Colchicine

Colchicine is a medication used to prevent and treat gout, to treat familial Mediterranean fever and Behçet's disease, and to reduce the risk of myocardial infarction. The American College of Rheumatology recommends colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs) or steroids in the treatment of gout. Other uses for colchicine include the management of pericarditis.

Colchicine is taken by mouth. The injectable route of administration for colchicine can be toxic. In 2008, the US Food and Drug Administration removed all injectable colchicine from the US market.

Colchicine has a narrow therapeutic index, so overdosing is a significant risk. Common side effects of colchicine include gastrointestinal upset, particularly at high doses. Severe side effects may include pancytopenia (low blood cell counts) and rhabdomyolysis (damage to skeletal muscle), and the medication can be deadly in overdose. Whether colchicine is safe for use during pregnancy is unclear, but its use during breastfeeding appears to be safe. Colchicine works by decreasing inflammation via multiple mechanisms.

Colchicine, in the form of the autumn crocus (Colchicum autumnale), was used as early as 1500 BC to treat joint swelling. It was approved for medical use in the United States in 1961. It is available as a generic medication. In 2023, it was the 215th most commonly prescribed medication in the United States, with more than 2 million prescriptions.

Colchicine is used in plant breeding to induce polyploidy, in which the number of chromosomes in plant cells are doubled. This helps produce larger, hardier, faster-growing, and in general, more desirable plants than the normally diploid parents.

Colchicine is an alternative for those unable to tolerate nonsteroidal anti-inflammatory drugs (NSAIDs) when treating gout. Low doses (1.2 mg in one hour, followed by 0.6 mg an hour later) appear to be well tolerated and may reduce gout symptoms and pain, perhaps as effectively as NSAIDs. At higher doses, side effects (primarily diarrhea, nausea, or vomiting) limit its use.

For treating gout symptoms, colchicine is taken orally, with or without food, as symptoms first appear. Subsequent doses may be needed if symptoms worsen.

There is preliminary evidence that daily colchicine may be effective as a long-term prophylaxis when used with allopurinol to reduce the risk of increased uric acid levels and acute gout flares; adverse gastrointestinal effects may occur, though overall the risk of serious side effects is low.