Colchicine is a well-established anti-inflammatory drug primarily used for acute gout attacks, gout prophylaxis, familial Mediterranean fever (FMF), and select inflammatory cardiac conditions like pericarditis. Unlike NSAIDs or steroids, colchicine works by inhibiting microtubule formation, thereby suppressing neutrophil activity and inflammation at its root.
What Is Colchicine?
Colchicine is an anti-mitotic, anti-inflammatory alkaloid derived from the plant Colchicum autumnale.
It does not relieve pain directly. Instead, it prevents inflammatory cell migration—especially neutrophils—to inflamed tissues, making it uniquely effective in crystal-induced inflammation like gout.
How Colchicine Works
Colchicine targets inflammation at the cellular level.
Step-by-Step Mechanism
1. Binds to tubulinKey Outcome
Inflammation is suppressed without affecting uric acid levels
That’s why colchicine is not a urate-lowering drug—it treats inflammation, not hyperuricemia.
Clinical Uses of Colchicine
1. Acute Gout Attack
- First-line option (especially if NSAIDs are contraindicated)
- Most effective when started within 12–24 hours
2. Gout Prophylaxis
- Prevents flares during initiation of urate-lowering therapy (e.g., allopurinol)
3. Familial Mediterranean Fever (FMF)
- Drug of choice
- Prevents amyloidosis and recurrent inflammatory attacks
4. Pericarditis (Acute & Recurrent)
- Reduces recurrence
- Used with NSAIDs
5. Other Off-Label Uses
- Behçet disease
- Calcium pyrophosphate deposition disease (CPPD)
- Post-MI inflammation (select cases)
Colchicine Dosage
Acute Gout (Adults)
Low-dose regimen (preferred):
- 1.2 mg orally at first signMax: 1.8 mg in 24 hours
Gout Prophylaxis
0.6 mg once or twice dailyFamilial Mediterranean Fever
- Adults: 1–2 mg/day (divided doses)
- Children: weight-based dosing
Pericarditis
- 0.5–0.6 mg once or twice daily
- Duration: 3–6 months
Dose reduction required in renal or hepatic impairment
Colchicine Pharmacokinetics
| Parameter | Detail |
|---|---|
| Absorption | Rapid oral absorption |
| Metabolism | Hepatic (CYP3A4) |
| Excretion | Biliary + renal |
| Half-life | ~26–31 hours |
| Protein binding | Moderate |
Side Effects of Colchicine
Common (Dose-dependent)
- Diarrhea (most common)
- Nausea
- Vomiting
- Abdominal cramps
Serious / Toxic Effects
- Bone marrow suppression
- Myopathy & rhabdomyolysis
- Peripheral neuropathy
- Pancytopenia
Signs of Colchicine Toxicity
GI upset → muscle weakness → multi-organ failure
Contraindications & Cautions
Absolute Contraindications
- Severe renal failure
- Severe hepatic impairment
- Concomitant strong CYP3A4 inhibitors
Use with Extreme Caution In
- Elderly patients
- Renal disease
- Hepatic disease
Drug Interactions You Must Know
| Drug | Risk |
|---|---|
| Clarithromycin | Fatal toxicity |
| Erythromycin | ↑ Colchicine levels |
| Ketoconazole | CYP3A4 inhibition |
| Cyclosporine | Myopathy |
| Statins | Rhabdomyolysis |
Colchicine + macrolides = dangerous combination
Colchicine vs NSAIDs vs Steroids
| Feature | Colchicine | NSAIDs | Steroids |
|---|---|---|---|
| Pain relief | Indirect | Direct | Direct |
| GI safety | Moderate | Poor | Good |
| Renal safety | Poor | Poor | Better |
| Gout prophylaxis | Yes | No | No |
| Onset | Slower | Fast | Fast |
Common Mistakes
❌ Using high-dose regimens
✅ Always use low-dose protocols
❌ Prescribing with macrolides
✅ Check drug interactions
❌ Using in renal failure without dose adjustment
✅ Reduce dose or avoid
❌ Assuming it lowers uric acid
✅ Combine with urate-lowering therapy when needed
What’s New & Current
- Low-dose colchicine proven safer and equally effective
- Expanded use in cardiovascular inflammation
- Stronger warnings on drug-drug interactions
- Increased preference over NSAIDs in elderly patients
Practical Example
Patient: 55-year-old male with acute podagra
Plan:
- Colchicine 1.2 mg stat
- 0.6 mg after 1 hour
- Continue 0.6 mg daily × 7 days
- Start urate-lowering therapy after flare resolves
FAQs
Is colchicine a painkiller?
No. It reduces inflammation, not pain directly.
How fast does colchicine work?
Improvement usually begins within 12–24 hours.
Can colchicine be taken daily?
Yes, for prophylaxis—but only at low doses.
Is colchicine safe long term?
Yes, with monitoring and proper dosing.
Can colchicine cause kidney damage?
It can worsen renal function if improperly dosed.
Does colchicine lower uric acid?
No. It only treats inflammation.
Is colchicine safe in pregnancy?
Use only if benefits outweigh risks.
