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Ngeyvijit J, Nuansuwan S, Phoophiboon V. CYP3A4/P-glycoprotein inhibitors related colchicine toxicity mimicking septic shock. BMJ Case Rep 2023; 16:e257186. [PMID: 37813551 PMCID: PMC10565285 DOI: 10.1136/bcr-2023-257186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Colchicine toxicity is uncommon when patients receive a therapeutic dose regularly. However, inadvertent drug interactions can result in unpredicted adverse outcomes. The toxicity of colchicine can manifest in various ways, ranging from mild and non-specific symptoms to severe form known as multiple organ dysfunction syndrome. This case highlights (1) the diagnostic challenge that arises when distinguishing between the severe manifestation of colchicine toxicity and septic shock and (2) concomitant prescription of colchicine with potent CYP3A4 and P-glycoprotein inhibitors (ie, clarithromycin) can lead to colchicine toxicity despite normal renal and hepatic clearance. Unfortunately, specific tests of colchicine toxicity were not routinely available. A high index of clinical suspicion and recognition of drug interactions with their common presentations are crucial for making diagnosis and management. Failure to recognise drug toxicity can result in poor outcomes.
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Affiliation(s)
- Jinjuta Ngeyvijit
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chaophraya Abhaibhubejhr Hospital, Prachin Buri, Thailand
| | - Sopita Nuansuwan
- Department of Medicine, Chaophraya Abhaibhubejhr Hospital, Prachin Buri, Thailand
| | - Vorakamol Phoophiboon
- Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Division of Critical Care Medicine, St.Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
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2
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Systematic review of colchicine neuromyopathy: Risk factors, duration and resolution. Semin Arthritis Rheum 2023; 58:152150. [PMID: 36512928 DOI: 10.1016/j.semarthrit.2022.152150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/25/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify reports of colchicine-induced neuropathy and myopathy and ascertain risk factors associated with this toxicity at commonly used doses. METHODS A systematic review of case reports was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA methodology). PubMed and EMBASE were searched through October 2021 for case reports of neuropathy and/or myopathy associated with the use of colchicine at therapeutic doses. RESULTS A total of 143 cases of neuromyopathy from 99 articles were identified as having a "definite" or "probable" association with colchicine usage, as assessed by the Naranjo algorithm. Most of these cases presented with features of both neuropathy and myopathy (n=72, 51%) but symptoms of myopathy were predominant. The mean total daily dose was 1.25±0.60 mg and 48% had been taking colchicine for more than 12 months before presenting with neuromyopathy. A total of 117 (82%) of all reports had either a significant co-morbidity or possible colchicine drug-drug interaction, while 57 (40%) had both risk factors. A total of 26 cases (18%) had no significant risk factor but only 15 of these reports contained complete descriptions of the patient's co-morbidities and co-medications. Cessation of colchicine generally led to complete resolution of symptoms in 70% of cases within a median of 21 days. There were 3 deaths reported which were due to multi-organ failure despite cessation of colchicine and medical management. Colchicine was restarted at reduced doses in 15 cases and 73% had no symptom recurrence. CONCLUSION Neuromyopathy is an uncommon but reported adverse effect of colchicine. Cases generally present with proximal myopathy symptoms. Cases of colchicine neuromyopathy are largely reported in patients on commonly used doses. Renal and hepatic dysfunction and medications that inhibit cytochrome P450 3A4 isozyme (CYP3A4) and P-glycoprotein (P-gp) appear to be the most significant risk factors. Fortunately, cessation of colchicine generally leads to complete resolution of symptoms. Recommencement of colchicine at reduced doses appeared to be usually safe.
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3
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Rousseau G, Clément J, Fezard JB, Laribi S. [Colchicum poisoning by confusion with wild garlic (Allium ursinum)]. Rev Med Interne 2022; 43:559-561. [PMID: 35597736 DOI: 10.1016/j.revmed.2022.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Colchicine poisoning is a life-threatening intoxication. CASE REPORT We report a case of food poisosing with Colchicum autumnale by confusion with wild garlic. The clinical presentation is the same as that of colchicine drug intoxication. The evolution can be fatal in case of massive ingestion. The proximity of the place of growth and their similar appearance in spring make Colchicum and wild garlic plants that can easily be confused. CONCLUSION Physicians have to be vigilant in case of dysenteric syndrome and biological disturbances in spring and look for the consumption of perennial plant preceding symptoms.
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Affiliation(s)
- G Rousseau
- Département de médecine d'urgences, CHRU Tours, Tours, France.
| | - J Clément
- Département de médecine d'urgences, CHRU Tours, Tours, France; Université de Tours, Tours, France
| | - J B Fezard
- Département de médecine d'urgences, CHRU Tours, Tours, France
| | - S Laribi
- Département de médecine d'urgences, CHRU Tours, Tours, France; Université de Tours, Tours, France
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Zhang Y, Ma C, Cai Z, Struwe J, Chen S, Xu J, Li S, Zeng W, Ackermann L. Electrooxidative tricyclic 6-7-6 fused-system domino assembly to allocolchicines by a removable radical strategy. GREEN CHEMISTRY : AN INTERNATIONAL JOURNAL AND GREEN CHEMISTRY RESOURCE : GC 2022; 24:3697-3703. [PMID: 35694222 PMCID: PMC9086860 DOI: 10.1039/d2gc00684g] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/09/2022] [Indexed: 06/15/2023]
Abstract
Natural allocolchicine and analogues derived thereof a tricyclic 6-7-6-system have been found as key scaffold of various biologically relevant molecules. However, the direct preparation of the allocolchicine motif remains difficult to date. Herein, we report on an electrooxidative radical cyclization of biarylynones with various carbon- and heteroatom-centered radical precursors via a sequential radical addition/7-endo-trig/radical cyclization domino reaction. This approach provides a step-economical and strategically novel disconnection for the facile assembly of a wide range of carbocyclic 6-7-6 fused ring systems. Remarkably, the sulfonyl group on the products could be easily removed by photocatalysis at room temperature with high yields.
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Affiliation(s)
- Yan Zhang
- Key Laboratory of the Ministry of Education for Advanced Catalysis Materials, and Drug discovery & innovation center, College of Chemistry and Life Sciences, Zhejiang Normal University China
| | - Chanchan Ma
- Key Laboratory of the Ministry of Education for Advanced Catalysis Materials, and Drug discovery & innovation center, College of Chemistry and Life Sciences, Zhejiang Normal University China
| | - Zhenzhi Cai
- Key Laboratory of the Ministry of Education for Advanced Catalysis Materials, and Drug discovery & innovation center, College of Chemistry and Life Sciences, Zhejiang Normal University China
| | - Julia Struwe
- Institut für Organische und Biomolekulare Chemie, Georg-August-Universität Göttingen Germany
| | - Shengjie Chen
- Key Laboratory of the Ministry of Education for Advanced Catalysis Materials, and Drug discovery & innovation center, College of Chemistry and Life Sciences, Zhejiang Normal University China
| | - Jinming Xu
- Key Laboratory of the Ministry of Education for Advanced Catalysis Materials, and Drug discovery & innovation center, College of Chemistry and Life Sciences, Zhejiang Normal University China
| | - Shiyin Li
- Key Laboratory of the Ministry of Education for Advanced Catalysis Materials, and Drug discovery & innovation center, College of Chemistry and Life Sciences, Zhejiang Normal University China
| | - Wangyu Zeng
- Key Laboratory of the Ministry of Education for Advanced Catalysis Materials, and Drug discovery & innovation center, College of Chemistry and Life Sciences, Zhejiang Normal University China
| | - Lutz Ackermann
- Institut für Organische und Biomolekulare Chemie, Georg-August-Universität Göttingen Germany
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5
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Schaffer DH, Overbeek DL, Erickson TB, Boyer EW, Goldfine C, Muhsin SA, Chai PR. Severe colchicine poisoning treated successfully with kidney replacement therapy and plasmapheresis: a case report. TOXICOLOGY COMMUNICATIONS 2022; 6:47-51. [PMID: 35497377 PMCID: PMC9049641 DOI: 10.1080/24734306.2022.2055817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Colchicine is commonly prescribed for treatment of inflammatory conditions but has a narrow therapeutic window and dangerous toxicity profile. Here we describe a case of survival after massive unintentional colchicine overdose treated with plasmapheresis and renal replacement therapy. A 37 year old male with history of pericarditis presented to the Emergency Department with a chief complaint of nausea, vomiting, and diarrhea after unintentionally ingesting 36 mg of colchicine 17 h prior to arrival. An initial colchicine concentration resulted at 5.1 ng/mL (30 h post-ingestion) and peaked at 12 ng/mL (40 h post-ingestion). He was treated with continuous kidney replacement therapy (CKRT) beginning on his first day of hospitalization and with plasmapheresis on hospital days two through four. The patient's course was complicated by multiorgan failure including coagulopathy, respiratory failure, neuropathy, renal failure, pancytopenia, and heart failure. He was discharged to inpatient rehabilitation on hospital day 24. On clinical follow up four months after discharge the patient was found to have no significant persistent morbidity related to colchicine overdose.
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Affiliation(s)
- D. H. Schaffer
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - D. L. Overbeek
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - T. B. Erickson
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Humanitarian Initiative, Cambridge, MA, USA
| | - E. W. Boyer
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - C. Goldfine
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - S. A. Muhsin
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - P. R. Chai
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- The Fenway Institute, Boston, MA, USA
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6
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Sarecka-Hujar B, Szulc-Musioł B. Herbal Medicines-Are They Effective and Safe during Pregnancy? Pharmaceutics 2022; 14:171. [PMID: 35057067 PMCID: PMC8802657 DOI: 10.3390/pharmaceutics14010171] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/13/2021] [Accepted: 01/08/2022] [Indexed: 02/05/2023] Open
Abstract
Since the teratogenicity of Thalidomide has been proven, herbal products are more commonly used in pregnancy to not only relieve morning sickness but also to fight infections. These products are frequently considered as natural and therefore harmless. However, herbs contain a number of active substances that, when used during pregnancy, can affect the development of the fetus. Often, pregnant women do not consult the usage of herbal medicines with a physician. The access to these products is easy and treatment of certain ailments with the use of herbs is common in many countries. The aim of the present literature review was to discuss available data regarding the efficacy and safety of cranberry, chamomile, Echinacea purpurea, garlic, ginger, Ginkgo biloba, and peppermint, which are used to counteract the most common ailments during pregnancy, i.e., infections and pregnancy-related ailments (e.g., nausea and vomiting, dizziness, and headache). Analysis of available data showed that ginger is one of the most extensively analyzed herbal remedies. The dose of ginger below 1000 mg per day may help to relief hypereremesis gravidarum, and such an amount of ginger did not increase frequency of adverse effects for either woman or developing fetus. Data regarding other herbs are most often heterogeneous and give conflicting results with no clear conclusions. However, all herbal products should be used with a special caution in pregnancy. Further high-quality human studies should be determined to confirm the safe doses of herbal products which could be used by pregnant or breast-feeding women.
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Affiliation(s)
- Beata Sarecka-Hujar
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Kasztanowa Str. 3, 41-200 Sosnowiec, Poland
| | - Beata Szulc-Musioł
- Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Kasztanowa Str. 3, 41-200 Sosnowiec, Poland;
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Abstract
We report a rare case of a 32-year-old male who ingested 32.4 to 54 mg of colchicine and presented after 44 hours. He developed progressive multiple organ failure with shock, acute kidney failure, troponemia, pancytopenia, absolute neutropenia, disseminated intravascular coagulation, acute liver failure, rhabdomyolysis, and lactic acidosis. He also developed electrolyte abnormalities and refractory hypoglycemia. Initial treatment consisted of activated charcoal, fluids, and broad-spectrum antibiotics with supportive treatment of mechanical ventilation, hemodialysis, vasopressors, N-acetylcysteine, colony-stimulating factors, and blood products. Literature shows potential benefit of colchicine-specific Fab fragments for acute toxicity with limited studies and is not currently available in the United States. Further research for N-acetylcysteine protocol for acute liver failure in colchicine toxicity and potential use of colchicine-specific Fab fragments is needed. Our case demonstrates the importance of early use of activated charcoal for ingestion overdose with the incorporation of poison control into multidisciplinary team for coordinated patient care.
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Affiliation(s)
- Justin Cozza
- Appalachian Regional Healthcare, Harlan, KY, USA
| | | | - Shyam Ganti
- Appalachian Regional Healthcare, Harlan, KY, USA
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8
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Quinton-Bouvier MC, Fabresse N, Bodeau S, Caillard P, Maizel J, Masmoudi K, Alvarez JC, Bennis Y, Lemaire-Hurtel AS. Toxicocinétique de la colchicine au cours d’une intoxication aiguë sévère d’issue favorable. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2020. [DOI: 10.1016/j.toxac.2020.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Abstract
RATIONALE Colchicine can inhibit cell division and intracellular transport in affected organs by fixing intracellular tubulin and preventing its polymerization into microtubules. A lethal dose of colchicine is considered to be 0.8 mg/kg. The wide distribution of colchicine through 70% of the body following an overdose makes it difficult to eliminate. PATIENT CONCERNS A 56-year-old man with a clear history of colchicine overdose was admitted to our hospital nearly 40 hours after taking 12 mg (0.17 mg/kg) of colchicine. He had a history of gout and chronic kidney disease. As the disease progressed, he showed most of the clinical manifestations and pathological features of colchicine overdose. DIAGNOSES AND INTERVENTIONS Colchicine overdose was clear, with symptoms of multiple organ failure including primary gastrointestinal failure, bone marrow hematopoietic inhibition, rhabdomyolysis, cardiac damage, hepatocyte damage. The patient developed secondary septic shock, renal failure, circulatory failure, and respiratory failure. We performed continuous renal replacement therapy and gastric lavage, and administered norepinephrine, frozen plasma, proton-pump inhibitors, adenosylmethionine, antibiotics, granulocyte colony stimulating factor, and total parenteral nutrition. OUTCOMES The patient rapidly developed complete hematopoietic function inhibition, gastrointestinal failure, and cardiac damage 32 hours after admission. Sustained severe infection and circulatory instability caused a progressive deterioration of respiratory function. Tracheal intubation was performed but the patient continued to deteriorate, and death occurred approximately 132 hours after admission. LESSONS Excessive colchicine levels cause continuous organ damage due to extensive tissue distribution, eventually leading to multiple organ failure. Colchicine metabolism is delayed in patients with liver or kidney dysfunction, and even a low dose of colchicine may result in poisoning in these individuals. Early diagnosis and reduction of colchicine levels is critical to improve prognosis, and colchicine poisoning should be considered in patients with poor liver or kidney function even when the ingested dose is low.
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Affiliation(s)
- Mingjie Fu
- Department of Surgical Intensive Care Unit, First Affiliated Hospital, College of Medicine, Zhejiang University
- Department of Anesthesiology, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, P.R. China
| | - Jie Zhao
- Department of Surgical Intensive Care Unit, First Affiliated Hospital, College of Medicine, Zhejiang University
- Department of Anesthesiology, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, P.R. China
| | - Zhitao Li
- Department of Surgical Intensive Care Unit, First Affiliated Hospital, College of Medicine, Zhejiang University
- Department of Anesthesiology, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, P.R. China
| | - He Zhao
- Department of Surgical Intensive Care Unit, First Affiliated Hospital, College of Medicine, Zhejiang University
- Department of Anesthesiology, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, P.R. China
| | - Anwei Lu
- Department of Surgical Intensive Care Unit, First Affiliated Hospital, College of Medicine, Zhejiang University
- Department of Anesthesiology, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, P.R. China
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10
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Giorgetti A, Nalesso A, Cecchetto G, Pizzi M, Bellan A, Viel G, Montisci M. Two fatal intoxications by colchicine taken for saffron. Clinical, medico-legal and forensic toxicological implications. Leg Med (Tokyo) 2019; 38:64-68. [PMID: 30991227 DOI: 10.1016/j.legalmed.2019.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/11/2019] [Accepted: 04/10/2019] [Indexed: 11/16/2022]
Abstract
Although fatal colchicine intoxications are rare and mostly related to suicidal intake or accidental overdose, other hypotheses should be considered when dealing with colchicine poisoning. We present a case of double, acute, and subacute, fatal colchicine intoxication in a married couple. The 70-year-old male victim suddenly died after vomiting and diarrhea. The next day his wife showed aggravating gastrointestinal symptoms and was hospitalized with a diagnosis of septic shock. A complete postmortem examination on the man was performed, together with histopathological analysis. Toxicological examination performed through liquid chromatography coupled to mass spectrometry revealed a colchicine blood peripheral concentration of 33 ng/mL. A few days after hospitalization, the woman showed a colchicine plasma concentration of 32 ng/mL. Despite veno-venous hemofiltration, she ultimately died of septic shock and multi-organ failure. Death scene investigation revealed that, a few days before the death of the male victim, the couple had collected wild saffron and had eaten a presumed saffron risotto. The integrated analysis of circumstantial, clinical, postmortem and toxicological data allowed to establish that the couple had died of a fatal accidental intoxication due to the ingestion of natural colchicine, mistaken for saffron. The death of the male was deemed caused by acute cardiovascular collapse induced by acute intoxication, while the female had suffered a subacute poisoning by antimitotic agent, resulting in immunosuppression and systemic infection. Toxicological analyses, promptly performed on the man for forensic purposes, directed the investigations and suggested the clinical diagnosis on the woman.
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Affiliation(s)
- Arianna Giorgetti
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
| | - Alessandro Nalesso
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
| | - Giovanni Cecchetto
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
| | - Marco Pizzi
- General Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Alberto Bellan
- General Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Guido Viel
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy.
| | - Massimo Montisci
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
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Wijerathna TM, Gawarammana IB, Mohamed F, Dissanayaka DM, Dargan PI, Chathuranga U, Jayathilaka C, Buckley NA. Epidemiology, toxicokinetics and biomarkers after self-poisoning with Gloriosa superba. Clin Toxicol (Phila) 2019; 57:1080-1086. [DOI: 10.1080/15563650.2019.1581939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Thilini Madushanka Wijerathna
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Indika Bandara Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Pharmacy, Faculty of Allied Health Science, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Nephrology, Prince of Wales Hospital and Clinical School, University of New South Wales, Sydney, Australia
- Clinical Pharmacology and Toxicology Research Group, Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
| | | | - Paul I Dargan
- Clinical Toxicology, Guy’s and St Thomas’, NHS Foundation Trust and Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Umesh Chathuranga
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Chamila Jayathilaka
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Nicholas Alan Buckley
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Clinical Pharmacology and Toxicology Research Group, Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
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12
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Bronchiolitis Obliterans Organising Pneumonia in a Case of Colchicine Overdose. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791101800411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Colchicine is a commonly prescribed medication. Overdose of colchicine is relatively uncommon but can be fatal. We report a 36-year-old female who survived from severe colchicine poisoning and was subsequently complicated with bronchiolitis obliterans with organizing pneumonia. The patient required a long period of mechanical ventilation but eventually recovered on supportive care.
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13
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Abstract
Drug-induced injury (DILI) is a frequent cause of abnormal liver tests and a leading cause of liver failure in the United States. Colchicine has long been used as a systemic anti-inflammatory agent for treatment of gout by inhibiting mitotic activity and neutrophil function. We present the first case of colchicine-induced hepatoxicity, supported by histopathologic findings characteristic of colchicine-induced injury and resolution of liver enzyme abnormalities after its discontinuation. Colchicine-associated DILI has implications for the evaluation of patients with abnormal liver tests and gout, especially for patients with alcoholism and non-alcoholic fatty liver disease, in whom there is an increased incidence of gout.
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14
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Paymode D, Ramana CV. Total Synthesis of (±)-Allocolchicine and Its Analogues Using Co-Catalyzed Alkyne [2 + 2 + 2]-Cyclotrimerization. ACS OMEGA 2017; 2:5591-5600. [PMID: 31457824 PMCID: PMC6644368 DOI: 10.1021/acsomega.7b00980] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 08/24/2017] [Indexed: 06/10/2023]
Abstract
The total synthesis of (±)-allocolchicine has been completed by employing cobalt-catalyzed alkyne [2 + 2 + 2]-cyclotrimerization as the key reaction. The essential diyne has been synthesized from easily available 3,4,5-trimethoxybenzaldehyde following simple chemical transformations. In general, the cycloaddition gave a mixture of C(9) and C(10) isomers thus allowing the synthesis of both allocolchicine and its C(10)-carboxylate. Because this cycloaddition was employed at the penultimate stage, it allowed the synthesis of various analogues having the diverse functionality at C(9) and/or C(10) of ring C.
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Affiliation(s)
- Dinesh
J. Paymode
- Division
of Organic Chemistry, CSIR-National Chemical
Laboratory, Dr. Homi Bhabha Road, Pune 411008, Maharashtra, India
- Academy
of Scientific and Innovative Research (AcSIR), New Delhi 110020, India
| | - Chepuri V. Ramana
- Division
of Organic Chemistry, CSIR-National Chemical
Laboratory, Dr. Homi Bhabha Road, Pune 411008, Maharashtra, India
- Academy
of Scientific and Innovative Research (AcSIR), New Delhi 110020, India
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15
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Chronic hepatitis following short-term colchicine use in a child. EGYPTIAN LIVER JOURNAL 2016. [DOI: 10.1097/01.elx.0000514232.66608.f6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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16
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Kande Vidanalage CJ, Ekanayeka R, Wijewardane DK. Case report: a rare case of attempted homicide with Gloriosa superba seeds. BMC Pharmacol Toxicol 2016; 17:26. [PMID: 27324655 PMCID: PMC4915169 DOI: 10.1186/s40360-016-0069-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/19/2016] [Indexed: 11/30/2022] Open
Abstract
Background Gloriosa superba, well known as the glory lily or superb lily, is a tropical climbing plant that features an exotic red flower. The plant is poisonous because of high concentrations of colchicine in all parts of the plant. It is commercially grown for use in Ayurveda medicine and as a cash crop for extracting colchicine in India and Africa. It is a wild plant in Sri Lanka and commercial cultivation is rare. Accidental and suicidal poisonings with Gloriosa tubers are well known and reported. There are no case reports of poisoning by Gloriosa seeds in Sri Lanka. Google and PubMed searches showed no reported cases of poisoning with seeds or their use with homicidal intent in other parts of the world. Case presentation A 27-year-old man was brought to hospital with profuse vomiting and diarrhea after drinking coriander tea, which is a common traditional treatment for common cold. The family members suspected poisoning by Gloriosa because they had seeds at home and the victim’s sister-in-law who had made the herbal tea went missing from home. They were able to identify Gloriosa seeds, which looked similar to coriander, in the pot. The patient developed shock and respiratory distress and needed ventilation and intensive care. He also developed mild renal impairment, and thrombocytopenia. He developed massive generalized alopecia while recovering from acute illness. Full recovery was achieved after 15 days of hospital care. Conclusions There are many poisonous plants in Asian countries. This case highlights the possibility of accidental or intentional use of Gloriosa seeds or its extracts to cause potentially fatal poisoning. It would be difficult to identify Gloriosa as the cause of poisoning without any background information because of multiple complications that can mimic a systemic infection. This case is a good example of the use of plants as biological weapons.
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More AA, Ramana CV. Alkyne [2 + 2 + 2]-Cyclotrimerization Approach for Synthesis of 6,7-Cyclopropylallocolchicinoids. J Org Chem 2016; 81:3400-6. [DOI: 10.1021/acs.joc.6b00020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Atul A. More
- Division of Organic Chemistry, CSIR-National Chemical Laboratory, Dr. Homi Bhabha Road, Pune, Maharashtra 411008, India
| | - Chepuri V. Ramana
- Division of Organic Chemistry, CSIR-National Chemical Laboratory, Dr. Homi Bhabha Road, Pune, Maharashtra 411008, India
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Bodeau S, Bennis Y, Abe E, Quinton MC, Andréjak M, Bricca G, Alvarez JC, Lemaire-Hurtel AS. Colchicine : une intoxication rare mais souvent mortelle – À propos de 3 cas d’intoxication aiguë. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2016. [DOI: 10.1016/j.toxac.2015.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ferey L, Delaunay N. Food Analysis on Electrophoretic Microchips. SEPARATION AND PURIFICATION REVIEWS 2015. [DOI: 10.1080/15422119.2015.1014049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Lee SH, Park SW, Han SK, Park SC. Acute Colchicine Poisoning Treated with Granulocyte Colony Stimulating Factor and Transfusion. Korean J Crit Care Med 2015. [DOI: 10.4266/kjccm.2015.30.3.207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Saito T, Umebachi R, Namera A, Oikawa H, Miyazaki S, Fujita Y, Inokuchi S. Identification and Quantification of Aconitines and Colchicine in Serum, Urine, and Plants using MonoSpin C18 and LC-MSMS. Chromatographia 2015. [DOI: 10.1007/s10337-015-2921-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Watterson JH, Imfeld AB, Cornthwaite HC. Determination of colchicine and O-demethylated metabolites in decomposed skeletal tissues by microwave assisted extraction, microplate solid phase extraction and ultra-high performance liquid chromatography (MAE-MPSPE-UHPLC). J Chromatogr B Analyt Technol Biomed Life Sci 2014; 960:145-50. [PMID: 24799069 DOI: 10.1016/j.jchromb.2014.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 04/02/2014] [Accepted: 04/06/2014] [Indexed: 11/29/2022]
Abstract
Microwave assisted extraction (MAE) followed by microplate solid phase extraction (MPSPE) coupled with ultra high performance liquid chromatography (UHPLC) for the semi-quantitative determination of colchicine, 3-demethyl colchicine and 2-demethyl colchicine in postmortem rat bone is described. Rats (n=4) received 50mg/kg colchicine (i.p), and euthanized by CO2 asphyxiation. Remains decomposed to skeleton outdoors and vertebral bones were collected cleaned, and ground to a fine powder. Powdered bone underwent MAE using methanol in a closed microwave system, followed by MPSPE and analysis using UHPLC-PDA. MAE analyte stability was assessed and found to be stable for at least 60 min irradiation time. The majority (>95%) of each analyte was recovered after 15 min. The MPSPE-UHPLC method was linear between 10 and 2,000 ng/mL, with coefficients of variation <20% in triplicate analysis, with a limit of detection of 10 ng/mL for each of the three analytes. Following MAE for 30 min (80°C, 1200W), MPSPE-UHPLC analysis of vertebral bone of colchicine-exposed rats detected colchicine (1.8-4.1 μg/g), 3-demethyl colchicine (0.77-1.8 μg/g) and 2-demethyl colchicine (0.43-0.80 μg/g) in all samples assayed.
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Affiliation(s)
- J H Watterson
- Department of Forensic Science, Laurentian University, 935 Ramsey Lake Rd, Sudbury, ON, Canada P3E 2C6.
| | - A B Imfeld
- Department of Forensic Science, Laurentian University, 935 Ramsey Lake Rd, Sudbury, ON, Canada P3E 2C6
| | - H C Cornthwaite
- Department of Forensic Science, Laurentian University, 935 Ramsey Lake Rd, Sudbury, ON, Canada P3E 2C6
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Erden A, Karagoz H, Gümüscü HH, Karahan S, Basak M, Aykas F, Bulut K, Cetinkaya A, Avci D, Poyrazoglu OK. Colchicine intoxication: a report of two suicide cases. Ther Clin Risk Manag 2013; 9:505-9. [PMID: 24353429 PMCID: PMC3862585 DOI: 10.2147/tcrm.s54558] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Colchicine, an old and well-known drug, is an alkaloid extracted from Colchicum autumnale and related species. Colchicine inhibits the deposition of uric acid crystals and is an inhibitor of mitosis. Nausea, vomiting, abdominal pain, and diarrhea, with a massive loss of fluid and electrolytes are the first clinical symptoms of colchicine poisoning. Stomach lavage and rapid gastric decontamination with activated charcoal are crucial. An acute dose of about 0.8 mg/kg of colchicine is presumed to be fatal. We report the clinical outcomes of two different cases of colchicine intoxication for attempted suicide. The dose required for morbidity or mortality varies significantly. The dose of 1 mg/kg in the first case was directly related with mortality, while the dose of 0.2 mg/kg in the second was related with survival. The other difference between the patients was the time of arrival to hospital after ingestion. This period was 4 hours for case 1 and only 1, hour for case 2. The initiation of treatment later than 2 hours after ingestion of colchicine may significantly impair treatment because the absorption time for colchicine after oral administration is about 30-120 minutes. The rising lactate level and high anion gap metabolic acidosis in our patient (case 1) were attributed to lactic acidosis, so hemodialysis was performed, and the duration of hemodialysis was prolonged. Lactic acidosis in the first case was one of the reasons for mortality. The most important parameters which define the chance of survival are the dose of ingested drugs and the arrival time to hospital after ingestion. The patients must be monitored closely for lactic acidosis and the decision to start hemodialysis must be made promptly for patients who develop lactic acidosis.
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Affiliation(s)
- Abdulsamet Erden
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Hatice Karagoz
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Hasan Hüseyin Gümüscü
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Samet Karahan
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Mustafa Basak
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Fatma Aykas
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Kadir Bulut
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Ali Cetinkaya
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Deniz Avci
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
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Long-term outcome after suicidal colchicine intoxication in a 14-year-old girl: case report and review of literature. Pediatr Emerg Care 2013; 29:89-92. [PMID: 23283275 DOI: 10.1097/pec.0b013e31827b5747] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Colchicine is used as an anti-inflammatory drug in the treatment of gout, familial Mediterranean fever, and Behçet disease. However, because of its potent inhibition of mitosis, adverse effects and symptoms of intoxication are frequent. Clinical manifestations of colchicine intoxication include abdominal cramps, diarrhea, and multiorgan failure including cardiovascular collapse with fatal outcome. OBJECTIVE We report here the case of a 14-year-old girl who ingested 12.5 mg (0.23 mg/kg body weight) colchicine in a suicide attempt. CASE REPORT Major complaints of this fully conscious patient at the time of presentation ∼2 hours after ingestion of colchicine were nausea and impaired vision. Apart from a colchicine serum concentration of 16.2 ng/mL, no abnormalities were seen in the physical examination and blood tests. Gastrointestinal decontamination by activated charcoal, repeated administrations of sodium sulfate (Glauber salt) and substitution of volume and electrolytes led to complete recovery.
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Colchicine intoxication mimicking an acute surgical abdomen: report of a pediatric observation. MEDECINE INTENSIVE REANIMATION 2012. [DOI: 10.1007/s13546-012-0444-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Ozdemir R, Bayrakci B, Teksam O. Fatal poisoning in children: acute colchicine intoxication and new treatment approaches. Clin Toxicol (Phila) 2011; 49:739-43. [PMID: 21910646 DOI: 10.3109/15563650.2011.610146] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Colchicine poisoning is potentially life-threatening. Deaths generally result from hypovolemic shock and cardiovascular collapse or secondary to rapidly progressive multiorgan failure. OBJECTIVE The purpose of this study is to discuss the clinical effects, treatments and outcomes of pediatric colchicine poisoning and highlight the possible benefits of urgent plasma and whole blood exchange therapy for those patients who were believed to ingest potentially lethal doses of the drug. METHODS Current study was designed as an observational case series study. The medical records of children aged 0-16 years who were hospitalized for colchicine poisoning at the Pediatric Intensive Care Unit of, between November 1985 and March 2011 were retrospectively evaluated. RESULTS We present twenty-three children with colchicine poisoning. Nausea and vomiting were the most common presenting complaint, in 70% of patients. Sixteen of the 23 cases presented after ingesting sub-toxic doses of colchicine (< 0.5 mg/kg), whereas 3 patients had consumed toxic doses of the drug (0.5-0.8 mg/kg). The remaining 4 patients were hospitalized after taking colchicine at a lethal dose (> 0.8 mg/kg). Three patients (13%) died. CONCLUSIONS Any patient suspected of ingesting high doses of colchicine should prompt immediate fluid and electrolyte resuscitation and invasive hemodynamic monitorization in a pediatric intensive care unit. Although there is lack of strong evidence, early initiation of either whole blood or plasma exchange may be considered in patients presenting with lethal-dose colchicine intoxication. These reported experience of us put forth further research for consideration.
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Affiliation(s)
- Ramazan Ozdemir
- Zekai Tahir Burak Maternity Teaching Hospital, Neonatal Intensive Care Unit, Ankara, Turkey.
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Nagesh K, Menezes RG, Rastogi P, Naik N, Rasquinha JM, Senthilkumaran S, Fazil A. Suicidal plant poisoning with Colchicum autumnale. J Forensic Leg Med 2011; 18:285-7. [DOI: 10.1016/j.jflm.2011.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2010] [Revised: 02/12/2011] [Accepted: 04/20/2011] [Indexed: 10/18/2022]
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Finkelstein Y, Aks SE, Hutson JR, Juurlink DN, Nguyen P, Dubnov-Raz G, Pollak U, Koren G, Bentur Y. Colchicine poisoning: the dark side of an ancient drug. Clin Toxicol (Phila) 2010; 48:407-14. [PMID: 20586571 DOI: 10.3109/15563650.2010.495348] [Citation(s) in RCA: 362] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Colchicine is used mainly for the treatment and prevention of gout and for familial Mediterranean fever (FMF). It has a narrow therapeutic index, with no clear-cut distinction between nontoxic, toxic, and lethal doses, causing substantial confusion among clinicians. Although colchicine poisoning is sometimes intentional, unintentional toxicity is common and often associated with a poor outcome. METHODS We performed a systematic review by searching OVID MEDLINE between 1966 and January 2010. The search strategy included "colchicine" and "poisoning" or "overdose" or "toxicity" or "intoxication." TOXICOKINETICS Colchicine is readily absorbed after oral administration, but undergoes extensive first-pass metabolism. It is widely distributed and binds to intracellular elements. Colchicine is primarily metabolized by the liver, undergoes significant enterohepatic re-circulation, and is also excreted by the kidneys. THERAPEUTIC AND TOXIC DOSES: The usual adult oral doses for FMF is 1.2-2.4 mg/day; in acute gout 1.2 mg/day and for gout prophylaxis 0.5-0.6 mg/day three to four times a week. High fatality rate was reported after acute ingestions exceeding 0.5 mg/kg. The lowest reported lethal doses of oral colchicine are 7-26 mg. DRUG INTERACTIONS CYP 3A4 and P-glycoprotein inhibitors, such as clarithromycin, erythromycin, ketoconazole, ciclosporin, and natural grapefruit juice can increase colchicine concentrations. Co-administration with statins may increase the risk of myopathy. MECHANISMS OF TOXICITY Colchicine's toxicity is an extension of its mechanism of action - binding to tubulin and disrupting the microtubular network. As a result, affected cells experience impaired protein assembly, decreased endocytosis and exocytosis, altered cell morphology, decreased cellular motility, arrest of mitosis, and interrupted cardiac myocyte conduction and contractility. The culmination of these mechanisms leads to multi-organ dysfunction and failure. REPRODUCTIVE TOXICOLOGY AND LACTATION: Colchicine was not shown to adversely affect reproductive potential in males or females. It crosses the placenta but there is no evidence of fetal toxicity. Colchicine is excreted into breast milk and considered compatible with lactation. CLINICAL FEATURES Colchicine poisoning presents in three sequential and usually overlapping phases: 1) 10-24 h after ingestion - gastrointestinal phase mimicking gastroenteritis may be absent after intravenous administration; 2) 24 h to 7 days after ingestion - multi-organ dysfunction. Death results from rapidly progressive multi-organ failure and sepsis. Delayed presentation, pre-existing renal or liver impairment are associated with poor prognosis. 3) Recovery typically occurs within a few weeks of ingestion, and is generally a complete recovery barring complications of the acute illness. DIAGNOSIS History of ingestion of tablets, parenteral administration, or consumption of colchicine-containing plants suggest the diagnosis. Colchicine poisoning should be suspected in patients with access to the drug and the typical toxidrome (gastroenteritis, hypotension, lactic acidosis, and prerenal azotemia). MANAGEMENT Timely gastrointestinal decontamination should be considered with activated charcoal, and very large, recent (<60 min) ingestions may warrant gastric lavage. Supportive treatments including administration of granulocyte colony-stimulating factor are the mainstay of treatment. Although a specific experimental treatment (Fab fragment antibodies) for colchicine poisoning has been used, it is not commercially available. CONCLUSION Although colchicine poisoning is relatively uncommon, it is imperative to recognize its features as it is associated with a high mortality rate when missed.
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Affiliation(s)
- Yaron Finkelstein
- Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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Fagan NL, Wear RE, Malesker MA, Morrow LE, Schuller D. Colchicine Overdose—The Need for a Specific Antidote. Hosp Pharm 2010. [DOI: 10.1310/hpj4501-49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To report the case of a colchicine overdose to highlight current limitations in the treatment of this toxicologic emergency. Summary A 23-year-old man was admitted to the intensive care unit (ICU) after attempting suicide via polypharmacy ingestion, which included 80 to 100 colchicine 0.6 mg tablets (approximately 0.9 mg/kg of body weight). He was taken to the emergency department where gastric decontamination was initiated. Because attempts to obtain a colchicine-specific antibody fragment (Fab) were unsuccessful, only supportive therapies were provided throughout his hospitalization. Over the course of several days, the patient experienced the 3 separate evolutionary phases of colchicine toxicity ultimately leading to multiple organ failure and hemodynamic collapse, and death. Conclusion Acute colchicine intoxication is a rare, but potentially life-threatening event. Although 1 case report demonstrated the successful use of a colchicine-specific Fab fragment in the management of acute colchicine overdose, there is presently no commercially-available antidote for colchicine toxicity. Prompt recognition of the overdose, aggressive gastrointestinal decontamination, and supportive therapies directed at the multi-organ failure remain the standard of care.
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Affiliation(s)
- Nancy L. Fagan
- Department of Pharmacy Practice, Creighton University, Omaha, Nebraska
| | - Robert E. Wear
- Department of Pulmonary/Critical Care Medicine, Creighton University
| | - Mark A. Malesker
- Departments of Pharmacy Practice and Pulmonary/Critical Care Medicine, Creighton University
| | - Lee E. Morrow
- Department of Pulmonary/Critical Care Medicine, Creighton University
| | - Dan Schuller
- Department of Pulmonary/Critical Care Medicine, Creighton University
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Huang WH, Hsu CW, Yu CC. Colchicine Overdose-Induced Acute Renal Failure and Electrolyte Imbalance. Ren Fail 2009; 29:367-70. [PMID: 17497454 DOI: 10.1080/08860220601166644] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Colchicine has been used to control gouty arthritis for long time; colchicine overdose, however, causes multiple organ dysfunction. To date, no investigation has revealed the site of kidney lesion or dysfunction. This investigation describes the case of a male with a history of gout who ingested a large amount of colchicine and developed renal, hematopoietic, gastrointestinal, muscular, electrolytic, and hepatic disorder. Glucosuria was noted during hospital days. Colchicine intoxication is shown to induce proximal tubule damage. Severe electrolytes imbalance was noted, including hypomagnesemia, hypophosphatemia, and hypocalcemia. After management, the renal function and serum electrolyte of the patient recovered on the sixth day of hospitalization.
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Affiliation(s)
- Wen-Hung Huang
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan, ROC
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Sundov Z, Nincevic Z, Definis-Gojanovic M, Glavina-Durdov M, Jukic I, Hulina N, Tonkic A. Fatal colchicine poisoning by accidental ingestion of meadow saffron-case report. Forensic Sci Int 2005; 149:253-6. [PMID: 15749368 DOI: 10.1016/j.forsciint.2004.06.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2004] [Revised: 06/09/2004] [Accepted: 06/10/2004] [Indexed: 11/16/2022]
Abstract
A 62-year-old male died of colchicine poisoning after accidental ingestion of Colchicum autumnale (meadow saffron). He ate a salad of plant with green leaves regarded as wild garlic (Allium ursinum). A few hours later he developed symptoms of gastroenteritis and was admitted to hospital. In spite of gastric lavage, activated charcoal and supportive measures, multi-organ system failure developed over the next two days. Laboratory analysis showed highly elevated blood concentrations of hepatic enzymes, creatine kinase, lactate dehydrogenase and blood urea nitrogen, as well as leukocytopenia and thrombocytopenia. Mechanical ventilation, dopamine, noradrenaline, crystalloid solutions and fresh frozen plasma were applied but despite treatment the patient died five days after the ingestion. Post-mortem examination revealed hepatic centrilobular necrosis, nephrotoxic acute tubular necrosis, petechial bleeding in fatty tissue, blunt and shortened intestinal villi and cerebral toxic edema. Botanical identification of incriminated plant gave Colchicum autumnale which confirmed colchicine poisoning. Although the accidental ingestion of Colchicum autumnale is rare and to our knowledge only five such cases have been described in detail, this is the second fatal case in Croatia described in the last 3 years.
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Affiliation(s)
- Zeljko Sundov
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Clinical Hospital Split, Spinciceva 1, 21000 Split, Croatia.
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Miller MA, Hung YM, Haller C, Galbo M, Levsky ME. Colchicine-related death presenting as an unknown case of multiple organ failure. J Emerg Med 2005; 28:445-8. [PMID: 15837027 DOI: 10.1016/j.jemermed.2004.12.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2004] [Revised: 10/15/2004] [Accepted: 12/01/2004] [Indexed: 11/24/2022]
Abstract
A 45-year-old man presented to the emergency department (ED) with acute renal and hepatic failure as well as hypotension and metabolic acidosis. Despite aggressive intensive care, he had continued hypotension, leukocytosis, fever, renal and hepatic failure, and lactic acidosis. On hospital day 3, pancytopenia was noted. Bone marrow biopsy showed marked aplasia without a specific etiology being elucidated. He received granulocyte colony-stimulating factor and antibiotics, but died on hospital day 12 after a cardiac arrest. The patient repeatedly denied intentional drug ingestion. Due to his clinical course, the poison center recommended obtaining a colchicine level. The plasma colchicine level, 72 h after admission, was 6.1 ng/mL (GC/MS). This level exceeds acute levels reported in some cases of prior fatalities. This case is novel in that the patient's multiple organ dysfunction remained unexplained for several days before occult colchicine toxicity was implicated as the probable cause by the colchicine level. Also, there was a paucity of gastrointestinal symptoms on presentation, the opposite of what is expected in colchicine toxicity.
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Affiliation(s)
- Michael A Miller
- Department of Emergency Medicine, Darnall Army Community Hospital, Ft. Hood, Texas 76544, USA
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Deveaux M, Hubert N, Demarly C. Colchicine poisoning: case report of two suicides. Forensic Sci Int 2004; 143:219-22. [PMID: 15240048 DOI: 10.1016/j.forsciint.2004.02.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2003] [Accepted: 02/13/2004] [Indexed: 10/26/2022]
Abstract
Colchicine overdose is uncommon but potentially life threatening because of the high toxicity of the drug. Poisoning by colchicine may occur following ingestion of medication used in acute attacks of gout and inflammatory diseases. We describe two cases involving suicide by the ingestion of medications marketed in France. In case 1, only heart blood was taken after body external examination. In case 2 an autopsy was performed and heart blood, urine, gastric contents and bile were taken for toxicological analysis. Colchicine was assayed in biological specimens by an HPLC-DAD method, after extraction by dichloromethane at pH 8, adding prazepam as internal standard (IS). Analyses were performed on a Symetry C-8 column. Mobile phase was a gradient of acetonitrile/pH 3.8 phosphate buffer. Colchicine is eluted at 13.1 min and the method is linear for blood, urine and bile over the range 4-1000 ng/mL. LOQ is 4 ng/mL. The concentrations of colchicine detected are: case 1: heart blood 13 ng/mL; case 2: heart blood 66 ng/mL, urine 500 ng/mL, gastric content 12 ng/mL, bile 5632 ng/mL. Our findings are in the range of lethal concentrations previously described, but there is no correlation with the amount of ingested drug. Even after massive overdose, it could be impossible to detect colchicine in blood, and as there is a widespread enterohepatic recirculation before excretion in bile and feces, bile is the target sample to analyse. We conclude in both cases that the cause of death was suicide with colchicine. It appears very important to perform an autopsy in order to obtain bile, urine, heart blood and femoral blood.
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Affiliation(s)
- Marc Deveaux
- Institut de Médecine Légale, Faculté de Médecine, Université de Lille II, Rue André Verhaeghe, F-59045, France.
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Gabrscek L, Lesnicar G, Krivec B, Voga G, Sibanc B, Blatnik J, Jagodic B. Accidental Poisoning with Autumn Crocus. ACTA ACUST UNITED AC 2004; 42:85-8. [PMID: 15083942 DOI: 10.1081/clt-120028750] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We describe a case of a 43-yr-old female with severe multiorgan injury after accidental poisoning with Colchicum autumnale, which was mistaken for wild garlic (Allium ursinum). Both plants grow on damp meadows and can be confused in the spring when both plants have leaves but no blossoms. The autumn crocus contains colchicine, which inhibits cellular division. Treatment consisted of supportive care, antibiotic therapy, and granulocyte-directed growth factor. The patient was discharged from the hospital after three weeks. Three years after recovery from the acute poisoning, the patient continued to complain of muscle weakness and intermittent episodes of hair loss.
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Affiliation(s)
- Lucija Gabrscek
- Department of Intensive Internal Medicine, General Hospital Celje, Slovenia
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Baker SK, Goodwin S, Sur M, Tarnopolsky MA. Cytoskeletal myotoxicity from simvastatin and colchicine. Muscle Nerve 2004; 30:799-802. [PMID: 15389652 DOI: 10.1002/mus.20135] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report the case of a 79-year-old man with mild chronic renal failure who developed severe rhabdomyolysis after combined exposure to simvastatin and colchicine. Colchicine induces myopathy through disruption of microtubular function with subsequent vacuolization and pseudomyelinic body accumulation. Statin therapy is associated with myonecrosis, membranous myeloid bodies, and vacuolization, presumably as a function of impaired isoprenoid metabolism. Vesicle trafficking requires small G-protein prenylation and statins can disrupt cytoskeletal integrity. We propose that synergistic cytoskeletal myotoxicity may account for the extreme elevation of serum creatine kinase not previously reported in pure colchicine myopathy.
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Affiliation(s)
- Steven K Baker
- Departments of Pediatrics and Medicine, McMaster University Medical Center, Hamilton, Ontario L8N 3Z5, Canada
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Calvert JF. Gout. Fam Med 2003. [DOI: 10.1007/978-0-387-21744-4_123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
OBJECTIVE To report a case of rhabdomyolysis occurring during treatment with colchicine. CASE SUMMARY A 44-year-old African American man was admitted to the hospital due to persistent diarrhea, vomiting, and diffuse weakness. Past medical history was significant for renal failure requiring peritoneal dialysis, gout, and a new skin lesion. Approximately 2 months prior to admission, he had been started on colchicine and allopurinol. Creatine kinase concentration on admission was >14 000 U/L. Liver function tests were elevated 5 times the upper limit of normal. Colchicine was discontinued on admission. Creatine kinase concentrations decreased significantly, and strength and ambulation improved throughout hospitalization. DISCUSSION Colchicine was thought to be the causative factor for rhabdomyolysis in conjunction with chronic renal failure and elevated liver function tests. After discontinuation of colchicine, creatinine kinase concentrations declined and the patient's ability to walk improved. Limited case reports of colchicine-induced rhabdomyolysis have been published. CONCLUSIONS Chronic renal failure in conjunction with elevated liver function tests appear to increase the possibility of colchicine-induced toxicity, specifically, rhabdomyolysis.
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Affiliation(s)
- Kellie H Boomershine
- Pharmacy Department, Trident Health System, 9330 Medical Plaza Dr., Charleston, SC 29406-9104, USA.
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Danel VC, Wiart JF, Hardy GA, Vincent FH, Houdret NM. Self-poisoning with Colchicum autumnale L. flowers. JOURNAL OF TOXICOLOGY. CLINICAL TOXICOLOGY 2001; 39:409-11. [PMID: 11527237 DOI: 10.1081/clt-100105163] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
UNLABELLED A 44-year-old man ingested about 40 flowers of Colchicum autumnale L. The patient presented with nausea, vomiting, and abdominal pain 2 hours after ingestion and had diarrhea 14 hours after ingestion. Hematological values remained within normal range. Treatment was mainly supportive. The outcome was favorable. The intoxication was confirmed by high-performance liquid chromatography-mass spectrometry. Maximal colchicine levels were 4.34 ng/mL at 13 hours in plasma and 5.43 ng/mL at 16 hours in erythrocytes. CONCLUSION We report one of the few symptomatic cases of Colchicum autumnale L. poisoning confirmed by toxicological analysis.
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Affiliation(s)
- V C Danel
- Département Pluridisciplinaire de Médecine, Centre Hospitalier Universitaire, Grenoble, France.
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Abstract
Deaths resulting from the oral ingestion of colchicine are occasionally associated with suicides and therapeutic toxicity. However, homicidal deaths in which this drug is used are extremely rare. Two homicides in which colchicine was used are reported.
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Dixon AJ, Wall GC. Probable colchicine-induced neutropenia not related to intentional overdose. Ann Pharmacother 2001; 35:192-5. [PMID: 11215839 DOI: 10.1345/aph.10184] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To report a case of neutropenia caused by colchicine not associated with intentional overdose or with preceding severe gastrointestinal symptoms. CASE SUMMARY A 68-year-old white man was admitted to the hospital with intractable pain from an acute attack of gout. The patient was treated with standard doses of oral colchicine for several days. He experienced mild loose stools, but no severe diarrhea or nausea during treatment. The patient then developed severe neutropenia, with an absolute neutrophil count of 240 cells/mm3. His white blood cell count returned to normal after discontinuing colchicine and administering filgrastim. DISCUSSION Although colchicine is commonly associated with neutropenia in cases of intentional or accidental overdose, the patient developed this adverse effect after being treated with doses commonly used for the acute treatment of gout. In addition, this patient had taken low-dose colchicine for many years without experiencing hematologic adverse effects. CONCLUSIONS Colchicine is often an attractive alternative to nonsteroidal antiinflammatory agents for the treatment of gout, especially in patients at risk for renal impairment or gastropathy. Our case illustrates that colchicine treatment can cause hematologic adverse effects; the clinician should monitor cell counts in patients receiving this agent, especially at the higher doses used for acute treatment of gout.
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Affiliation(s)
- A J Dixon
- College of Pharmacy and Health Sciences, Drake University, Des Moines, IA 50311-4505, USA
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Mullins ME, Carrico EA, Horowitz BZ. Fatal cardiovascular collapse following acute colchicine ingestion. JOURNAL OF TOXICOLOGY. CLINICAL TOXICOLOGY 2000; 38:51-4. [PMID: 10696925 DOI: 10.1081/clt-100100916] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND A previously published prognostic rule predicts 100% survival after ingestion of cochicine doses less than 0.5 mg/kg and 100% mortality after ingestion of more than 0.8 mg/kg. This rule inaccurately predicted survival in a recent case. CASE REPORT We present a case of fatal colchicine poisoning in an adult who ingested a maximum of 39.6 mg of colchicine (0.40 mg/kg). He subsequently developed hypotension which was refractory to fluid resuscitation and infusion of vasopressors. He died of cardiovascular collapse approximately 35 hours after ingestion. DISCUSSION Fatal outcomes are possible even with colchicine doses less than 0.5 mg/kg. Physicians caring for colchicine-poisoned patients must be prepared for the possibility of acute cardiovascular collapse and ventricular dysrhythmias regardless of the reported dose of colchicine.
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Affiliation(s)
- M E Mullins
- Oregon Poison Center, Oregon Health Sciences University, Portland, USA.
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Abstract
Myoglobinuria refers to an abnormal pathologic state in which an excessive amount of myoglobin is found in the urine, imparting a cola-like hue, usually in association with myonecrosis and a clinical picture of weakness, myalgias, and edema. Myoglobinuria is produced by multiple causes: any condition that accelerates the use or interferes with the availability of oxygen or energy substrates to muscle cells can result in myoglobinuria, as can events that produce direct muscle injury, either mechanical or chemical. Acute renal failure is the most serious complication, which can be prevented by prompt, aggressive treatment. In patients surviving acute attacks, recovery of muscle and renal function is usually complete.
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Affiliation(s)
- W S David
- Department of Neurology, University of Minnesota Medical School, Minneapolis, MN 55415, USA.
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