Dr Sharon Rees @reesprescribe
Day 1: Cited for centuries as a herbal remedy for joint pain, #colchicine also has a long history as a treatment for gout. An alkaloid derived from the bulbs of the autumn crocus (Colchicum), the drug is extracted & purified for use
Dr Sharon Rees @reesprescribe
Day 2: #colchicine is an oral agent licensed for use in acute gout & short-term gout prophylaxis. Because of toxicity, the treatment duration is limited; acute dose 500mcg x2-4/day max 6mg per course. No repeat for minimum of 3 days. Unlicensed use for prophylaxis of familial Mediterranean fever
Dr Sharon Rees @reesprescribe
Day 3: #colchicine has high oral bioavailability, low Vd & some liver metabolism via CYP3A4 & Pgp, but most is not broken down. Excretion is via bile & unchanged drug in faeces with around 20% in urine. T½ 7-9 hrs. Has a narrow therapeutic index. Avoid if severe renal/hepatic impairment
Dr Sharon Rees @reesprescribe
Day 4: #colchicine suppresses inflammation by several mechanisms. Best known is accumulation in neutrophils, where the drug disrupts cytoskeletal functions & impaired actions such as cell division & chemotaxis
Dr Sharon Rees @reesprescribe
Day 5: Common adverse drug effects include GI disorders; frequency is unknown for blood disorders e.g aplastic anaemia, bone marrow suppression, as well as alopecia, menstrual irregularities & nerve disorders (NOT exhaustive)
Dr Sharon Rees @reesprescribe
Day 6: drug-drug interactions: All drugs increasing exposure (#colchicine has a narrow therapeutic index) have a ‘severe’ warning, e.g ritonavir, fluconazole, mirabegron, verapamil. Concurrent use with statins reported to cause rhabdomyolysis;caution/monitor (NOT exhaustive). NHS site & SPC for #colchicine advise to avoid/dose reduction if grapefruit juice consumption (this increases exposure), but BNF omits in interactions list
Dr Sharon Rees @reesprescribe
Day 7: #colchicine is under investigation for wider anti-inflammatory roles e.g ischaemic heart disease, pericardial disease, liver disease (not exhaustive). There is also ongoing research into roles for COVID-19 cardiovascular complications
Earn Your CPD Certificate
With the help of Prescribing and Therapeutics Training Ltd and the Journal of Prescribing Practice, you can earn your 1-hour CPD certificate
In addition to the tweets, read the BNF treatment summary on gout, as well as the monograph on colchicine and the SPC for colchicine. Once you have completed this, answer the 10 questions. Submit your answers to reesprescribe@gmail.com. If you answer at least eight out of 10 questions correctly, you will receive your CPD certificate via email.
Further reading on #colchicine
- https://bnf.nice.org.uk/treatment-summaries/gout/
- https://bnf.nice.org.uk/drugs/colchicine/
- https://www.medicines.org.uk/emc/product/6415/smpc#gref
- Colchicine is derived from a fungus TRUE or FALSE?
- Colchicine is used first-line for treatment of acute gout TRUE or FALSE?
- The duration of treatment for colchicine is kept very short so as to minimise toxicity TRUE or FALSE?
- Colchicine is mostly excreted unchanged which has implications for renal impairment TRUE or FALSE?
- Which of the following is FALSE?
- Colchicine accumulates in white blood cells
- Colchicine impairs cell division
- Colchicine impairs the movement of white blood cells by binding to tubulin
- Colchicine inhibits cyclooxygenase production
- Colchicine has a narrow therapeutic index TRUE or FALSE?
- Which of the following is a common adverse drug effect for colchicine?
- Menstrual problems
- Diarrhoea
- Aplastic anaemia
- Alopecia
- Drugs which increase exposure to colchicine are likely to be categorised as having a ‘severe’ drug-drug interaction TRUE or FALSE?
- Which of the following is NOT a group of signs for colchicine toxicity?
- Sweating, palpitations, ear pain
- Nausea/vomiting, abdominal pain, bloody diarrhoea
- Respiratory distress, convulsions, arrythmias
- Bone marrow depression, organ failure
- Colchicine is being investigated for deployment in neurological diseases, such as dementia TRUE or FALSE?