Podcast 585: You Sure You Want Colchicine for Gout?

Contributor: Don Stader, MD

Educational Pearls:

• Gout is an arthritis caused by the deposition of urate crystals into the joint space
• Colchicine works by disrupting microtubules and prevents white blood cells from getting into the joint space which stops the inflammatory response 
• Colchicine has a high rate of adverse events, in particular explosive diarrhea
• The drug also has a very narrow therapeutic index and overdose is nearly universally fatal, with no antidote or effective treatment option available
• Alternative agents such as steroids, which reduce the inflammatory response to urate crystals, along with NSAIDs may be better options for treatment

References

Angelidis C, Kotsialou Z, Kossyvakis C, et al. Colchicine Pharmacokinetics and Mechanism of Action. Curr Pharm Des. 2018;24(6):659-663. doi:10.2174/1381612824666180123110042

Finkelstein Y, Aks SE, Hutson JR, et al. Colchicine poisoning: the dark side of an ancient drug. Clin Toxicol (Phila). 2010;48(5):407-414. doi:10.3109/15563650.2010.495348

Dalbeth N, Merriman TR, Stamp LK. Gout. Lancet. 2016;388(10055):2039-2052. doi:10.1016/S0140-6736(16)00346-9

Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD