Gouter

Colchicine

Relief of acute gout & for prophylaxis of acute attacks, particularly during 1st few mth of treatment w/ allopurinol or uricosurics. Several other conditions including amyloidosis, Behcet's syndrome, familial Mediterranean fever, ITP, pericarditis, primary biliary cirrhosis & pyoderma gangrenosum.

Acute attacks of gout Initially 1 mg, then 0.5 mg every 2-3 hr until pain relief is obtained or GI adverse effects occur. Max: 10 mg. 2nd course at 3-day interval: Initially 0.5-1.2 mg, then 0.5 or 0.6 mg every 1-2 hr or 1-1.2 mg every 2 hr until pain is relieved or GI adverse effects occur. Max: 6 mg. Short-term prophylaxis of gout 0.5 or 0.6 mg once daily to tid.

Should be taken with food.

Blood dyscrasias. Severe renal (including haemodialysis patients), & hepatic impairment (except in familial Mediterranean fever). Concomitant use w/ P-gp inhibitors or strong CYP3A4 inhibitors in patients w/ renal or hepatic impairment. Pregnancy & lactation.

Old & debilitated patients who may be particularly susceptible to cumulative toxicity. Patients w/ cardiac, hepatic, renal or GI disease. Mild to moderate renal impairment.

Diarrhea, nausea, vomiting, & abdominal pain. Bone marrow depression w/ agranulocytosis, thrombocytopenia, & aplastic anaemia in prolonged treatment & local reactions eg, thrombophlebitis & neuritis. Extravasation may cause tissue necrosis.

Increased risk of myopathy & rhabdomyolysis w/ statins, fibrates, digoxin, ciclosporin. Increased plasma conc w/ cimetidine & tolbutamide. May cause reversible malabsorption of vit B₁₂. Concomitant use w/ phenylbutazone may increase risk of leucopenia, thrombocytopenia or bone marrow depression. NSAIDs may increase risk of GI ulceration or haemorrhage. Reduced efficacy of prophylactic gout therapy w/ cytolytic antineoplastic agents. Increased risk of toxicity w/ CYP3A4 or P-gp inhibitors eg, macrolides (eg, clarithromycin, erythromycin), HIV PIs (eg, ritonavir, atazanavir), Ca²⁺ channel blockers (eg, verapamil, diltiazem), ketoconazole, itraconazole, voriconazole, ciclosporin, disulfiram. Increased plasma conc w/ grapefruit juice. Increased blood uric acid levels & risk of GI toxicity w/ alcohol. May cause false +ve results in urine tests for erythrocytes or Hb levels. May interfere w/ urinary determination of 17-hydroxycorticosteroids using Reddy, Jenkins & Thorn procedures.

Hyperuricemia & Gout Preparations

M04AC01 - colchicine ; Belongs to the class of preparations with no effect on uric acid metabolism. Used in the treatment of gout.

Rx