Makindo Medical Notes

⚠️ Important Safety: Do not give colchicine in those who are, or might be, pregnant. 💊 Manufacturer advises: - Reduce dose by half with concurrent use of moderate CYP3A4 inhibitors. - Reduce dose by 75% (to one quarter of usual dose) with potent CYP3A4 or P-glycoprotein inhibitors. - Avoid concurrent use in patients with hepatic or renal impairment. 👉 Always check the BNF for current prescribing.

🌿 About

• Colchicine is a highly poisonous alkaloid with both cytotoxic and anti-inflammatory properties.
• Extracted from the plant Colchicum autumnale (autumn crocus), used in medicine since antiquity.
• It works by modifying the immune response and reducing inflammation.

⚙️ Mode of Action

• Inhibits microtubule polymerization by binding to tubulin.
• Prevents formation of the mitotic spindle → cells arrest in metaphase.
• Alters neutrophil cytoskeleton → reduced motility and activity → anti-inflammatory effect.

📌 Indications

• Acute gout (treatment).
• Prophylaxis of recurrent gout attacks.
• Acute pericarditis – reduces pain and recurrence (Merck Manual).
• Familial Mediterranean Fever (FMF).
• Pseudogout – prevention of acute attacks.
• Amyloidosis, Behçet’s disease, Dermatitis herpetiformis, Leukocytoclastic vasculitis.

💊 Indication and Dose

Always check the BNF for the latest prescribing information.

⛔ Contraindications

• Severe renal, hepatic, blood, or cardiac disorders.
• Pregnancy (contraindicated).

⚠️ Side Effects

• GI: abdominal pain, diarrhoea, vomiting, mucositis, GI haemorrhage.
• Hematological: rare myelosuppression.
• Renal: rare renal failure.
• Musculoskeletal/neurological: myopathy, peripheral neuritis.

🔗 Interactions

• ↑ Risk of myopathy when combined with statins.
• Avoid macrolides (clarithromycin, erythromycin) – inhibit metabolism and ↑ toxicity risk.

📚 References

• BNF – Colchicine
• Summary of Product Characteristics (SPC)
• Merck Manual – Gout and Pericarditis sections.