Colchicine: 7 things you should know

Medically reviewed by Carmen Pope, BPharm. Last updated on May 16, 2024.

1. How it works

• Colchicine is a medicine that is used to relieve the symptoms of gout.
• It is thought to work by blocking how our immune system responds to the presence of urate crystals in synovial fluid (the fluid between our joints). Colchicine may also reduce the effect of other inflammatory substances.
• Colchicine belongs to the class of medicines called anti-gout agents. It treats the symptoms of gout but is not a cure for gout.

2. Upsides

• May be used to prevent gout flares in adults.
• May also be used to treat familial Mediterranean fever (FMF) in adults and children ages 4 and older. FMF is a condition that causes fever, pain, and swelling of the lungs, joints, and stomach.
• There have been no reports of tolerance, dependence, or abuse associated with colchicine use.
• Colcrys is a brand name for colchicine.
• Colchicine is available as a cost-saving generic.

3. 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 number 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 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 not be suitable for some people with ulcerative colitis, Crohn's disease, bleeding disorders, or certain other medical conditions.
• Colchicine may also interact with other medications such as statins and fibrates (may increase the risk of muscle damage).
• There have been reports of illegal generic versions of Colcrys being sold by fraudulent online pharmacies. Only buy medicines online from a reputable and valid pharmacy.
• Only use during pregnancy if the benefits justify the risk. There are no adequate and well-controlled studies. Colchicine crosses the human placenta and animal studies have demonstrated embryofetal toxicity, teratogenicity, and altered postnatal development. Colchicine is excreted into human milk at less than 10% of the maternal weight-adjusted dose. Although no adverse effects have been reported in breastfeeding infants of mothers taking colchicine, colchicine can affect gastrointestinal cell renewal and permeability.

Note: 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. View complete list of side effects

4. Bottom Line

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

5. 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.
• Regular blood tests may be needed if you take colchicine long-term.
• 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, bruising, or skin discoloration.
• Talk to your doctor if you are pregnant, intending to become pregnant, or breastfeeding because colchicine may not be suitable for you.

6. Response and effectiveness

• Peak concentrations of colchicine are reached within 0.7 to 2.5 hours after oral administration. Food does not affect the absorption of colchicine. Some reduction in pain should be expected within 24 hours of taking colchicine.

7. Interactions

Medicines that interact with colchicine may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with colchicine. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with colchicine include:

• aprepitant
• antifungals such as itraconazole, fluconazole, and ketoconazole
• cyclosporine
• digoxin
• HIV medications, such as amprenavir, atazanavir, fosamprenavir, indinavir, nelfinavir, ritonavir, and saquinavir
• macrolide antibiotics, such as azithromycin, clarithromycin, or erythromycin
• medications used to treat high cholesterol such as statins (eg, atorvastatin, fluvastatin, lovastatin, pravastatin, and simvastatin) or fibrates (eg, fenofibrate and gemfibrozil)
• nefazodone
• ranolazine
• verapamil.

Grapefruit juice and grapefruit products (eg, marmalade) can increase the amount of colchicine your body absorbs and should not be taken with colchicine.

Note that this list is not all-inclusive and includes only common medications that may interact with colchicine, You should refer to the prescribing information for colchicine for a complete list of interactions.

References

• Colchicine. Revised 05/2024. Aurobindo Pharma Limited. https://www.drugs.com/pro/colchicine.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use colchicine only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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