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Colchicine

  • Colchicine, an alkaloid derivative from the plant Colchicum autumnale, has been used in the treatment of acute gout for nearly two centuries and for joint pain since the sixth century.
  • Colchicine can be used in the treatment of acute gouty attacks and as prophylaxis against future attacks, especially when hypouricemic therapy is initiated.
  • The dose for colchicine must be reduced (or not used) in patients with severe renal insufficiency, severe hepatic disease, or on medications that are CYP 3A4 inhibitors

Most adverse effects of colchicine are dose and duration related. There are no antidotes to overdose and hemodialysis is ineffective. Potential side effects include:

  • GI effects (diarrhea, nausea, vomiting, rarely malabsorption syndrome and hemorrhagic gastroenteritis).
  • Bone marrow suppression (thrombocytopenia, leukopenia)
  • Neuromyopathy (elevated creatine kinase, proximal weakness, peripheral neuropathy, lysosomal vacuoles on biopsy)
  • Alopecia
  • Oligospermia and amenorrhea – chronic use of colchicine
  • Central nervous system dysfunction

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