Colchicine

Colchicine is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

Definition

Colchicine is the active alkaloid extracted from two plants of the Liliaceae family: Colchicum autumnale (autumn crocus) and Gloriosa superba (glory lily). It has been used in the therapy of gout for centuries.

Etiology

Colchicine has a very narrow therapeutic index. Severe poisoning and death can result from the ingestion of as little as 0.8 mg/kg of body weight.1

Pathophysiology

Colchicine is an effective inhibitor of intracellular microtubule formation, leading to impaired leukocyte chemotaxis, and phagocytosis, resulting in a decrease in the inflammatory cascade.2 In overdose, colchicine causes mitotic arrest, leading to cellular dysfunction and death.3

Prevention

Patients who are started on colchicine for gout symptoms should be explicitly directed to stop taking the medication as soon as symptoms of diarrhea occur. They should also be told that increasing the dose in an acute flare can result in significant toxicity; therefore, if they are unable to control the symptoms at home, they should seek expert care early.

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