Pericarditis / Coronary Inflammation Pregnancy: Avoid in 1st trimester (risk of aneuploidy); risk/benefit assessment with specialist in 2nd/3rd trimester. Some data support use in familial Mediterranean fever throughout pregnancy.

Colchicine (Pericarditis / Post-MI Inflammation)

Brand names: Colchicine Zurich

Adult dose

Dose: Pericarditis: 0.5 mg twice daily (weight <70 kg: 0.5 mg OD) for 3 months (acute); 6 months (recurrent). Post-MI inflammation (LoDoCo2 dose): 0.5 mg once daily long-term.

Route: Oral

Frequency: Once or twice daily (dose and duration vary by indication)

Max: 0.5 mg BD

Anti-inflammatory via NLRP3 inflammasome inhibition. COPE trial (acute pericarditis), CORP/CORP-2 (recurrent), LoDoCo2 (chronic CAD), COLCOT (post-MI). Low-dose protocol avoids traditional GI toxicity of higher doses used in gout.

Paediatric dose

Route: Oral

Seek specialist paediatric cardiology opinion for pericarditis in children

Dose adjustments

Renal

eGFR 10-30: 0.5 mg OD only (do not use BD dose). eGFR <10: avoid — significant accumulation and toxicity risk. Monitor for myopathy in CKD.

Hepatic

Avoid in severe hepatic impairment

Clinical pearls

COPE trial (Imazio et al. Lancet 2005): colchicine added to aspirin in first episode acute pericarditis — 50% reduction in recurrence at 18 months. Established colchicine as standard of care for acute pericarditis (now ESC Class I recommendation).
COLCOT trial (Tardif et al. NEJM 2019): colchicine 0.5 mg OD vs placebo started within 30 days of MI — 23% relative risk reduction in composite cardiovascular events at 22 months. First demonstration of colchicine benefit post-MI.
LoDoCo2 trial (Nidorf et al. NEJM 2020): colchicine 0.5 mg OD in stable chronic coronary disease — 31% relative risk reduction in cardiovascular events. Residual inflammatory risk addressed.
Mechanism: colchicine inhibits the NLRP3 inflammasome → blocks IL-1beta and IL-18 release → reduces neutrophil recruitment and systemic inflammation. Particularly effective in pericarditis (IL-1-driven) and post-MI (NLRP3-driven).
Fatal colchicine toxicity: clarithromycin (CYP3A4 + P-gp inhibitor) + colchicine is a well-documented fatal drug interaction. Even a short antibiotic course with clarithromycin can cause fatal multiorgan failure in colchicine-treated patients — use azithromycin instead.

Contraindications

Severe renal impairment (eGFR <10)
Severe hepatic impairment
Concomitant strong CYP3A4 inhibitors + P-gp inhibitors (clarithromycin + cyclosporin — potentially fatal colchicine toxicity)
Blood dyscrasias

Side effects

GI upset (nausea, diarrhoea — most common; reduced at low-dose regimen)
Myopathy (especially with statins, ciclosporin, clarithromycin)
Bone marrow suppression (prolonged high-dose use)
Azoospermia (reversible — high dose)

Interactions

Clarithromycin + ciclosporin — potentially FATAL colchicine toxicity (dual CYP3A4 + P-gp inhibition); avoid combination
Statins — additive myopathy risk (especially simvastatin)
Ciclosporin alone — increases colchicine levels 2-fold; reduce dose or avoid
Clarithromycin alone — increases colchicine levels 3-fold; fatal cases reported

Monitoring

FBC (prolonged use)
Renal function (eGFR)
CRP/ESR (pericarditis response)
Myopathy symptoms (CK if on statins)
GI symptoms

Reference: BNFc; BNF 90; COPE Trial (Imazio et al. Lancet 2005); COLCOT Trial (Tardif et al. NEJM 2019); LoDoCo2 Trial (Nidorf et al. NEJM 2020); ESC Pericardial Disease Guidelines 2015; SPC Colchicine. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways