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Colchicine: An Ancient Drug with Modern Uses

Discovered more than 3,000 years ago, colchicine is one of the oldest drugs still in use today. Like most old remedies, colchicine is a chemical substance found in many plants, most notably in colchicum autumnale, known as wild saffron or autumn crocus. It was mentioned in the oldest Egyptian medical text, Ebers Papyrus (circa 1550 B.C., where it was described for the use of pain and swelling... Colchicine is an effective treatment for acute gout if used soon after initiation of the gout attack. It works well even when used at a lower dose, as described in the AGREE trial and is well tolerated at that dose. It can be safely used in patients with chronic kidney disease, which is a contraindication…

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Articles of Interest

A New Way to Protect Against Heart Attacks

It is increasingly clear to researchers that inflammation can raise the risk of a heart attack. Now doctors have a drug that addresses that risk.

Colchicine for Acute Gout

Low-quality evidence shows that low-dose colchicine (up to 1.8 mg over one hour) is an effective therapy for acute gout. However, it has not been compared with nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids in clinical trials. Concerns include high cost, drug-drug interactions, and potential toxicity. (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.) Colchicine is an alkaloid inhibitor of microtubule formation derived from the meadow saffron or autumn crocus in the Northern Hemisphere. It has been used since ancient times for medicinal purposes. In 2009, after sponsoring a small randomized controlled trial, URL Pharma received exclusive rights to produce colchicine (Colcrys) for gout and the much rarer disease, familial Mediterranean fever. As a result, the price increased 50-fold from about $0.10 to $5.00 per pill.

Colchicine is not a silver bullet for COVID-19

Although it is possible that colchicine has a tiny benefit among outpatients with COVID-19, this is a negative trial. The benefit claimed is based on a secondary analysis using a subjective and biased outcome. Based on the available research, it is unclear if there are any real benefits from colchicine, or whether benefits might outweigh risks, and so colchicine should not be prescribed routinely for COVID-19.

Colchicine's Price Goes Through the Roof

URL Pharma, a generic manufacturer, took the time and trouble to get fresh data on colchicine for gout attacks, and was granted a three-year marketing exclusivity period. So far, so good - but they then turned around and ran the price up by a factor of fifteen. They also filed suit against other small companies that were selling colchicine in the generic market, with the result that other domestic sources of the drug might dry up (four of the other companies are fighting back in court).

Colchicine: an ancient drug with novel applications

The list of therapeutic and prophylactic applications for colchicine in multiple fields of medicine is lengthening, as our appreciation of the anti-inflammatory properties of this natural drug expand and as our understanding of the many mechanisms affected by colchicine’s action deepens.

Colchicine: the good, the bad, the ugly and how to minimize the risks

Colchicine has an important role in managing various conditions, including gout, familial Mediterranean fever, amyloidosis, Behçet’s syndrome, recurrent pericarditis and calcium pyrophosphate deposition disease. The adverse effect profile of colchicine is well understood. However, due to its narrow therapeutic index, colchicine has been associated with overdose and fatalities. When ingested in toxic amounts, the mainstay of management is supportive care.

The Efficacy and Safety of Colchicine for Pericarditis

Based on this evidence, we have assigned a color recommendation of Green (Benefit > Harm) in favor of colchicine for pericarditis. Further data are required evaluating colchicine for pericarditis in the ED setting, as well as further evaluation of contraindications and combination therapy.

The Therapeutic Potential of the Ancient Drug Colchicine

Colchicine is an alkaloid derivative from the plant "colchicum autumnale" that has been traditionally used in treating rheumatologic conditions such as gout and Familial Mediterranean Fever. However, growing evidence suggests that colchicine's mechanisms of action are multifaceted and hold promise for therapy in atherosclerotic cardiovascular disease (ASCVD), atrial fibrillation (AF), and more recently, treating COVID-19.

The Use of Colchicine in Pericardial Diseases

Colchicine is an ancient pharmaceutical which has shaped the way we treat inflammatory pericardial conditions. The European Society of Cardiology, currently endorsed by the American College of Cardiology, recommends the use of colchicine for both acute and recurrent episodes of pericarditis, and is supported by a series of trials and robust evidence. Post cardiac injury syndrome is increasing in frequency, and though colchicine has been proven efficacious in this arena, its utilization is underwhelming. Currently, there is no strong evidence for the use of colchicine for pericardial effusions and constrictive pericarditis...

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Dose

The usual dose to treat acute gout attacks is: 1.2 mg at the first sign of flare, then 0.6 mg in 1 hour. Start preventative doses 12 hours later.

StatPearls

Colchicine is FDA-approved for gout prevention, treatment of acute gouty flares, and familial Mediterranean fever. Off-label applications include hepatic cirrhosis, primary biliary cirrhosis, and pseudogout. The primary mechanism of action involves anti-inflammatory effects, which are central to managing these conditions.