Colchicine

Colchicine

Colchicine is a medication approved by the FDA to treat gout flares, Familial Mediterranean Fever (FMF), and other inflammatory conditions. This is a generic medication and also available in the brand name Colcrys. It comes in the form of 0.6 mg oral tablets and capsules, with dosage varying based on the condition being treated. For adults with gout flares, the typical initial dosage is 1.2 mg. It then followed by 0.6 mg an hour later. In FMF, dosages range from 1.2 to 2.4 mg daily for adults. This medication works by reducing swelling and uric acid crystal buildup in joints. It’s essential to use this medication under a doctor’s supervision due to potential side effects, such as nausea and vomiting, and more serious risks, like muscle damage and liver issues.

Product Overview

Colcrys (Colchicine) is primarily used for treating gout flares, a condition characterized by sudden and severe aches in the joints due to the accumulation of uric acid crystals. It is also used for managing Familial Mediterranean Fever (FMF), a genetic disorder causing recurrent fevers & inflammation in the abdomen, chest, or joints. Additionally, Colcrys is prescribed for various inflammatory conditions such as pericarditis, biliary cirrhosis, pulmonary fibrosis, and vasculitides.

The medication comes in oral tablet and capsule forms, with a standard strength of 0.6 mg. The recommended dosage for gout flares in adults is 1.2 mg at the onset of symptoms, followed by 0.6 mg one hour later. For FMF, the dosage varies based on age, starting from 0.3 mg for children aged 4-5 years to 1.2-2.4 mg for adults. Patients should follow their healthcare giver’s instructions regarding the dosage and scheduling of Colcrys. The medication may need to be adjusted for those with liver or kidney impairments and for senior citizens due to the risk of side effects. You may notice or have some common side effects, including gastrointestinal issues such as vomiting, diarrhea, and nausea, as well as muscle pain and rash.

Colcrys can interact with other medications, including those that inhibit P-glycoprotein and CYP3A4 enzymes, leading to an increased risk of toxicity. Patients should inform their healthcare provider about all other medications they are taking to avoid potential drug interactions. Colcrys is an effective medication for managing gout flares, FMF, and other inflammatory conditions. However, it is essential to use it under the guidance of a healthcare provider and adhere to the prescribed dosage. Be aware of side effects & drug interactions to use the drug and get most of the benefits.

Uses of Colchicine

Colchicine is used to treat a variety of conditions, including:

• Gout
• Familial Mediterranean Fever (FMF)
• Pericarditis
• Pulmonary Fibrosis
• Biliary Cirrhosis
• Various Vasculitides
• Pseudogout
• Spondyloarthropathy
• Calcinosis
• Scleroderma
• Amyloidosis
• Atherosclerosis

How to Use Colchicine?

Dosage

Colcrys (Colchicine) comes in the following forms and strengths: 

Form 1: Oral Tablet

Strengths: 0.6 mg

Form 2: Oral Capsule

Strengths: 0.6 mg

Recommended Dosage for Different Patients

Dosage for the Treatment of Gout Flares

• Adult Dosage (Ages 16 to 64 years): For oral tablets (Colcrys), the recommended dosage is 1.2 mg (it is to be taken at the first sign of a gout flare) and then followed by 0.6 mg one hour later.
• Child Dosage (Aged 0 to 15 years): Colchicine has not been studied for gout treatment or prevention in children. It should not be used for these purposes in individuals under 16 years old.
• Senior Dosage (Aged 65 Years & Older): Older adults’ kidneys may not function as well as they used to, leading to slower drug processing in the body. As a result, a drug may stay in the body longer and increase the risk of side effects. Doctors may start seniors on a lower dose or a different dosing schedule to prevent too much of the drug from accumulating in the body.

Dosage for Prevention of Gout Flares

• Adult Dosage (Age 16 to 64 Years): For the oral tablet (Colcrys), the usual dosage is 0.6 mg, taken once or twice a day.
• Child Dosage (Age 0 to 15 Years): Colchicine has not been studied for treating or preventing gout in children. It is not recommended for use in individuals under 16 years of age for these conditions.
• Senior Dosage (Age 65 years or Older): As people age, their kidneys might not work as efficiently. This can slow down how drugs are processed in the body, which further leads to a higher risk of side effects. Doctors may prescribe a lower dose or adjust the dosing schedule for older adults to prevent the drug from accumulating in the body.

Dosage for Familial Mediterranean Fever

• Typical Dosage for Adults (ages 16–64 years): 1.2–2.4 mg, taken once per day.
• Typical Dosage for Children (ages 12–15 years): 1.2–2.4 mg, taken once per day.
• Typical Dosage for Children (ages 6–11 years): 0.9–1.8 mg, taken once per day.
• Typical Dosage for Children (ages 4–5 years): 0.3–1.8 mg, taken once per day.
• Typical Dosage for Children (ages 0–3 years): Colchicine is not recommended for children younger than 3 years old.
• Senior Dosage (Aged 65 Years or Older): For older adults aged 65 and over, their kidneys may not work as efficiently as before. This slower processing of medications means that drugs can stay in the body longer and further increase the risk of side effects. Therefore, doctors may prescribe a lower dose or a different dosing schedule to prevent the drug from accumulating too much in the body. 

[Note: Remember these recommendations may vary depending on person to person. Discuss it with your doctor, and they’ll customize your dosage accordingly.]

How to Take It?

The timing for taking Colchicine oral tablets depends on the reason you are using the medication:

For Familial Mediterranean Fever (FMF) and Gout Prevention:

• You may need to take Colchicine once or twice daily as per your doctor’s instructions.
• If taken once daily, you can choose any time, but try to take it at the same time each day.
• If taken twice daily, space your doses about 12 hours apart and maintain a consistent schedule daily.
• Consistent timing helps maintain a steady level of the drug in your body for effective results.

For Treating a Gout Flare:

• You will take two doses of Colchicine. The first dose should be taken as soon as you notice gout flare symptoms and the second dose one hour later.
• Your healthcare giver might also recommend taking a nonsteroidal anti-inflammatory drug or NSAID like ibuprofen to alleviate pain and swelling.

To ensure you don’t miss a dose, consider using a medication reminder such as setting an alarm, using a timer, or downloading a reminder app on your phone.

• Follow the instructions: If you find the instructions on your prescription label challenging to read, talk to your doctor or pharmacist. Some pharmacies provide labels with larger print, braille, or a code that may be scanned with a smartphone to convert text into speech. If your local pharmacy doesn’t offer these options, your healthcare provider may guide you to one that does.
• Handling Medication Bottles: If you struggle to open a bottle of the medication, ask your pharmacist if they can provide Colchicine in a container that’s easier to open. They might also suggest tools to make opening lids simpler.
• Taking Colchicine: You can take Colchicine with or without food. Moreover, avoid consuming grapefruit or grapefruit juice while taking Colchicine, as grapefruit can interfere with the breakdown of the medication in your body, increasing the risk of serious side effects.
• Splitting Tablets: Colchicine oral tablets are scored, meaning they can be split in half. However, the manufacturer hasn’t specified whether the tablet can be crushed or chewed. If you have difficulty swallowing colchicine tablets, discuss this with your doctor or pharmacist for advice.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Colcrys Work?

Colcrys is a medication used to prevent or treat gout attacks, which are sudden and often affect joints like the big toe, knee, or ankle. This condition is caused by the increased levels of uric acid in the blood. Which can form crystals in the joints. Colcrys reduces swelling and the buildup of these uric acid crystals, easing pain in the affected joints. Additionally, Colcrys is used to prevent pain attacks in the chest, abdomen, or joints caused by familial Mediterranean fever, a genetic disease. It is believed to work by reducing the production of a specific protein that accumulates in people with this condition. Colcrys is not a general pain reliever and should not be used for pain unrelated to these conditions.

Important Safety Information

Side Effects

Common side effects of Colchicine may include:

• Nausea
• Vomiting
• Diarrhea
• Constipation
• Abdominal pain

Serious side effects of Colchicine may include:

• Unusual bleeding or bruising.
• Fast heartbeat.
• Severe diarrhea or vomiting.
• Changes in the amount of urine.
• Shortness of breath.
• Symptoms of an infection, like a persistent sore throat or fever.
• Muscle weakness or pain.
• Unusual weakness or tiredness.
• Tingling or numbness in your fingers & toes.
• The pale or gray color of the tongue, lips, or palms of the hands.

If you experience any of these symptoms, it’s essential to contact your healthcare provider immediately. 

[Note: Remember, this list may not cover all possible side effects. Always consult with your healthcare giver for medical advice about side effects.]

Warnings

• Blood Disorders Warning: Colchicine can reduce the number of different types of blood cells your body makes. This can increase your risk of getting infections or bleeding because some of these blood cells help fight infections, and others help your blood to clot. If you have any blood disorders, it’s important to talk to your doctor about whether Colchicine is safe for you.
• Overdose Warning: Consuming too much Colchicine can be extremely dangerous and could lead to death. It’s important to always follow your doctor’s instructions and never exceed the prescribed dosage of this medication.
• Muscle Damage Warning: Taking Colchicine for six months or more can harm your muscles. Older adults are at a higher risk. If you’re also using medications for cholesterol, which can harm muscles, this risk might increase. It’s important to talk to your doctor about the safety of using Colchicine alongside cholesterol medications.
• Allergy Warning: Colchicine can sometimes cause a serious allergic reaction. If you experience symptoms like trouble breathing or swelling of your throat or tongue, seek medical help immediately. Call your local poison control center or doctor, or go to the nearest emergency room if your symptoms are severe. If you’ve ever had an allergic reaction to Colchicine, you should not take this medication again, as it could be life-threatening. 

Precautions

• For People with Kidney Disease: For those who have kidney disease, it’s important to know that your kidneys help remove Colchicine from your body. If your kidneys aren’t working correctly, Colchicine can build up in your system and increase the risk of side effects. Your doctor might lower your dose of Colchicine to prevent this.
• For People with Liver Disease: if you have liver disease, your liver helps process Colchicine in your body. If your liver isn’t functioning well, colchicine levels can rise, leading to a higher chance of side effects. To reduce this risk, your doctor may reduce your colchicine dosage.

Other Important Precautions

• For Pregnant Women: Colchicine is classified as a Category C pregnancy drug. This indicates that animal studies have shown adverse effects on the fetus, but there is insufficient human data to determine the impact on pregnancy. Discuss with your doctor about all the benefits and risks if you are pregnant or planning to become pregnant. Colchicine should only be used if the potential benefits outweigh the risks to the fetus. Contact your primary caregiver immediately if you become pregnant while taking Colchicine.
• For Breastfeeding Women: Colchicine may be transferred to breast milk and could affect a breastfed child. If you are breastfeeding, talk to your doctor about the risks. You may need to choose between discontinuing breastfeeding or stopping the medication.
• For Seniors: Older adults may experience reduced kidney function, leading to slower drug processing. As a result, the drug may remain in the body longer, increasing the risk of side effects.
• For Children: The safety and effectiveness of Colchicine for treating gout in children have not been established.

Contraindications

• Patients with kidney (renal) or liver (hepatic) problems should not take colchicine capsules along with medications that inhibit both P-glycoprotein and CYP3A4 enzymes. This combination can lead to dangerous or even deadly levels of Colchicine in the body.
• Individuals with both kidney and liver issues should not be prescribed colchicine capsules.

Missed Dose

What you should do if you miss a dose of Colchicine depends on why you’re taking the medication.

• If you’re using Colchicine to treat a gout flare and you’re not taking it regularly to prevent gout, take the dose that you have missed as soon as you remember.
• If you’re using Colchicine to treat a gout flare with this you are also take it regularly to prevent gout, take the missed dose as soon as you remember. Or wait for 12 hours & then continue with your regular dosing schedule.
• If you’re taking Colchicine to prevent gout flares or episodes of Familial Mediterranean Fever (FMF), take the missed dose as soon as you remember. If it’s almost time for your next scheduled dose, skip the dose & take your next dose at the regular time. Do not take extra doses to make up for the missed one.

[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]

Overdose

Taking more Colchicine than your doctor recommends can be dangerous and may even lead to death. Symptoms of an overdose can include:

• Stomach pain
• Nausea and vomiting
• Diarrhea
• Dehydration
• Multi-organ failure

If you believe you’ve taken too much Colchicine, contact your doctor immediately. If your symptoms are severe, call your local emergency number or go to the nearest emergency room right away.

[Note: If you consumed more than recommended dose, get medical help right away, or call the Poison Help line at 1-800-222-1222.]

Storage

• Store the medication at room temperature.
• Keep it away from direct light and moisture to maintain its effectiveness.
• Regularly check the medication for any expired or unneeded items and safely discard them.
• Avoid storing it in the bathroom, as the moisture and temperature changes can affect the medication’s stability.

[Note: Discuss with your healthcare professional about the proper disposal of any unused medicine and any questions you may have regarding its storage.]

Colchicine Interactions

Interaction with Medications

Colchicine oral tablets can interact with other medications, vitamins, or herbs you’re taking. An interaction means that a substance can affect how a medication works, which might be harmful or stop the medication from working properly. To avoid interactions, your doctor should carefully manage all of your medications. 

Make sure to tell your doctor about all the medications, vitamins, or herbs you’re taking. If you want to know how Colchicine might interact with something else you’re taking, talk to your primary healthcare giver or pharmacist. 

Drugs You Should Not Use with Colcrys

Here are some drugs that you should avoid taking with Colcrys (Colchicine) due to the risk of serious side effects:

• Antifungal Medications: Drugs like ketoconazole and itraconazole, when taken with Colchicine, can lead to extremely high levels of Colchicine in your body. It then increases the risk of side effects such as severe muscle damage.
• Antibiotics: Antibiotics such as clarithromycin and telithromycin, when used with Colchicine, can result in dangerously high colchicine levels, raising the risk of severe muscle damage.
• HIV Medications: HIV drugs, including indinavir, atazanavir, nelfinavir, saquinavir, and ritonavir, can also cause a significant increase in colchicine levels in your body, leading to severe muscle damage.
• Antidepressants: Using antidepressants like nefazodone with Colchicine can lead to very high levels of Colchicine in your body, increasing the risk of severe muscle damage.

It’s important to consult with your healthcare provider before taking any new medications with Colcrys to avoid potentially harmful interactions.

Interactions That Increase Your Risk of Side Effects

When you take Colchicine with certain medications, it can increase your risk of side effects from Colchicine. Here are some examples:

• Heart drugs like verapamil or diltiazem can lead to increased side effects such as vomiting, constipation, diarrhea, stomach pain, or nausea. To avoid these issues, your doctor might reduce your colchicine dosage.
• Cholesterol medications such as gemfibrozil, atorvastatin, lovastatin, pravastatin, simvastatin, fluvastatin, or fibrates can cause serious muscle damage as a side effect. Your doctor may lower your colchicine dosage to prevent this.
• Digoxin, a medication used for heart rhythm problems, can also lead to increased side effects like serious muscle damage. To avoid this, your doctor might reduce your colchicine dosage.

Food Interactions

Grapefruit or its juice can interfere with how your body processes Colchicine, leading to higher levels of the drug in your system and an increased risk of side effects. To avoid this, do not consume grapefruit or grapefruit juice while taking Colchicine.

[Note: This isn’t a complete list, and there could be other drugs that interact with Colcrys. Make sure to tell your doctor about any prescription, over-the-counter medicines, and herbal products you’re taking.]

Colchicine Alternatives

• Bufferin (aspirin)
• Celebrex (celecoxib)
• Advil (ibuprofen)
• Indocin (indomethacin)
• Ketoprofen
• Aleve (naproxen)
• Dexamethasone
• Triamcinolone
• Probenecid
• Betamethasone
• Dexamethasone Intensol
• Aristospan
• Prednisone

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.] 

Frequently Asked Questions

How long does it take for Colchicine to work for gout?

It usually starts working between 30 minutes and 2 hours after taking it. However, it might take a day or two for you to notice a reduction in inflammation and pain. It’s important to follow your doctor’s instructions and continue taking the medication as prescribed, even if you don’t feel immediate relief. If your symptoms don’t improve or if you experience adverse side effects, contact your healthcare provider for further guidance. 

How do I know if Colchicine is working?

You can tell that Colchicine is working if you start to feel less pain from your gout flare. This medication usually begins to take effect between 30 minutes and 2 hours after you take it, but it might take a day or two for your pain to significantly improve. It’s vital to follow the dosage instructions provided by your doctor precisely, as taking even a small amount more than prescribed can be very dangerous. Additionally, while on Colchicine, you should avoid consuming grapefruit and its juice, as they may interact with the medication & lead to unwanted side effects.

What is the use of Colchicine other than gout?

Colchicine is primarily approved by the FDA for preventing gout attacks and treating sudden gout flares. Additionally, it is approved for treating familial Mediterranean fever, a genetic condition that causes recurrent fevers and inflammation. Beyond these uses, Colchicine is also employed off-label for various conditions. These include liver diseases such as hepatic cirrhosis and primary biliary cirrhosis, as well as pseudogout, a condition similar to gout but caused by calcium pyrophosphate crystals instead of uric acid crystals. The versatility of Colchicine in treating different inflammatory conditions highlights its importance in medicine.

Why is Colchicine a high-alert medication?

Colchicine is considered a high-alert medication because it carries a significant risk of toxicity if not used properly. This means that incorrect dosage or usage can lead to severe side effects, including potentially life-threatening conditions. It’s essential to adhere closely to the prescribed dosage & usage instructions and consult a doctor if there are any concerns or questions about taking Colchicine. Due to its high-risk nature, extra caution is advised when prescribing, dispensing, and administering this medication. 

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