Kolkicin Strides (Colchicine)

• Colchicine is employed to control inflammatory conditions affecting joints and periodic fever syndromes.
• Acute gout flares: reduces pain and swelling during an attack.
• Prophylaxis of gout attacks: lowers the frequency of recurrent gout episodes.
• Familial Mediterranean fever: prevents febrile attacks and associated inflammation.

• Colchicine binds to tubulin proteins, preventing microtubule polymerisation. This disrupts neutrophil motility and degranulation, thereby limiting the inflammatory response that drives gouty arthritis and the febrile episodes of familial Mediterranean fever.

Colchicine may cause a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Nausea: mild stomach upset.
• Vomiting: occasional expulsion of stomach contents.
• Diarrhoea: frequent loose stools.
• Abdominal pain: cramping or discomfort.
• Loss of appetite: reduced desire to eat.
• Headache: mild to moderate head pain.

Serious or Rare Side Effects

• Bone marrow suppression: can lead to low blood counts.
• Severe neutropenia: markedly reduced neutrophil levels.
• Aplastic anaemia: rare but life‑threatening blood disorder.
• Rhabdomyolysis: muscle breakdown with potential kidney injury.
• Severe liver injury: marked elevation of liver enzymes.
• Stevens‑Johnson syndrome: rare severe skin reaction.

• When prescribing colchicine, several safety considerations should be observed.
• Renal function: adjust dose in patients with impaired renal clearance.
• Hepatic function: use cautiously in individuals with liver disease.
• Concomitant CYP3A4 inhibitors: avoid or monitor for toxicity.
• Drug‑induced myopathy: watch for unexplained muscle pain or weakness.
• Pregnancy and lactation: safety not established; avoid unless essential.
• Store at room temperature: keep in the original container, protect from moisture and light.

Colchicine interacts with several medicines that can alter its plasma concentration or increase toxicity.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., clarithromycin, itraconazole): risk of severe toxicity.
• P‑glycoprotein inhibitors (e.g., cyclosporine, verapamil): increase colchicine levels.
• Statins (especially simvastatin): heightened risk of myopathy and rhabdomyolysis.
• Macrolide antibiotics: may precipitate colchicine overdose.
• Protease inhibitors (e.g., ritonavir): can cause life‑threatening toxicity.

Moderate Interactions (Monitor Closely)

• Moderate CYP3A4 inhibitors (e.g., fluconazole): monitor for side effects.
• Diuretics (e.g., thiazides): may raise colchicine concentrations.
• ACE inhibitors: watch renal function closely.
• NSAIDs: additive gastrointestinal irritation.
• Anticoagulants (e.g., warfarin): monitor INR for changes.