Colchicine (Acute Gout)

How it works

It binds tubulin and inhibits microtubule polymerisation, impairing neutrophil chemotaxis, activation and the inflammatory response to urate crystals.

Prescribing in practice

• Colchicine has a narrow therapeutic index and toxicity (severe diarrhoea, vomiting, then multi-organ and bone-marrow effects) can be fatal; do not give a further course within a short interval and reduce dose or avoid in significant renal or hepatic impairment.
• Potent CYP3A4 and P-glycoprotein inhibitors (such as clarithromycin, certain antifungals, ciclosporin and some protease inhibitors) markedly raise colchicine levels and can precipitate fatal toxicity.
• Diarrhoea is an early sign of toxicity, and concurrent statins may increase the risk of myopathy.

Monitoring

Monitor for gastrointestinal toxicity as an early warning sign, and review renal and hepatic function and interacting drugs before and during use.

Counselling the patient

• Stop taking it and seek advice if you develop diarrhoea, vomiting or severe stomach upset.
• Do not take more than directed, as overdose can be dangerous.
• Tell clinicians about this medicine if prescribed certain antibiotics or antifungals.

Evidence & guidelines

Low-dose colchicine regimens are supported by NICE for acute gout, achieving comparable efficacy to higher doses with substantially less toxicity.