Colchicine

About Colchicine

Colchicine is an anti-gout agent that stops the processes behind the swelling and other symptoms of gout and familial Mediterranean fever (FMF); it is not a pain reliever for other causes. Generic tablets are labeled to prevent and treat gout flares in adults and to treat FMF in adults and children 4 and older. For a flare, adults take 1.2 mg at the first sign and 0.6 mg an hour later, no more than 1.8 mg in that hour; to prevent flares, 0.6 mg once or twice a day, no more than 1.2 mg a day; for FMF, adults take 1.2 to 2.4 mg a day, and children take doses set by age. Mitigare capsules and Gloperba solution are labeled only to prevent gout flares in adults, with the same daily limit; treating a flare with them during prevention has not been studied. Lodoco, 0.5 mg once a day, is labeled to reduce the risk of heart attack, stroke, coronary revascularization and cardiovascular death in adults with established atherosclerotic disease or multiple cardiovascular risk factors. Use for pericarditis is not FDA-approved, and the prescriber decides.

There is no boxed warning, but fatal overdoses have been reported in adults and children. Life-threatening and fatal toxicity has occurred when colchicine was taken with strong CYP3A4 inhibitors or P-gp inhibitors. On the tablet labels, people with kidney or liver impairment must not combine it with these drugs, and others need lower doses; the capsule and solution labels rule out drugs that inhibit both in kidney or liver impairment, and rule out the products altogether when both are impaired. Lodoco is contraindicated with either kind of inhibitor, kidney failure, severe liver impairment or an existing blood disorder. Blood disorders, including low white cell and platelet counts and aplastic anemia, and nerve and muscle toxicity, including rhabdomyolysis, can occur. Diarrhea is the most common side effect, and nausea, vomiting, abdominal pain and muscle pain also occur.

The products are not interchangeable: generic tablets and capsules are rated equivalent only within their own form (the capsules to Mitigare), and Gloperba and Lodoco have no generic. With the tablets, a flare during daily prevention can be treated with the flare dose, and the daily dose resumes 12 hours later; with a strong CYP3A4 inhibitor, a reduced flare course is repeated no sooner than 3 days later. Colchicine crosses the placenta and is present in breast milk, so pregnancy and breastfeeding are discussed with the prescriber, and the tablet label says infertility in men from colchicine is rare and may be reversible.

Taking Colchicine

How to take it

With or without food. Take a flare dose at the first sign of a flare and never exceed the prescribed limit; daily prevention and FMF doses are taken once or twice a day. Measure Gloperba with an accurate milliliter measuring device, not a household spoon. If a flare does not settle, talk to the prescriber before taking more.

If you miss a dose

Take the missed dose as soon as you remember, but if you take it regularly and the next dose is almost due, skip it and carry on as usual; do not take a double dose. If you miss the second dose of a flare treatment taken during daily prevention, take it when you remember, then wait at least 12 hours before your next scheduled dose.

Storage

In the original container, tightly closed, at room temperature, away from light, excess heat and moisture, and out of reach of children, since overdoses have been fatal.

Interactions to know about

Strong CYP3A4 inhibitors (such as clarithromycin, ketoconazole, itraconazole and ritonavir), moderate ones (such as diltiazem, verapamil, erythromycin and fluconazole), P-gp inhibitors (cyclosporine, ranolazine) and grapefruit juice raise colchicine levels, so grapefruit is avoided. Statins, fibrates, digoxin and cyclosporine add to the risk of muscle damage.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Colchicine differs from pharmacy to pharmacy

Generic 0.6 mg tablets and capsules each come from several makers, so quotes for the same prescription differ by each pharmacy’s fee and markup and by whether colchicine is on its flat-price generic list. The pharmacist fills the product written, and Gloperba and Lodoco are quoted as brands.

Ways to pay less for Colchicine without insurance

• Ask whether colchicine is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• For daily use, once the dose is settled, ask the prescriber about a ninety-day supply.
• If an older prescription names Colcrys, check that it allows a generic, since the brand is listed as discontinued.
• For Lodoco or Gloperba, which have no generic, ask the maker whether a savings or patient assistance program applies to someone paying cash.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Colchicine

1. 1.Do any of my medicines, such as an antibiotic, an antifungal, a statin or a heart medicine, interact with it?
2. 2.Exactly how do I take it at the first sign of a flare, and when may I take it again?
3. 3.Does my kidney or liver function change my dose?
4. 4.Which muscle, nerve or blood side effects mean I should stop it and call?

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