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Colchicine: interactions and severe, sometimes fatal adverse effects

The use of colchicine is controversial due to its severe, sometimes fatal adverse effects. It is best only to prescribe it for gout attacks if analgesics and antiinflammatory treatments prove ineffective.

Colchicine is often prescribed to treat acute attacks of gout and some other less-frequent diseases.

Colchicine can have severe adverse effects: the sometimes fatal destruction of blood cells; kidney failure; muscle damage; frequent gastrointestinal disorders including diarrhoea, which is an indicator of overdose, etc.

These disorders are more likely in the case of kidney failure, especially in the elderly, and also when colchicine is taken in combination with some drugs: antibiotics (some macrolides in particular), nonsteroidal antiinflammatory drugs (NSAIDs), antihypertensive drugs, cholesterol lowering substances (statins and fibrates), etc.

In the event of a gout attack, treatment with an ice pack and paracetamol, even a NSAID such as ibuprofen, often proves effective. If not, colchicine can sometimes be helpful, keeping to the minimum dosage and monitoring the patient frequently. Adverse effects, particularly diarrhoea, which is one of the earliest warnings, should be monitored, especially in patients with kidney failure and the elderly.

©Prescrire April 2008

Source: "Colchicine : interactions graves" Rev Prescrire 2008; 28 (294) 266-270.

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