Colchicine Overdoses: Risks, Impacts, and Prevention Strategies

Report on the impact side from PDF to report suspected adverse effects.

Review Order reminiscent of the narrow therapeutic-toxic margin of colchicine. An overdose can have serious side effects. The dose had to be strictly respected, taking into account renal or hepatic insufficiency and the many interactions.

The indications of Colchicine in the SKP are the treatment of acute gout attacks and the prevention of gout attacks at the beginning of uric acid lowering treatment. They are also known as symptoms: Mediterranean family fever and scleroderma. Low-dose colchicine has been studied in recent years for various heart problems (see Folia March 2016) and is currently being studied in patients with coronary artery disease after percutaneous coronary intervention (PCI, KCE website).

In two recent articles1,2remembering Journal of Education on

• that colchicine a therapeutically toxic edge yes, and

• there is that overdose there is a risk of rhabdomyolysis, neuropathy, bone marrow depression, kidney damage and liver damage. Gastrointestinal complaints (diarrhea, nausea, vomiting) can be the first symptoms of alcohol.

Journal of Education reports that there is still one a large number of overdoses have been reported in Francedespite the risk mitigation measures taken, such as the distribution of DHPC to French health professionals in 2016. In fact, French toxicological surveillance and pharmacovigilance data (period 2016-2020) show that

• medication errors (eg errors in dosage) are still a frequent cause of overdose;

• he is therapeutic scheme often complicated for the patient;

• issues with fatal outcome reported, including at conversation colchicine with a macrolide or statin;

• there are reports about this too deliberate overdosein the context of a suicide attempt.

NB In Belgium he got Antigifcentrum In the’ period 2018-2022 approximately 90 reports of colchicine exposure, of which 29 were accidental overdoses and 19 were intentional overdoses.

To limit the risk of overdose with colchicine, the following elements are important:

• Respect the dosage, taking into account the presence of renal or hepatic insufficiency (note in the elderly).

  • YesAs dosage for acute gout attack as stated therein Directory > 9.3.1. Colchicine (edition 2024) as follows (sources: SKP, Pharmacotherapeutic compass, Normal Arthritis NHG (2017)):

    • Start colchicine as soon as possible. Start with 1 mg in the first 12 hours, then 0.5 mg an hour later, and continue with 0.5 mg 2 to 3 times a day for the next few days.

    • In the elderly and in the case of kidney disease, a dose of 0.5 mg is recommended as the first intake.

    • In the case of moderate renal impairment, a dose of 0.5 mg every two days is recommended. The treatment period should be as short as possible. In patients with severe renal impairment, colchicine is contraindicated.

    • Treatment should be stopped or reduced when pain resolves or when adverse gastrointestinal effects occur.

    • Use up to 6 mg in total during the course of treatment. If a new attack occurs after completing a course of treatment, wait at least 72 hours before starting a new course of treatment.

  • Some additional information about use in acute gout attacks from other sources:

    • Treatment for up to 5 days. Stop treatment as soon as there are signs of intoxication (diarrhea, nausea, vomiting), or if the symptoms have not improved after 5 days, or if the pain has disappeared existence (NHG Status “Arthritis” (2017)).

    • According to the Normal Arthritis NHG (2017) During short-term treatment with the low dose (0.5 mg 2-3 times / day), no dose adjustment is required for patients with renal impairment (moderate or moderately severe).

• Be aware of the many interactions:

  • YesRisk of alcohol When colchicine is associated CYP3A4 inhibitors (in addition to macrolidene clarithromycine and erythromycine; of azolderivaten itraconazol, ketoconazol, posaconazol and voriconazol; pompelmoessap) and from P-gp (including amiodarone; cyclosporine; clarithromycin; the azole derivatives itraconazole and ketoconazole; verapamil): see Table Ic. In Inl.6.3. in Register ID. in Inl.6.3. Contraindications according to the SKP:

    • used together with a strong inhibitor of CYP3A4 or P-gp in patients with renal or hepatic insufficiency;

    • used together with a macrolide in all patients.

  • Increased risk muscle toxicity when you connect to statins of fibrates.

• Avoid antidiarrheals during treatment because they can hide the first signs of an overdose.

  In France there is a strong association of colchcine powder + opium. The opium powder can mask the symptoms of diarrhea. This no doubt explains why several overdoses are reported in France with this link.

Special names:

– Colchicine: Colchicine Opocalcium® (see Repertoire)

Special sources

1 Colchicine and gout attacks. The dose in the RCPs was further reduced due to the risks of overdose. Prescrire Review 2023; 43:347
2 Colchicine: more overdoses and deaths. Prescrire Review 2023; 43:512-515
3 Report of the ANSM Permanent Research and Drug Investigations Committee, meeting on 9/27/2021, via Event – Interface committee with the toxic surveillance network – ANSM (sante.fr)