Colchicine: Difference between revisions
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==Adult Dosing== | ==Adult Dosing== | ||
*Gout | *Gout | ||
**Flare treatment: Initial: 1.2mg and then 0.6mg in an hour (maximum 1. | **Flare treatment: Initial: 1.2mg and then 0.6mg in an hour (maximum 1.8mg within 1 hour). In patient receiving prophylaxis treatment wait for 12 h after flare dosing before resuming prophylaxis dose. Do not repeat treatment for at least 3 days (Canadian labelling recommendation) | ||
**Prophylaxis Treatment: 0.6mg twice daily (maximum 1.2mg/day) for 3 months (without tophi) to 6 months (≥1 tophi) after reaching target serum uric acid levels <ref>Khanna D. et al.2012 ACR Guidelines for Management of Gout Part I: Systemic Non-pharmacologic and Pharmacologic Therapeutic Approach to Hyperuricemia. Arthritis Care Res (Hoboken). 2012 Oct; 64(10): 1431–1446.</ref> | **Prophylaxis Treatment: 0.6mg twice daily (maximum 1.2mg/day) for 3 months (without tophi) to 6 months (≥1 tophi) after reaching target serum uric acid levels <ref>Khanna D. et al.2012 ACR Guidelines for Management of Gout Part I: Systemic Non-pharmacologic and Pharmacologic Therapeutic Approach to Hyperuricemia. Arthritis Care Res (Hoboken). 2012 Oct; 64(10): 1431–1446.</ref> | ||
*Familial Mediterranean Fever (FMF): 1.2mg to 2.4 mg per day in 1-2 decided dose. Titrate (increase or decrease) 0.3mg daily increment based on efficacy and adverse effects. | *Familial Mediterranean Fever (FMF): 1.2mg to 2.4 mg per day in 1-2 decided dose. Titrate (increase or decrease) 0.3mg daily increment based on efficacy and adverse effects. | ||
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==Pediatric Dosing== | ==Pediatric Dosing== | ||
*Familial Mediterranean Fever (FMF): | *Familial Mediterranean Fever (FMF): | ||
**Children 4 to 6 years: 0.3 to 1. | **Children 4 to 6 years: 0.3 to 1.8mg daily in 1-2 divided doses | ||
**Children 6 to 12 years: 0.9 to 1. | **Children 6 to 12 years: 0.9 to 1.8mg daily in 1-2 divided doses | ||
**Adolescents >12 years: Adult dosing | **Adolescents >12 years: Adult dosing | ||
*Gout prophylaxis/treatment: Adult dosing | *Gout prophylaxis/treatment: Adult dosing | ||
Revision as of 20:33, 19 July 2016
Administration
- Type: Antigout
- Dosage Forms: Capsules, Tablets
- Routes of Administration: Oral
- Common Trade Names: Colcris; Mitigare (US), Jamp-Colchicine; PMS-Colchicine (Canadian)
Adult Dosing
- Gout
- Flare treatment: Initial: 1.2mg and then 0.6mg in an hour (maximum 1.8mg within 1 hour). In patient receiving prophylaxis treatment wait for 12 h after flare dosing before resuming prophylaxis dose. Do not repeat treatment for at least 3 days (Canadian labelling recommendation)
- Prophylaxis Treatment: 0.6mg twice daily (maximum 1.2mg/day) for 3 months (without tophi) to 6 months (≥1 tophi) after reaching target serum uric acid levels [1]
- Familial Mediterranean Fever (FMF): 1.2mg to 2.4 mg per day in 1-2 decided dose. Titrate (increase or decrease) 0.3mg daily increment based on efficacy and adverse effects.
Pediatric Dosing
- Familial Mediterranean Fever (FMF):
- Children 4 to 6 years: 0.3 to 1.8mg daily in 1-2 divided doses
- Children 6 to 12 years: 0.9 to 1.8mg daily in 1-2 divided doses
- Adolescents >12 years: Adult dosing
- Gout prophylaxis/treatment: Adult dosing
Special Populations
- Pregnancy Rating: C
- Lactation risk: Colchicine enters breast milk, caution should be used when administering in a nursing woman.
Renal Dosing
- Adult:
- Gout flare treatment:
- Use colchicine to treat acute route flare is contraindicated in patients with renal impairment who are receiving colchicine for prophylaxis.
- CrCl 30-80 mL/minute: dose adjustment not required, monitor closely for adverse effects.
- CrCl <30 mL/minute: consider dose reduction, should not repeat dose more frequently that every 14 days.
- Dialysis: A single dose of 0.6mg, should not repeat dose more frequently that every 14 days.
- Gout prophylaxis:
- CrCl 30-80 mL/minute: dose adjustment not required, monitor closely for adverse effects.
- CrCl <30 mL/minute: nitial dose: 0.3mg daily, titrate with caution, monitor closely for adverse effects.
- Dialysis: 0.3mg twice weekly, monitor closely for adverse effects.
- FMF:
- CrCl 30-80 mL/minute: monitor closely for adverse effects, consider dosage reduction.
- CrCl <30mL/minute: Initial dose: 0.3mg daily, titrate with caution, monitor closely for adverse effects.
- Dialysis: a single dose of 0.3mg, titrate with caution, monitor closely for adverse effects.
- Gout flare treatment:
- Pediatric: Not defined
Hepatic Dosing
- Adult:
- Mild to moderate impairment: use with caution, closely monitor for adverse effects.
- Severe impairment: consider dosage adjustment.
- Pediatric: Not defined
Contraindications
- Allergy to class/drug
- Concomitant use with P-glycoprotein or strong CYP3A4 inhibitor in patients with renal or hepatic impairment
- Patient with both renal and hepatic impairment
- Serious gastrointestinal or cardiac disease
Adverse Reactions
Serious (<1%)
- Bone marrow suppression
- Disseminated intravascular coagulation
- Toxic neuromuscular disease
- Rhabdomyolysis
- Hepatotoxicity
- Hypersensitivity reaction
Common
- Diarrhoea
- Nausea
- Vomiting
- Abdominal cramp/abdominal pain
- Gout
- Pharyngolaryngeal pain
- Fatigue
- Headache
Pharmacology
- Half-life: 27 to 31 hours (multiple dose; young, healthy volunteers)
- Metabolism: Hepatic (CYP3A4)
- Excretion: Urine
Mechanism of Action
- Disrupts cytoskeleton function: inhibit beta-tubulin polymerization into microtubules.
- Prevent activation, migration and degranulation of neutrophils mediating some gout symptoms.
Comments
See Also
References
- ↑ Khanna D. et al.2012 ACR Guidelines for Management of Gout Part I: Systemic Non-pharmacologic and Pharmacologic Therapeutic Approach to Hyperuricemia. Arthritis Care Res (Hoboken). 2012 Oct; 64(10): 1431–1446.