colchicine
Colchicine is used for the treatment and prevention of gout flares, but its cost and side effects limit its use. It's also a first-choice medication for treating familial Mediterranean fever (FMF). This medication comes as tablets, capsules, and an oral solution.
What is Colchicine?
What is Colchicine used for?
- Gout prevention
- Gout treatment - tablets only
- Familial Mediterranean fever (FMF) - tablets only
How Colchicine works
Colchicine is an anti-inflammatory medication. It blocks cells that cause joint inflammation and pain in people who have gout flares and familial Mediterranean fever.
Drug facts
Side effects of Colchicine
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Diarrhea (23%)
- Nausea (4%)
Less Common Side Effects
- Tiredness
- Headache
- Throat pain
More on Colchicine side effects
The following Colchicine side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Muscle injury—unusual weakness or fatigue, muscle pain, dark yellow or brown urine, decrease in the amount of urine
- Pain, tingling, or numbness in the hands or feet
- Unusual bleeding or bruising
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
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Pros and cons of Colchicine
Pros
- Can be taken once or twice a day with or without food
- Helpful for preventing gout when people are first starting allopurinol (Zyloprim)
- Tablets work quickly to treat gout flares if they happen
- For tablets, dose easily adjustable based on how you respond to the medication; they're scored to make it easier to split your dose if needed
- Tablets are a first-choice medication for treating familial Mediterranean fever (FMF)
Cons
- Tablets and capsules available as a generic, but can be still more expensive than other treatment options for gout like nonsteroidal anti-inflammatory drugs (NSAIDs)
- Risk of blood problems if taken long term
- Might need lower dose if you have kidney or liver problems
- Interacts with a lot of medications
- Might affect fertility in males
Pharmacist tips for Colchicine
- Take colchicine with or without food, but don't take it with grapefruit juice.
- To treat gout attacks, take 2 colchicine tablets at the first sign of an attack; then after an hour, take another 1 tablet. If you have an attack while you're taking it to prevent an attack, wait 12 hours after the second dose and then restart your prophylaxis (prevention) dose.
- Wait 3 days before you repeat the gout treatment dose with the tablets, even if you have a flare.
- If you're taking the oral solution, make sure to measure your dose with the measuring device (e.g., cup, syringe) provided by your pharmacy. Don't use household measuring or kitchen spoons, since they might not be accurate and cause you to take the wrong dose.
- Avoid grapefruit and grapefruit juice while you're taking colchicine. It can make the medication levels in your body go too high and raise your risk of side effects.
- If you're a male with a female partner who can become pregnant, talk to your healthcare provider about plans for having children. Rarely, colchicine can cause infertility in men (can't have children). This might be reversible when you stop taking the medication.
Common questions about Colchicine
For the prevention of gout flares, Colchicine can be taken every day at the recommended dose for prevention of gout flares. For the treatment of gout flares, the colchicine tablets (Colcrys) shouldn't be taken daily; it should only be taken once every 3 days.
Colchicine will lower inflammation in your joints to help with gout-related pain. It won't help with other kinds of pain and shouldn't be taken as a pain killer.
Your kidneys help your body get rid of colchicine. So if your kidneys aren't working at a certain level, your provider may lower your dose to avoid a buildup of medication in your body, which raises your risk of unwanted side effects.
Grapefruit and grapefruit juice will slow down the breakdown of colchicine and cause the medication levels in your body to get too high. Other medications like HIV ARVs (antiretrovirals), antibiotics, and cholesterol-lowering statins can also have this same effect. High levels of medication in your body raise your risk of unwanted side effects.
No. Colchicine is FDA approved to treat gout symptoms and Familial Mediterranean Fever. But, another brand medication, Lodoco (colchicine), is FDA approved to prevent heart problems. Even though they both have the same active ingredient, colchicine, they are different medications with different dosages. Ask your provider about which medication is right for you.
Colchicine capsules, tablets, and oral solution include the same medication at the same dose (0.6 mg). The capsule is sold under the brand name Mitigare. The oral solution is sold under the brand name Gloperba, and 5 mL (about 1 teaspoon) of it contains the recommended 0.6 mg dose. The capsules and oral solution can only be used to prevent gout flares. The tablets (brand name Colcrys) can be used to treat and prevent gout flares, as well as to treat familial Mediterranean fever (FMF). The tablets are scored so you can cut them in half; this makes adjusting your dose easier if needed.
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Risks and warnings for Colchicine
Colchicine can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Life-threatening overdose
Deadly overdoses, both accidental and on purpose, have happened in adults and children who took too much colchicine. Take colchicine as directed by your healthcare provider. Keep all medications, including colchicine, out of reach from children. Early symptoms of an overdose include stomach pain, nausea, vomiting, and diarrhea, which can lead to dehydration. If you think you or a loved one has overdosed on colchicine call the Poison Control Center at 1-800-222-1222 or get medical help right away.
Blood problems
Colchicine can lower your body's ability to make new blood cells. This can happen at recommended doses and can be serious if it's not caught in time. Get your regular labs drawn on time and let your provider know if you notice bleeding, bruising, fevers, or always feel tired.
Medication and food interactions
Many medications can interact with colchicine and can make the medication levels in your body go too high, which can be dangerous. Some of these medications include calcium channel blockers (CCBs) or digoxin (Lanoxin) for the heart, statins for cholesterol, fungal infection medications, protease inhibitors for HIV, and cyclosporine (Neoral or Sandimmune for organ transplant. Always make sure your providers have a full list of the medications you're taking, even if you only take colchicine a few times a year. If you're taking a medication that interacts with colchicine, your provider will need to adjust your dose.
Also let your provider know if you have any liver or kidney problems, since these medication interactions can be worse. In addition, avoid grapefruit and grapefruit juice while you're taking colchicine, since eating or drinking grapefruit-containing products can also cause high medication levels.
Nerve or muscle toxicity
- Risk factors: Long-term use | Poor kidney function | Older adults | Taking statins, fibrates, or cyclosporine (Neoral or Sandimmune)
Taking colchicine for a long time can lead to nerve or muscle toxicity. It can also cause a problem called rhabdomyolysis, which is when damaged muscle releases a harmful protein into your blood. Your risk might be higher if you're also taking statins, fibrates, or cyclosporine (Neoral or Sandimmune). If you experience muscle pain, dark or reddish urine, or trouble moving your arms and legs, get medical help right away. You might need to stop colchicine. Typically, these symptoms go away after about a week of stopping the medication (sometimes, it can take several months).
Colchicine dosage
Typical dosage for Colchicine
Prevention of gout flare (tablets, capsules, and oral solution): The typical dose is 0.6 mg by mouth once or twice a day.
Treatment of gout flare (tablets only): The typical dose is 1.2 mg by mouth at the first sign of a flare, then 0.6 mg one hour later.
Familial Mediterranean Fever (tablets only):
- Adults and children aged 12 years or older: The typical dose is 1.2 mg to 2.4 mg by mouth a day.
- Children aged 4 to 12 years: The typical dose ranges from 0.3 mg to 1.8 mg by mouth a day and will be based on the child's age.
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How much does Colchicine cost?
Colchicine contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Colchicine will not be safe for you to take.
- Kidney or liver disease, along with interacting medications
What are alternatives to Colchicine?
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