7 Colchicine Side Effects and How to Manage Them

Colchicine (Colcrys, Mitigare, Gloperba) has been around for thousands of years. Its anti-inflammatory effects were routinely used as an herbal remedy to treat joint pain.

Today, colchicine is a prescription medication that’s FDA approved to prevent and treat gout flares in adults. It’s also used to treat an autoimmune condition called familial Mediterranean fever in children and adults.

Despite its widespread use, colchicine has some possible side effects that are important to note. It also has a narrow therapeutic index, meaning even small dose changes can lead to extra side effects. Here are details on the top seven colchicine side effects and how to manage them.

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1. Diarrhea

Diarrhea is the most common side effect of colchicine. It can throw off the fluid balance in your gut and cause diarrhea as a result. A little over 1 in 5 people report experiencing it, sometimes within the first day of starting the medication.

Thankfully, diarrhea is usually manageable and reversible. Ask your healthcare provider about lowering your colchicine dose if this side effect is bothersome. Many cases of diarrhea caused by colchicine resolve within a few days.

While you’re waiting for your body to adjust to the medication, try to stay hydrated by drinking plenty of water and electrolyte drinks. When needed, you can consider taking an over-the-counter (OTC) medication like loperamide (Imodium A-D) with your healthcare provider’s OK.

If you have diarrhea that’s bothersome or lasts longer than 2 weeks, it’s important to tell your provider. Severe or prolonged diarrhea may ring alarm bells for something more serious and taking additional colchicine doses might not be appropriate.

2. Nausea and vomiting

Nausea and vomiting are also gut-related side effects that can happen after starting colchicine. You’re more likely to have this side effect with higher doses of colchicine; lower doses are better tolerated.

Feeling nauseated generally doesn't need medical attention. This should go away with time and resolve on its own. Staying hydrated and eating bland foods can help manage temporary nausea.

But, if nausea persists or feels intense, it can start to affect your quality of life. If this happens, talk to your healthcare provider. They may recommend a dose adjustment or a different treatment altogether.

3. Throat pain

Throat pain is another side effect that’s possible with colchicine. This type of pain may feel like a sore throat, much like you feel with the flu. Thankfully, it’s less likely to occur than gut-related side effects like diarrhea and nausea.

Most of the time, throat pain should resolve on its own. But if you need some relief, ask your pharmacist about trying an OTC pain reliever like acetaminophen (Tylenol) or a numbing spray like Chloraseptic. You can also try medication-free remedies, like drinking warm beverages and staying hydrated. Sticking to soft foods, like yogurt or soup, is a good idea if swallowing is difficult.

Some instances of throat pain may be a sign of a more serious problem. If your throat pain is severe or accompanied by symptoms like swelling or fever, you should contact your healthcare provider. There may be another issue, like an infection, that’s important to address.

4. Headache

Many medications can cause headaches. Although this is possible with colchicine, it’s not very common.

If you do experience a headache after starting colchicine, it should be short lived. But if it doesn’t get better or gets worse at any point, talk to your healthcare provider. They may suggest taking an OTC pain reliever, like acetaminophen. They may adjust your dose of colchicine, too. 

5. Fatigue

Colchicine can sometimes make you feel fatigued. If it happens, it should be mild and not need treatment.

But, if you have uncharacteristic intense fatigue — or feel so tired that you can’t perform your normal daily tasks — this is more concerning. This could be a sign of muscle injury or a blood-related problem. Ongoing fatigue that lasts longer than 2 weeks should be evaluated by a healthcare professional.

Although many of us feel tired for various reasons, it’s important to stay in tune with your energy levels after starting colchicine. Recognizing fatigue early and reporting it to your healthcare provider can help prevent any meaningful colchicine-related problems.

6. Muscle and nerve problems

Too much colchicine can sometimes cause nerve or muscle problems. These are rare, but serious side effects of the medication.

Nerve damage from colchicine can feel like pain, tingling, or numbness in the hands or feet. Muscle problems from colchicine can actually project as fatigue, but you may also experience muscle pain or dark-colored urine. In severe cases, muscle pain can progress to a condition called rhabdomyolysis. This is when muscle tissue breaks down and enters the blood. It’s important to get medical help right away if you suddenly feel symptoms like these.

Older adults, and those with poor kidney health, have a higher risk of these serious side effects. If you fall into either of these groups, your healthcare provider may recommend starting with a lower colchicine dosage. Certain medications can also interact with colchicine, increasing your chances of serious side effects. Be sure to give your pharmacist and provider a medication list with all the medications and supplements you take.

7. Changes in blood counts

Colchicine can sometimes cause blood-related concerns. It’s been linked to a drop in blood cells, including lower-than-expected platelets and white blood cell counts. Although this is more likely to happen if you’re taking a high dose of colchicine, it can happen at recommended doses too.

It’s important to get medical help right away if you spot any unusual bleeding or bruising. If this happens, your healthcare provider will likely watch your blood counts through a lab test. Depending on the results, they may temporarily (or permanently) stop your colchicine prescription.

When to contact a healthcare provider about colchicine side effects

You may experience gut-related side effects, throat pain, or headaches after starting colchicine. These are usually mild and should resolve on their own. But, if they feel problematic at any point or don’t go away, you should contact your healthcare provider. They may want to help you adjust your dose or stop the medication.

There are also more serious situations to keep in mind. It’s important to get emergency care right away if you experience any of these less common side effects:

• Unusual bleeding or bruising

• Feel excessively tired — especially beyond your own standards

• Intense muscle aches

• Dark-colored urine

• Pain, tingling, or numbness in your hands or feet

Good to know: More intense side effects from colchicine could be a sign of colchicine toxicity, which is having more colchicine than your body can tolerate. This can be life-threatening if left untreated.

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Written by:

Hindu Rao, PharmD, APh, BCACP

Hindu Rao, PharmD, APh, BCACP is a clinical assistant professor of pharmacy practice at Chapman University School of Pharmacy and a clinical pharmacist at Providence Medical Foundation. She specializes in chronic disease management and has her board certification in ambulatory care.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Tegan Smedley, PharmD, APh

Tegan Smedley, PharmD, APh, has 10 years of experience as a pharmacist. She has worked in a variety of settings, including retail, hospital, and ambulatory care.

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