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(KOHL-chih-seen)

Colchicine

Tablets: 0.6 mg

Injection: 0.5 mg/mL

Class: Analgesic, Gout

  Action Inhibits inflammation and reduces pain and swelling associated with gouty arthritis.

  Indications Treatment and relief of pain in attacks of acute gouty arthritis; regular prophylaxis between attacks and is often effective in aborting an attack when taken at the first sign of articular discomfort; colchicine IV is used when rapid response is desired or if GI side effects interefere with oral use. Familial Mediterranean fever; hepatic cirrhosis; primary biliary cirrhosis; treatment of Behcet disease; scleroderma; Sweet syndrome

  Contraindications Serious GI, renal, hepatic, or cardiac disorders; blood dyscrasias.

  Route/Dosage

Acute Gouty Arthritis

Adults: Initial dose (give at first sign of attack) PO 1.2 mg; then 0.6 q hr or 1.2 mg q 2 hr until pain is relieved or diarrhea ensues. Total dose is usually 4 to 8 mg. Wait 3 days before initiating a second course of therapy. IV Initial dose 2 mg; then 0.5 mg q 6 hr until satisfactory response is achieved (max, 4 mg/24 hr or 1 course of treatment).

Prophylaxis

Adults: PO 0.6 mg/day for 3 to 4 days/wk if fewer than 1 attack/yr; if more than 1 attack/yr, 0.6 mg/day. Severe cases may require 1.2 to 1.8 mg/day.

Prophylaxis or Maintenance of Recurrent or Chronic Gouty Arthritis

Adults: IV 0.5 to 1 mg 1 or 2 times/day; however, oral form is preferable, usually in conjunction with a uricosuric agent.

Surgical Patients

Adults: PO 0.6 mg tid for 3 days before and 3 days after surgery.

  Interactions None well documented.

Do not dilute with 5% Dextrose in water.

  Lab Test Interferences May cause false-positive results in urine tests for RBCs and hemoglobin.

  Adverse Reactions

DERMATOLOGIC: Dermatoses; purpura; alopecia. GI: Nausea; vomiting; diarrhea; abdominal pain. HEMATOLOGIC: Bone marrow depression with aplastic anemia; agranulocytosis, leukopenia or thrombocytopenia (long-term therapy). HEPATIC: Elevated alkaline phosphatase and AST. OTHER: Reversible azoospermia; myopathy; peripheral neuritis.

  Precautions

Pregnancy: Category C (oral). Category D (parenteral). Lactation: Undetermined. CHILDREN: Safety and efficacy not established. Elderly: Administer with great caution to elderly and debilitated patients. Hepatic function impairment: Increased colchicine toxicity may occur. GI effects: Drug may cause nausea, vomiting, diarrhea, and abdominal pain that may aggravate pre-existing peptic ulcer or spastic colon. Discontinue drug if these symptoms appear. Injection: Severe local irritation occurs if drug is given by SC or IM route. Myopathy and neuropathy: Myoneuropathy may occur and cause weakness in patients with impaired kidney function; serum creatine kinase may be elevated. Usually resolves in 3 to 4 wk after drug withdrawal. Vitamin B₁₂ malabsorption: Colchicine induces reversible malabsorption of vitamin B₁₂ with long-term use.

PATIENT CARE CONSIDERATIONS

  Administration/Storage

Parenteral

• Reconstitute with 0.9% Sodium Chloride (without preservatives) only.
• Administer parenterally via IV route only. Considerable irritation and tissue damage may occur if leakage into surrounding tissue occurs.

Oral

• Store tablets in airtight, light-resistant container.

  Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Monitor serum uric acid and creatinine throughout therapy.
• Check blood counts periodically in patients undergoing long-term therapy.
• Monitor for phlebitis and extravasation.
• Assess for signs of toxicity (eg, abdominal pain, alopecia, nausea, vomiting, diarrhea, myopathy, peripheral neuritis). Notify health care provider immediately if these signs occur.
• Assess for signs of vitamin B₁₂ deficiency (eg, anemia, paresis of extremities).

OVERDOSAGE: SIGNS & SYMPTOMS   Nausea, severe abdominal pain, vomiting, diarrhea, shock, ST segment elevation, paralysis, respiratory failure, liver damage, renal failure, leukopenia, thrombocytopenia, coagulopathy, alopecia, stomatitis

  Patient/Family Education

• Instruct patient to take colchicine regularly to prevent acute attacks.
• Instruct patient not to exceed 8 mg in course of therapy for acute attack. To minimize cumulative toxicity, patient should wait 3 days before starting second course.
• Advise patient with gout to drink at least 2000 mL of fluid daily, unless contraindicated.
• Reinforce health care provider’s instructions about weight loss, diet, and alcohol intake.
• Advise patient to have extra supply of drug on hand in case health care provider gives instructions to increase dosage.
• Instruct patient to stop taking drug if nausea, vomiting, diarrhea, or abdominal pain occurs, especially if patient has history of spastic colon or ulcers.

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