Colchicine
(KOL-chi-seen) is used to prevent or treat attacks of gout (also called
gouty arthritis). People with gout have too much uric acid in their blood
and joints. An attack of gout occurs when uric acid causes inflammation
(pain, redness, swelling, and heat) in a joint. Colchicine does not cure
gout or take the place of other medicines that lower the amount of uric
acid in the body. It prevents or relieves gout attacks by reducing inflammation.
Colchicine is not an ordinary pain reliever and will not relieve most
kinds of pain.
Colchicine
may also be used for other conditions as determined by your doctor.
Colchicine
may be used in 2 ways. Most people take small amounts of it regularly
for a long time (months or even years) to prevent severe attacks or other
problems caused by inflammation. Other people take large amounts of colchicine
during a short period of time (several hours) only when the medicine is
needed to relieve an attack that is occurring. The chance of serious side
effects is much lower with the first (preventive) kind of treatment.
Because
some of colchicine's side effects can be very serious, you should discuss
with your doctor the good that this medicine can do as well as the risks
of using it. Make sure you understand exactly how you are to use it, and
follow the instructions carefully, to lessen the chance of unwanted effects.
This medicine
is available only with your doctor's prescription, in the following dosage
forms:
Oral
Tablets (U.S. and
Canada)
Parenteral
Injection (U.S.)
Before Using This Medicine
In deciding
to use a medicine, the risks of taking the medicine must be weighed against
the good it will do. This is a decision you and your doctor will make.
For colchicine, the following should be considered:
Allergies—Tell your doctor
if you have ever had any unusual or allergic reaction to colchicine. Also
tell your health care professional if you are allergic to any other substances,
such as foods, preservatives, or dyes.
Pregnancy—Studies in humans
taking large amounts of colchicine to relieve attacks have not been done.
Fertility problems have occurred in some men taking small amounts of colchicine
regularly (preventive treatment), but these problems went away after treatment
was stopped. Many other men taking preventive amounts of colchicine have
fathered children without stopping treatment. Also, many women receiving
preventive treatment with colchicine have become pregnant and given birth
to normal, healthy babies. Some women receive preventive amounts of colchicine
regularly for a medical condition that can cause fertility problems or
miscarriages. Treatment with colchicine does not increase, and may actually
decrease, the occurrence of these problems in women with this condition.
Colchicine
has caused birth defects and other problems in animal studies.
Breast-feeding—Colchicine passes
into breast milk. When breast-feeding mothers receive preventive treatment
with one 0.6-milligram (mg) tablet twice a day, the amount that appears
in the breast milk is not likely to cause problems in nursing babies.
There is no information about whether colchicine can cause problems in
nursing babies when the mother takes larger amounts of it. Mothers who
are taking this medicine and who wish to breast-feed should discuss this
with their doctor.
Children—Studies on the effects
of colchicine in patients with gout have been done only in adults. Gout
is very rare in children. However, colchicine is used in children 3 years
of age and older who need preventive treatment for other medical conditions.
It has not been reported to cause different side effects or problems in
these children than it does in adults.
Older
adults—Elderly people are especially
sensitive to the effects of colchicine. Also, colchicine may stay in the
body longer in older patients than it does in younger adults. This may
increase the chance of side effects during treatment.
Other
medicines—Although certain medicines should
not be used together at all, in other cases two different medicines may
be used together even if an interaction might occur. In these cases, your
doctor may want to change the dose, or other precautions may be necessary.
When you are taking colchicine, it is especially important that your health
care professional know if you are taking any of the following:
Amphotericin B
by injection (e.g., Fungizone) or
Antineoplastics
(cancer medicine) or
Antithyroid agents
(medicine for overactive thyroid) or
Azathioprine (e.g.,
Imuran) or
Chloramphenicol
(e.g., Chloromycetin) or
Cyclophosphamide
(e.g., Cytoxan) or
Flucytosine (e.g.,
Ancobon) or
Ganciclovir (e.g.,
Cytovene) or
Interferon (e.g.,
Intron A, Roferon-A) or
Mercaptopurine
(e.g., Purinethol) or
Methotrexate (e.g.,
Mexate) or
Phenylbutazone
(e.g., Butazolidin) or
Plicamycin (e.g.,
Mithracin) or
Zidovudine (e.g.,
Retrovir)—The chance of serious side effects caused by a decrease in
the numbers of certain blood cells may be increased
Other
medical problems—The presence of other medical
problems may affect the use of colchicine. Make sure you tell your doctor
if you have any other medical problems, especially:
Alcohol abuse or
Intestinal disease
or
Stomach ulcer or
other stomach problems—The chance of stomach upset may be increased.
Also, colchicine can make some kinds of stomach or intestinal problems
worse
Heart disease or
Kidney disease
or
Liver disease—The
chance of serious side effects may be increased because these conditions
can cause colchicine to build up in the body
Low white blood
cell count or
Low platelet count—The
chance of serious side effects may be increased because colchicine can
make these conditions worse
Proper Use of This Medicine
Colchicine
can build up in the body and cause serious side effects if too much of
it is taken or if it is taken too often. Therefore, do not take more
of this medicine, and do not take it more often, than directed by your
doctor . This is especially important for elderly patients, who are
more likely than younger adults to have colchicine build up in the body
and who are also more sensitive to its effects.
For patients
taking small amounts of colchicine regularly (preventive treatment)
:
Take this medicine
regularly as directed by your doctor, even if you feel well. If you
are taking colchicine to prevent gout attacks, and you are also taking
another medicine to reduce the amount of uric acid in your body, you
probably will be able to stop taking colchicine after a while. However,
if you stop taking it too soon, your attacks may return or get worse.
If you are taking colchicine for certain other medical conditions, you
may need to keep taking it for the rest of your life.
If you are taking
colchicine to prevent gout attacks, ask your doctor to recommend other
medicine to be taken if an attack occurs. Most people receiving preventive
amounts of colchicine should not take extra colchicine to relieve an
attack. However, some people cannot take the other medicines that are
used for gout attacks and will have to take extra colchicine. If you
are one of these people, ask your doctor to tell you the largest amount
of colchicine you should take for an attack and how long you should
wait before starting to take the smaller preventive amounts again. Be
sure to follow these directions carefully.
For patients
taking large amounts of colchicine only when needed to relieve an attack
:
Start taking this
medicine at the first sign of the attack for best results.
Stop taking this
medicine as soon as the pain is relieved or at the first sign of nausea,
vomiting, stomach pain, or diarrhea . Also, stop taking colchicine
when you have taken the largest amount that your doctor ordered for
each attack, even if the pain is not relieved or none of these side
effects occurs.
The first few times
you take colchicine, keep a record of each dose as you take it. Then,
whenever stomach upset (nausea, vomiting, stomach pain, or diarrhea)
occurs, count the number of doses you have taken. The next time you
need colchicine, stop taking it before that number of doses is reached.
For example, if diarrhea occurs after your fifth dose of medicine, take
no more than four doses the next time. If taking fewer doses does not
prevent stomach upset from occurring after a few treatments, check with
your doctor.
After taking colchicine
tablets to treat an attack, do not take any more colchicine for at
least 3 days. Also, after receiving the medicine by injection for an
attack, do not take any more colchicine (tablets or injection) for at
least 7 days . Elderly patients may have to wait even longer between
treatments and should check with their doctor for directions.
If you are taking
colchicine for an attack of gout, and you are also taking other medicine
to reduce the amount of uric acid in your body, do not stop taking
the other medicine . Continue taking the other medicine as directed
by your doctor.
Dosing—The dose of colchicine
will be different for different patients. Follow your doctor's orders
or the directions on the label . The following information includes
only the average doses of colchicine. If your dose is different, do
not change it unless your doctor tells you to do so.
The number
of doses you take each day, the time allowed between doses, and the length
of time you take the medicine depend on how often your attacks occur and
on whether you are taking the medicine to prevent or to relieve attacks.
The amount of medicine you take will also depend on how you react to the
medicine .
For oral
dosage form (tablets):
Adults:
For preventing
gout attacks —Most people start with one 0.5-milligram (mg)
or 0.6-mg tablet a day. If gout attacks continue to occur, the
doctor may direct you to increase the dose to one tablet two
or even three times a day for a while. Some people with mild
gout may need only one tablet every other day, or even less.
For treating
a gout attack that has already started —Your doctor will
probably recommend one of the following treatment plans:
One or two
0.5-mg or 0.6-mg tablets for the first dose, then one 0.5-mg
or 0.6-mg tablet every one or two hours, or
Two 0.5-mg
or 0.6-mg tablets or one 1-mg tablet every two hours.
For both plans, stop taking this medicine after you have
taken the largest amount ordered by your doctor . If
your doctor has not told you the largest amount that you
should take for one attack, do not take more than 6 mg
of this medicine (a total of twelve 0.5-mg tablets,
ten 0.6-mg tablets, or six 1-mg tablets, spread over a period
of several hours).
Children: Use
and dose must be determined by the doctor.
For parenteral
dosage form (injection):
Adults:
For preventing
gout attacks —0.5 or 1 mg one or two times a day, injected
into a vein.
For treating
an attack of gout that has already started —1 or 2 mg for
the first dose, then 0.5 mg or 1 mg every six to twelve hours,
injected into a vein. After a total of 4 mg has been given,
no more colchicine (tablets or injections) should be given for
at least seven days .
Children: Use
and dose must be determined by the doctor.
Missed
dose—If you are taking colchicine
regularly (for example, every day) and you miss a dose, take it as soon
as possible. However, if it is almost time for your next dose, skip the
missed dose and go back to your regular dosing schedule. Do not double
doses.
Storage—To store this medicine:
Keep out of the
reach of children.
Store away from
heat and direct light.
Do not store this
medicine in the bathroom, near the kitchen sink, or in other damp places.
Heat or moisture may cause the medicine to break down.
Do not keep outdated
medicine or medicine no longer needed. Be sure that any discarded medicine
is out of the reach of children.
Precautions While Using This Medicine
If you must
take colchicine for a long time (preventive treatment), your doctor may
want to check your progress at regular visits. He or she may also want
to check for certain side effects. Finding these side effects early can
help to keep them from becoming serious.
Stomach
problems may be more likely to occur if you drink large amounts of alcoholic
beverages while taking colchicine. Also, drinking too much alcohol may
increase the amount of uric acid in your blood. This may lessen the effects
of colchicine when it is used to prevent gout attacks. Therefore, people
who take colchicine should be careful to limit the amount of alcohol they
drink.
For patients
taking small amounts of colchicine regularly (preventive treatment)
:
Attacks of gout
or other problems caused by inflammation may continue to occur during
treatment. However, the attacks or other problems should occur less
often, and they should not be as severe as they were before you started
taking colchicine. Even if you think the colchicine is not working,
do not stop taking it and do not increase the dose . Check with
your doctor instead.
Side Effects of This Medicine
Along with
its needed effects, a medicine may cause some unwanted effects. Although
not all of these side effects may occur, if they do occur they may need
medical attention.
Stop
taking this medicine immediately if any of the following side
effects occur:
More common
Diarrhea; nausea or vomiting;
stomach pain
If any of these side effects
continue for 3 hours or longer after you have stopped taking colchicine,
check with your doctor .
Also, check
with your doctor immediately if any of the following side effects
occur:
Rare
Black, tarry stools; blood in
urine or stools; difficulty in breathing when exercising; fever with or
without chills; headache; large, hive-like swellings on the face, eyelids,
mouth, lips, and/or tongue; pinpoint red spots on skin; sores, ulcers,
or white spots on lips or in mouth; sore throat; unusual bleeding or bruising;
unusual tiredness or weakness
Signs and symptoms of overdose
Burning feeling in the stomach, throat, or
skin; diarrhea (severe or bloody); nausea, stomach pain, or vomiting (severe)