Colchicine

How it works

     * Colchicine is thought to relieve the symptoms of gout by blocking
       the inflammatory response to the presence of urate crystals in
       synovial fluid (the fluid between joints) mediated by neutrophils.
       Colchicine may also dampen down the effect of other inflammatory
       substances.

Upsides

     * May be used to prevent gout flares in adults.
     * There have been no reports of tolerance, dependence or abuse
       associated with colchicine use.

Downsides

   If you are between the ages of 18 and 60, take no other medication or
   have no other medical conditions, side effects you are more likely to
   experience include:
     * Gastrointestinal effects (such as abdominal pain, diarrhea, nausea,
       or vomiting). These may be an initial sign of toxicity and the
       dosage of colchicine may need to be reduced or stopped. Contact
       your doctor for further advice.
     * Other side effects include muscle pain or weakness, hair loss,
       rash, changes in the numbers of blood cells or liver enzymes, and
       low sperm counts.
     * There is a lack of evidence regarding the safety and effectiveness
       of colchicine when used as a treatment for acute gout (although it
       has been used for this purpose in certain circumstances).
     * Colchicine should not be used to treat pain that occurs as a result
       of other conditions.
     * Colchicine is a substrate for the P-glycoprotein transporter and
       for the CYP3A4 metabolizing enzyme. In people with kidney or liver
       disease, colchicine may cause a potentially fatal reaction with
       other medications that inhibit P-glycoprotein or CYP3A4 (such as
       ketoconazole, clarithromycin, erythromycin, grapefruit juice,
       cyclosporine, or verapamil). Colchicine should not be given to
       people with kidney or liver disease.
     * Colchicine may also interact with other medications such as statins
       and fibrates (may increase the risk of muscle damage).

   Notes: In general, seniors or children, people with certain medical
   conditions (such as liver or kidney problems, heart disease, diabetes,
   seizures) or people who take other medications are more at risk of
   developing a wider range of side effects. For a complete list of all
   side effects, [84]click here.

Bottom Line

   Colchicine is effective for preventing gout flares in adults; however,
   colchicine may interact with a number of other medications and cause
   gastrointestinal side effects at higher dosages.

Tips

     * May be taken with or without food.
     * When colchicine is used to prevent gout flares it should be taken
       regularly, once or twice a day as prescribed by your doctor.
     * If you experience any gastrointestinal side effects from colchicine
       such as abdominal pain, diarrhea, nausea or vomiting, contact your
       doctor to discuss.
     * Do not take colchicine with any other medications or
       over-the-counter medicines without first talking with your doctor
       or pharmacist.
     * Do not take colchicine with grapefruit or grapefruit products.
     * If you develop any symptoms of muscle pain or weakness or numbness
       in the fingers or toes, contact your doctor immediately and
       discontinue colchicine. Also, contact your doctor if you experience
       any unusual bleeding or bruising or skin discoloration.

Response and Effectiveness

     * Peak concentrations of colchicine are reached within 0.7 to 2.5
       hours after oral administration. Food has no effect on the
       absorption of colchicine. Some reduction in pain should be expected
       within 24 hours of taking colchicine.

References