Anti-Inflammatory — NLRP3 Inflammasome Inhibitor (Cardiovascular Indication) Pregnancy: Avoid — teratogenic in animal studies; limited human data; if required for FMF in pregnancy, specialist haematology/rheumatology review; some registry data suggests safety in FMF but not established for CV indication.

Colchicine (Cardiovascular Anti-Inflammatory)

Brand names: Colchicine 500 mcg, Zynreva (low-dose MR — US only)

Adult dose

Dose: Post-MI secondary prevention: 0.5 mg once daily long-term; Pericarditis (loading then maintenance): 0.5 mg twice daily for 3 months (>70 kg) or 0.5 mg once daily (<70 kg)

Route: Oral

Frequency: Once daily (CV prevention); twice daily (pericarditis)

Max: 0.5 mg twice daily

Low-dose colchicine for CV prevention — mechanism via NLRP3 inflammasome inhibition, reducing IL-1β and IL-18 production. Different to gout dose (1.5–3 mg/day). Must NOT be combined with strong CYP3A4/P-gp inhibitors. NICE is reviewing colchicine for CV indication (2024).

Paediatric dose

Route:

Not licensed for CV indication in children.

Dose adjustments

Renal

eGFR 30–60: use with caution — reduce dose to 0.5 mg once daily max. eGFR <30: avoid (accumulation risk — colchicine toxicity). Dose 0.5 mg once daily every other day if eGFR 10–30.

Hepatic

Avoid in severe hepatic impairment — hepatic metabolism (CYP3A4); significant accumulation risk.

Clinical pearls

COLCOT trial (Tardif et al. NEJM 2019): colchicine 0.5 mg once daily started 30 days post-MI — 23% relative reduction in primary endpoint (CV death, cardiac arrest, MI, stroke, urgent hospitalisation for angina) vs placebo. NNT approximately 45 over 22 months. First anti-inflammatory agent to reduce CV events post-MI in a large RCT
LoDoCo2 trial (Nidorf et al. NEJM 2020): colchicine 0.5 mg once daily in chronic coronary artery disease (not just post-MI) — 31% relative risk reduction in CV events vs placebo. Together with COLCOT, established low-dose colchicine as a new anti-inflammatory approach to atherosclerotic CV disease
CYP3A4 drug interaction warning: colchicine toxicity with clarithromycin is a well-documented and potentially fatal interaction. Colchicine accumulates dramatically — presenting as GI toxicity progressing to rhabdomyolysis, multi-organ failure, and death. Always check for macrolide co-prescribing; use azithromycin (less CYP3A4 inhibition) or another antibiotic class instead

Contraindications

eGFR <10 mL/min (severe renal failure)
Severe hepatic impairment
Concurrent strong CYP3A4 + P-gp inhibitors (clarithromycin, cyclosporin — colchicine toxicity risk; potentially fatal)

Side effects

GI effects (nausea, diarrhoea, abdominal cramps — dose-dependent; less with low 0.5 mg dose)
Myopathy (particularly with statin co-administration — MHRA warning)
Neuromuscular toxicity (overdose or CYP3A4 inhibitor interaction)
Bone marrow suppression (prolonged high doses)
Alopecia (rare)

Interactions

CYP3A4 inhibitors (clarithromycin, azithromycin, ketoconazole, ciclosporin — life-threatening colchicine toxicity — avoid or dose-reduce significantly per SPC)
P-gp inhibitors (verapamil, amiodarone — increase colchicine levels)
Statins (additive myopathy risk — monitor CK; avoid simvastatin 40–80 mg with colchicine per MHRA guidance)

Monitoring

GI tolerability (dose reduction if intolerable GI side effects)
CK and muscle symptoms (myopathy risk — particularly with statins)
Renal function (dose adjustment criterion)
LFTs (hepatic accumulation)
Drug interaction check at every prescription review (CYP3A4 inhibitors)

Reference: BNFc; BNF 90; COLCOT Trial (Tardif et al. NEJM 2019); LoDoCo2 Trial (Nidorf et al. NEJM 2020); MHRA SPC Colchicine; ESC ACS Guidelines 2023. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways