Colchicine and Gout

Colchicine and Gout

This Post is in the ''Treatments for Gout'' Category

For over 2000 years, an extract from the root of the autumn crocus, called Colchicum autumnale, has been used to treat gout. Since 1820, the active ingredient from this root, col¬chicine, has been extracted. It is available in tiny tablets con¬taining either 0.5 or 0.6 mg of the pure substance.

Colchicine is rapidly absorbed from the stomach and intestines and distributed throughout the body, remaining in many tissues for a prolonged period. It has been shown to per¬sist in cells as long as 10 days after the last dose was taken. The body eliminates colchicine in the bile, in the intestinal secre¬tions and about 20 per cent in the urine. It acts by interfering with the ingestion of foreign material, such as crystals, by the polymorphonuclear leucocytes (polymorphs) which are the chief inflammatory cells in the body. It also blocks the release of factors produced by these polymorphs which call up further inflammatory cells as a response to crystal formation. It also suppresses the generation of inflammatory substances at the site of any interaction and reduces the risk of an acute attack of gout because this limits the risk of inflammation developing as a response to urate crystal formation.

The principal serious side-effects with colchicine are dia¬rrhoea together with nausea and vomiting. The dose which produces these effects is very close to the dose needed to pro-duce the beneficial response, and both these doses are different in every patient. Thus, the dose for treatment of an acute attack needs to be individualised. This is achieved by giving a dose of 2 tablets initially (1 mg) followed by 0.5 mg each second hour until either the acute gout subsides or the patient develops dia¬rrhoea, vomiting or abdominal discomfort. When any of these happen, no further colchicine should be taken. Acute gout will then usually subside in 80 per cent of patients within 24 hours of development of diarrhoea. The total dose of colchicine need¬ed may vary up to 14 tablets (7 mg) and occasionally higher than this if the patient is large. Some patients need considerably less than this and the method of administering it each 2 hours enables it to be stopped when the side-effects occur.

The amount of colchicine which each individual patient needs to treat acute gout is usually fairly constant from one attack to the next so that if a patient finds that 10 tablets (5 mg) is effective on one occasion, a dose of 9 tablets (4.5 mg) can be taken on the next occasion (again, in divided doses) and this may cause the acute attack of gout to subside without gas¬trointestinal side-effects.

The dose should be reduced in patients with either kidney or liver disease, in the elderly, or in those who have been receiving it on a regular basis prior to the acute attack. Overdosage is very dangerous, destroying a wide variety of cells in the body and leading to failure of many organs, and is always a life-threatening condition which may be irreversible.

No doubt it seems strange that a drug with this potential for serious side-effects is still used. However, almost all beneficial medications also have associated risks and, if used as recom¬mended, the risk/benefit ratio of colchicine is favourable.

In some countries, colchicine is available in a preparation for intravenous use. Administration in this way does not cause any diarrhoea, vomiting, or other gastrointestinal side-effects. However, the potential for general toxicity—poisoning—4s greatly increased, so there are clear recommendations for its use that must be followed. Intravenous colchicine cannot be self-administered. The drug is not available in intravenous form for use in either Australia or the United Kingdom, although it is often used in the USA.

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