Colchicine

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 24.04.2021

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Synonym(s)

Colchicine

Definition
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Alkaloid of autumn crocus, N-acetylated troponal alkaloid, immunosuppressant. S.a. Colchici semen.

Pharmacodynamics (Effect)
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Inhibition of metaphase in granulocytes by interaction with microtubules, inhibition of chemotaxis, inhibition of granular release from mast cells, inhibition of melanin transfer between melanocytes and keratinocytes.

Indication
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Acute gout attack(according to S2e guideline), Behçet, M., CREST syndrome.

Indication gout - according to S2 e guideline gouty arthritis.

Mechanism of action: inhibition of the formation of the microtubule apparatus with prevention of migration and phagocytosis activity of neutrophil granulocytes and macrophages, which phagocytose the precipitated urate crystals and induce inflammation.

Indication: rheumatism: anti-inflammatory action.

Indication: constipation: inhibition of the regeneration of the cells of the intestinal mucosa with laxative effect - strict indication! caution: poisoning ! maximum dose 6 mg !

Indication stent implantation: low-dose colchicine treatment can prevent restenosis!

Prophylaxis and therapy of familial Mediterranean fever

COVID 19 infection: In macrophage activation syndrome with respiratory distress - (small randomized trial in 2019).

Limited indication
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Reduced general condition, age > 65 years, women of childbearing age, liver diseases, severe gastrointestinal disorders.

Dosage and method of use
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  • Acute gout attack: First 1 mg, then 0.5 mg p.o. every 1-2 hrs until pain subsides, max. 8 mg/day.
  • Behçet, M., CREST syndrome: 2 times/day 0.6 mg p.o.

Reminder. In women of childbearing age, a pregnancy test should be performed before initiating therapy. During therapy and up to 3 months after discontinuation of the preparations, safe contraception must be carried out!

Reminder. Men should not father children during long-term therapy and up to 3 months after discontinuation of the preparations. In addition, a spermiogram should be performed before initiation and after completion of treatment, and patients should be advised of the possibility of sperm cryopreservation!

Undesirable effects
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Blood formation disorders, spermatogenesis inhibition, gastrointestinal disorders, liver or kidney damage, stomatitis, alopecia, allergic reactions, peripheral neuropathy, peripheral optic nerve inflammation, myopathy, rhabdomyolysis.

Interactions
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See Table 1.

Contraindication
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Pregnancy (fetotoxic risk in the 2nd and 3rd trimester), lactation, severe anaemia, severe heart disease, cardiovascular disorders, children and adolescents < 16 years, leukopenia, severe kidney damage.

Preparations
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Colchicum Dispert, Agnesin forte

Tables
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Major interactions of colchicine

Ciclosporin A

Myopathy, kidney damage, rhabdomyolysis

Cyanocobalamin p.o.

Cyanocobalamin level ↓ by malabsorption

Erythromycin

Colchicine toxicity ↑

Sulfinpyrazone

Leukemia in long-term therapy with colchicine

Sympathomimetics

Sympathomimetic effect

Authors

Last updated on: 24.04.2021