drive or operate machinery.
Monitor CBC, serum uric acid, renal function, LFT. Monitor for signs and symptoms of blood dyscrasias.
Symptoms: 1st stage: Nausea, vomiting, abdominal pain, haemorrhagic gastroenteritis, electrolyte imbalance, volume depletion, leucocytosis, hypotension in severe cases. 2nd stage: Multisystem organ dysfunction, acute renal failure, confusion, coma, ascending peripheral motor and sensory neuropathy, myocardial depression, pancytopenia, dysrhythmias, respiratory failure, and consumption coagulopathy. Management: Symptomatic and supportive treatment. Perform gastric lavage within 1 hour of ingestion. Consider activated charcoal administration within 1 hour of presentation in adults who ingested doses >0.1 mg/kg and any amount in children.
Increased risk of myopathy and rhabdomyolysis with statins, fibrates, digoxin, ciclosporin. Increased plasma concentration with cimetidine and tolbutamide. May cause reversible malabsorption of vitamin B12. Concomitant use with phenylbutazone may increase risk of leucopenia, thrombocytopenia or bone marrow depression. NSAIDs may increase risk of gastrointestinal ulceration or haemorrhage. Reduced efficacy of prophylactic gout therapy with cytolytic antineoplastic agents. Potentially Fatal: Increased risk of toxicity with CYP3A4 or P-gp inhibitors such as macrolides (e.g. clarithromycin, erythromycin), HIV protease inhibitors (e.g. ritonavir, atazanavir), Ca channel blockers (e.g. verapamil, diltiazem), ketoconazole, itraconazole, voriconazole, ciclosporin, disulfiram.
Increased plasma concentrations with grapefruit juice. Increased blood uric acid levels and risk of gastrointestinal toxicity with alcohol.
May cause false-positive results in urine tests for erythrocytes or Hb levels. May interfere with urinary determination of 17-hydroxycorticosteroids using the Reddy, Jenkins and Thorn procedures.
Description: Colchicine reduces neutrophil-mediated inflammatory response by disrupting cytoskeletal functions thereby blocking the β-tubulin polymerisation into microtubules, and preventing the activation, degranulation, and migration of neutrophils into the inflamed area. In familial Mediterranean fever, it may interfere with intracellular assembly of the inflammasome complex present in neutrophils and monocytes which mediates interleukin-1β activation. Onset: Pain relief: Approx 18-24 hours. Pharmacokinetics: Absorption: Rapidly and almost completely absorbed from the gastrointestinal tract. Bioavailability: Approx 45%. Time to peak plasma concentration: 0.5-3 hours. Distribution: Concentrated in leucocytes, kidney, spleen and liver (except the heart, skeletal muscle and brain). Crosses placenta, enters breast milk. Volume of distribution: 5-8 L/kg. Plasma protein binding: Approx 39%. Metabolism: Metabolised in the liver via demethylation by CYP3A4 isoenzyme to form 2 primary metabolites (2-O-demethylcholchicine and 3-O-demethylcolchicine), and 1 minor metabolite (10-O-demethylcholchicine or known as colchiceine); undergoes enterohepatic recycling. Excretion: Mainly via faeces (80%, as unchanged drug and metabolites); urine (10-20%). Elimination half-life: 27-31 hours.
Store between 20-25°C. Protect from light and moisture. Follow applicable procedures for receiving, handling, administration, and disposal.
L01CC - Colchicine derivatives ; Used in the treatment of cancer.
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