Colcrys

Action

Unclear. Antigout action may occur through white blood cell (WBC) migration and reduced lactic acid production by WBCs. This action in turn decreases uric acid deposition, kinetin formation, and phagocytosis, leading to reduction in inflammatory response.

Availability

Tablets: 0.6 mg

Indications and dosages

➣ Prophylaxis of gout flares

Adults and adolescents age 16 and older: 0.6 mg P.O. daily or b.i.d. Maximum dosage, 1.2 mg/day.

➣ Treatment of gout flares

Adults and adolescents age 16 and older: 1.2 mg P.O. at first sign of a gout flare, followed by 0.6 mg 1 hour later. Wait 12 hours; then resume prophylactic dose.

➣ Familial Mediterranean fever

Adults and adolescents age 12 and older: 1.2 to 2.4 mg P.O. in one or two divided doses. Increase or decrease dosage as indicated and as tolerated in increments of 0.3 mg/day; not to exceed the maximum recommended daily dosage.

Children ages 6 to 12: 0.9 to 1.8 mg P.O. as a single dose or as divided doses b.i.d.

Children ages 4 to 6: 0.3 to 1.8 mg P.O. as a single dose or as divided doses b.i.d.

Dosage adjustment

• Mild hepatic or renal impairment

Off-label uses

• Hepatic cirrhosis

• Chronic progressive multiple sclerosis

• Pyoderma gangrenosum associated with Crohn's disease

• Psoriasis

• Dermatitis herpetiformis

Contraindications

• Hypersensitivity to drug

• Blood dyscrasias

• Serious GI, renal, hepatic, or cardiac disorders

• Concurrent use of P-glycoprotein or strong CYP3A4 inhibitors (including all protease inhibitors except fosamprenavir)

Precautions

Use cautiously in:

• renal impairment

• elderly or debilitated patients

• pregnant or breastfeeding patients

• children (safety not established).

Administration

• Give tablets without regard to meals.

• Know that GI reactions may be troublesome in patients with peptic ulcer or irritable bowel.

Adverse reactions

CNS: peripheral neuritis, neuropathy

GI: nausea, vomiting, diarrhea, abdominal pain

GU: anuria, hematuria, reversible azoospermia, renal impairment

Hematologic: purpura, agranulocytosis, aplastic anemia, thrombocytopenia

Metabolic: vitamin B₁₂ malabsorption

Musculoskeletal: myopathy

Skin: dermatosis, alopecia

Other: hypersensitivity reactions

Interactions

Drug-drug. Cyclosporine: colchicine-induced myopathy

Vitamin B₁₂: reversible vitamin malabsorption

Drug-diagnostic tests. Alkaline phosphatase, aspartate aminotransferase: increased levels

Hematocrit, hemoglobin, platelets: decreased values

Urine hemoglobin, urinary red blood cells: false-positive results

Drug-food. Caffeine-containing foods and beverages: decreased colchicine effect

Drug-herbs. Herbal teas, St. John's wort: decreased drug effect

Drug-behaviors. Alcohol use: increased uric acid level

Patient monitoring

☞ Monitor patient for signs and symptoms of toxicity (nausea, vomiting, abdominal pain, bloody diarrhea, burning sensation, muscle weakness, oliguria, hematuria, ascending paralysis, delirium, and seizures). Discontinue drug if these occur.

• Monitor CBC and renal function test results regularly.

• Be aware that patient may need opioids to control drug-induced diarrhea (especially if he's receiving maximum colchicine dosage).

Patient teaching

• Tell patient to take tablets with or without food.

• Instruct patient to report rash, sore throat, fever, tiredness, weakness, numbness, or tingling.

☞ Tell patient to immediately report muscle tremors, weakness, fatigue, bruising, bleeding, yellowing of eyes or skin, pale stools, dark urine, severe vomiting, watery or bloody diarrhea, or abdominal pain.

• Advise patient to increase fluid intake to prevent renal calculi (unless prescriber wants him to restrict fluids).

• Instruct patient to avoid alcohol, herbal teas, and caffeine during therapy.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.