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Stamp LK, Horsley C, Te Karu L, Dalbeth N, Barclay M. Colchicine: the good, the bad, the ugly and how to minimize the risks. Rheumatology (Oxford) 2024; 63:936-944. [PMID: 38019947 PMCID: PMC10986813 DOI: 10.1093/rheumatology/kead625] [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] [Received: 09/07/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Colchicine has an important role in managing various conditions, including gout, familial Mediterranean fever, amyloidosis, Behçet's syndrome, recurrent pericarditis and calcium pyrophosphate deposition disease. The adverse effect profile of colchicine is well understood. However, due to its narrow therapeutic index, colchicine has been associated with overdose and fatalities. When ingested in toxic amounts, the mainstay of management is supportive care. Strategies to minimize the risk of colchicine poisoning can focus on three broad causes: unauthorized access, intentional overdose and inappropriate dosing. Culturally safe and appropriate education about storage and appropriate use of colchicine is essential to minimize the risk of overdose.
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Affiliation(s)
- Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Carl Horsley
- Critical Care Complex, Middlemore Hospital, Auckland, New Zealand
| | - Leanne Te Karu
- Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Murray Barclay
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
- Department of Clinical Pharmacology, Te Whatu Ora, Waitaha Canterbury, New Zealand
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Mondeshki T, Bilyukov R, Mitev V. Effect of an Accidental Colchicine Overdose in a COVID-19 Inpatient With Bilateral Pneumonia and Pericardial Effusion. Cureus 2023; 15:e35909. [PMID: 37038575 PMCID: PMC10082222 DOI: 10.7759/cureus.35909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 04/12/2023] Open
Abstract
A 32-year-old patient with COVID-19 pneumonia and pericardial effusion mistakenly took 15 mg of colchicine over 10 hours. He developed diarrhea that resolved two days after colchicine was stopped. Remarkably, this single overdose of colchicine, without any additional therapy, resulted in the complete recovery of bilateral pneumonia and pericardial effusion, and the patient was discharged on the hospital day 9th. This case demonstrates the possibility that high colchicine doses may have a major role and a dramatic effect in the treatment of COVID-19 patients.
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Affiliation(s)
- Tsanko Mondeshki
- Department of Propaedeutics of Internal Diseases, University Hospital Alexandrovska, Medical University-Sofia, Sofia, BGR
| | - Radoslav Bilyukov
- Department of Propaedeutics of Internal Diseases, University Hospital Alexandrovska, Medical University-Sofia, Sofia, BGR
| | - Vanyo Mitev
- Department of Chemistry and Biochemistry, Medical University-Sofia, Sofia, BGR
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Transient Pancytopenia and Granulocyte Abnormalities After Suicide Attempt With Colchicine in a Patient With Familial Mediterranean Fever. J Pediatr Hematol Oncol 2019; 41:489. [PMID: 30883459 DOI: 10.1097/mph.0000000000001456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Guo X, Chen Y, Li Q, Yang X, Zhao G, Peng Y, Zheng J. Studies on hepatotoxicity and toxicokinetics of colchicine. J Biochem Mol Toxicol 2019; 33:e22366. [DOI: 10.1002/jbt.22366] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 04/29/2019] [Accepted: 07/02/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Xiucai Guo
- Wuya College of InnovationShenyang Pharmaceutical University Shenyang China
| | - Yan Chen
- Wuya College of InnovationShenyang Pharmaceutical University Shenyang China
| | - Qingmei Li
- Wuya College of InnovationShenyang Pharmaceutical University Shenyang China
| | - Xiaojing Yang
- Wuya College of InnovationShenyang Pharmaceutical University Shenyang China
| | - Guode Zhao
- School of Pharmaceutical EngineeringShenyang Pharmaceutical University Shenyang China
| | - Ying Peng
- Wuya College of InnovationShenyang Pharmaceutical University Shenyang China
| | - Jiang Zheng
- Wuya College of InnovationShenyang Pharmaceutical University Shenyang China
- State Key Laboratory of Functions and Applications of Medicinal PlantsGuizhou Medical University Guiyang Guizhou China
- Key Laboratory of Pharmaceutics of Guizhou ProvinceGuizhou Medical University Guiyang Guizhou China
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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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Jamal S, Ali W, Nagpal P, Grover S, Grover A. Computational models for the prediction of adverse cardiovascular drug reactions. J Transl Med 2019; 17:171. [PMID: 31118067 PMCID: PMC6530172 DOI: 10.1186/s12967-019-1918-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/10/2019] [Indexed: 02/06/2023] Open
Abstract
Background Predicting adverse drug reactions (ADRs) has become very important owing to the huge global health burden and failure of drugs. This indicates a need for prior prediction of probable ADRs in preclinical stages which can improve drug failures and reduce the time and cost of development thus providing efficient and safer therapeutic options for patients. Though several approaches have been put forward for in silico ADR prediction, there is still room for improvement. Methods In the present work, we have used machine learning based approach for cardiovascular (CV) ADRs prediction by integrating different features of drugs, biological (drug transporters, targets and enzymes), chemical (substructure fingerprints) and phenotypic (therapeutic indications and other identified ADRs), and their two and three level combinations. To recognize quality and important features, we used minimum redundancy maximum relevance approach while synthetic minority over-sampling technique balancing method was used to introduce a balance in the training sets. Results This is a rigorous and comprehensive study which involved the generation of a total of 504 computational models for 36 CV ADRs using two state-of-the-art machine-learning algorithms: random forest and sequential minimization optimization. All the models had an accuracy of around 90% and the biological and chemical features models were more informative as compared to the models generated using chemical features. Conclusions The results obtained demonstrated that the predictive models generated in the present study were highly accurate, and the phenotypic information of the drugs played the most important role in drug ADRs prediction. Furthermore, the results also showed that using the proposed method, different drugs properties can be combined to build computational predictive models which can effectively predict potential ADRs during early stages of drug development. Electronic supplementary material The online version of this article (10.1186/s12967-019-1918-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Salma Jamal
- JH-Institute of Molecular Medicine, Jamia Hamdard, New Delhi, India
| | - Waseem Ali
- JH-Institute of Molecular Medicine, Jamia Hamdard, New Delhi, India
| | - Priya Nagpal
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Sonam Grover
- JH-Institute of Molecular Medicine, Jamia Hamdard, New Delhi, India.
| | - Abhinav Grover
- School of Biotechnology, Jawaharlal Nehru University, New Delhi, India.
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Shchegravina ES, Tretiakova DS, Alekseeva AS, Galimzyanov TR, Utkin YN, Ermakov YA, Svirshchevskaya EV, Negrebetsky VV, Karpechenko NY, Chernikov VP, Onishchenko NR, Vodovozova EL, Fedorov AY, Boldyrev IA. Phospholipidic Colchicinoids as Promising Prodrugs Incorporated into Enzyme-Responsive Liposomes: Chemical, Biophysical, and Enzymological Aspects. Bioconjug Chem 2019; 30:1098-1113. [PMID: 30817133 DOI: 10.1021/acs.bioconjchem.9b00051] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Enzyme-responsive liposomes release their cargo in response to pathologically increased levels of enzymes at the target site. We report herein an assembly of phospholipase A2-responsive liposomes based on colchicinoid lipid prodrugs incorporated into lipid bilayer of the nanosized vesicles. The liposomes were constructed to addresses two important issues: (i) the lipid prodrugs were designed to fit the structure of the enzyme binding site; and (ii) the concept of lateral pressure profile was used to design lipid prodrugs that introduce almost no distortions into the lipid bilayer packing, thus ensuring that corresponding liposomes are stable. The colchicinoid agents exhibit antiproliferative activity in subnanomolar range of concentrations.
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Affiliation(s)
- Ekaterina S Shchegravina
- Lobachevsky State University of Niznhy Novgorod , 23 Gagarin Prospest , Nizhny Novgorod , 603950 Russian Federation.,Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences , 16/10 Miklukho-Maklaya Street , Moscow , 117997 Russian Federation
| | - Daria S Tretiakova
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences , 16/10 Miklukho-Maklaya Street , Moscow , 117997 Russian Federation
| | - Anna S Alekseeva
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences , 16/10 Miklukho-Maklaya Street , Moscow , 117997 Russian Federation
| | - Timur R Galimzyanov
- A. N. Frumkin Institute of Physical Chemistry and Electrochemistry, Russian Academy of Sciences , 31/4 Leninskii Prospekt , Moscow , 119071 Russian Federation.,National University of Science and Technology MISiS , 4 Leninskiy Prospekt , Moscow , 119049 Russian Federation
| | - Yuri N Utkin
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences , 16/10 Miklukho-Maklaya Street , Moscow , 117997 Russian Federation
| | - Yuri A Ermakov
- A. N. Frumkin Institute of Physical Chemistry and Electrochemistry, Russian Academy of Sciences , 31/4 Leninskii Prospekt , Moscow , 119071 Russian Federation
| | - Elena V Svirshchevskaya
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences , 16/10 Miklukho-Maklaya Street , Moscow , 117997 Russian Federation
| | - Vadim V Negrebetsky
- Pirogov Russian National Research Medical University , 1 Ostrovityanov Street , Moscow , 117997 Russian Federation
| | - Natalia Yu Karpechenko
- N. N. Blokhin National Medical Research Center of Oncology , 24 Kashirskoye Shosse , Moscow , 115478 Russian Federation
| | - Valery P Chernikov
- Scientific Research Institute of Human Morphology , 3 Tsurupa Street , Moscow , 117418 Russian Federation
| | - Natalia R Onishchenko
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences , 16/10 Miklukho-Maklaya Street , Moscow , 117997 Russian Federation
| | - Elena L Vodovozova
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences , 16/10 Miklukho-Maklaya Street , Moscow , 117997 Russian Federation
| | - Alexey Yu Fedorov
- Lobachevsky State University of Niznhy Novgorod , 23 Gagarin Prospest , Nizhny Novgorod , 603950 Russian Federation
| | - Ivan A Boldyrev
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences , 16/10 Miklukho-Maklaya Street , Moscow , 117997 Russian Federation
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Hirayama I, Hiruma T, Ueda Y, Doi K, Morimura N. A critically ill patient after a colchicine overdose below the lethal dose: a case report. J Med Case Rep 2018; 12:191. [PMID: 29970148 PMCID: PMC6030797 DOI: 10.1186/s13256-018-1737-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/05/2018] [Indexed: 11/29/2022] Open
Abstract
Background Although 0.8 mg/kg is considered a lethal dose of colchicine, fatal cases of patients who followed a critical disease course after an intake below this lethal dose have been reported. Case presentation An 18-year-old Japanese woman who had taken an overdose of prescription colchicine (15 mg; 0.2 mg/kg) was brought to our emergency out-patient department. Although her colchicine intake was below 0.8 mg/kg (considered the lethal dose), she reached a critical state and underwent three phases characterizing colchicine poisoning (gastrointestinal symptoms, multiple organ failure, and recovery). Her condition was critical, with a Sequential Organ Failure Assessment score of a maximum of 14. Conclusions Patients might reach a critical stage after colchicine ingestion at a non-lethal dose. Thus, it might be necessary to review which dose of colchicine should be considered lethal.
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Affiliation(s)
- Ichiro Hirayama
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Takahiro Hiruma
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoshihiro Ueda
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kent Doi
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Naoto Morimura
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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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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Guo X, Lin D, Li W, Wang K, Peng Y, Zheng J. Electrophilicities and Protein Covalent Binding of Demethylation Metabolites of Colchicine. Chem Res Toxicol 2016; 29:296-302. [PMID: 26845511 DOI: 10.1021/acs.chemrestox.5b00461] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Colchicine, an alkaloid existing in plants of Liliaceous colchicum, has been widely used in the treatment of gout and familial Mediterranean fever. The administration of colchicine was found to cause liver injury in humans. The mechanisms of colchicine-induced liver toxicity remain unknown. The objectives of this study were to determine the electrophilicities of demethylation metabolites of colchicine and investigate the protein adductions derived from the reactive metabolites of colchicine. Four demethylated colchicine (1-, 2-, 3-, and 10-DMCs), namely, M1-M4, were detected in colchicine-fortified microsomal incubations. Four N-acetyl cysteine (NAC) conjugates (M5-M8) derived from colchicine were detected in the microsomes in the presence of NAC. M5 and M6 were derived from 10-DMC. M7 resulted from the reaction of 2-DMC or 3-DMC with NAC, and M8 originated from 10-DMC. Microsomal protein covalent binding was observed after exposure to colchicine. Two cysteine adducts (CA-1 and CA-2) derived from 10-DMC were found in proteolytically digested microsomal protein samples after incubation with colchicine. The findings allow us to define the chemical property of demethylation metabolites of colchicine and the interaction between protein and the reactive metabolites of colchicine generated in situ.
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Affiliation(s)
| | | | | | | | | | - Jiang Zheng
- Center for Developmental Therapeutics, Seattle Children's Research Institute, Division of Gastroenterology and Hepatology, Department of Pediatrics, University of Washington School of Medicine , Seattle, Washington 98101, United States
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Abstract
Colchicine is an anti-inflammatory drug, which has been used for the treatment of familial Mediterranean fever for several decades with narrow therapeutic-toxicity window. Colchicine poisoning is rare but frequently a life-threatening emergency condition in pediatric practice. It may occur by excessive ingestion of colchicine tablets accidentally or intentionally. Herein, we report a suicide attempt with colchicine in a 12-year-old girl who had been followed up with the diagnosis of familial Mediterranean fever. She was admitted to our emergency department with gastrointestinal complaints and subsequently died because of the rapidly deteriorating metabolic and hemodynamic conditions.
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Gasparyan AY, Ayvazyan L, Yessirkepov M, Kitas GD. Colchicine as an anti-inflammatory and cardioprotective agent. Expert Opin Drug Metab Toxicol 2015; 11:1781-94. [PMID: 26239119 DOI: 10.1517/17425255.2015.1076391] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Colchicine has been successfully used for the treatment of neutrophilic disorders such as familial Mediterranean fever (FMF), Behçet disease (BD) and gout. There is a growing interest in its cardiovascular effects. AREAS COVERED A MEDLINE/PubMed search for English articles published from January 1972 to June 2015 was completed using the following terms: therapy, pharmacokinetics, efficiency, side effects, toxicity, heart, colchicine, inflammation, FMF, amyloidosis, BD, gout, cardiovascular disorders, pericarditis, arrhythmias, inflammation, neutrophils, platelets. EXPERT OPINION By targeting neutrophils, endothelial cells and platelets, inhibiting mitosis, vascular hyperplasia and fibrosis, colchicine improves outcomes of pericarditis, myocardial ischemia and coronary interventions. Studies in neutrophilic rheumatic diseases and cardiovascular disorders demonstrated that oral colchicine at doses of 0.5 - 2.5 mg/daily is useful for treating pericarditis, myocardial ischemia and coronary occlusion. In rheumatic and cardiovascular disorders, therapeutic doses of the drug reduce C-reactive protein to levels below 2 mg/L, prevent myocardial damage and preserve normal values of atrial and ventricular impulse generation. One of the drug's frequent side effects is diarrhea, which is treated by diet modification or temporary discontinuation of the therapy. Certain drugs (macrolides, statins), comorbidities and certain genetic factors increase risk of colchicine toxicity.
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Affiliation(s)
- Armen Yuri Gasparyan
- a 1 Dudley Group NHS Foundation Trust (Teaching Trust of University of Birmingham), Russells Hall Hospital, Departments of Rheumatology and Research & Development , DY1 2HQ, Dudley, UK +44 138 424 4842 ; +44 138 424 4808 ;
| | - Lilit Ayvazyan
- b 2 Yerevan State Medical University, Department of Medical Chemistry , Yerevan, Armenia
| | - Marlen Yessirkepov
- c 3 South Kazakhstan State Pharmaceutical Academy, Department of Biochemistry, Biology and Microbiology , Shymkent, Kazakhstan
| | - George D Kitas
- a 1 Dudley Group NHS Foundation Trust (Teaching Trust of University of Birmingham), Russells Hall Hospital, Departments of Rheumatology and Research & Development , DY1 2HQ, Dudley, UK +44 138 424 4842 ; +44 138 424 4808 ; .,d 4 University of Manchester, Arthritis Research UK Epidemiology Unit , Manchester, UK
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Batu ED, Arici ZS, Bilginer Y, Özen S. Current therapeutic options for managing familial Mediterranean fever. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1073149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Little A, Tung D, Truong C, Lapinsky S, Burry L. Colchicine overdose with coingestion of nonsteroidal antiinflammatory drugs. CAN J EMERG MED 2015; 16:252-6. [DOI: 10.2310/8000.2013.130957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ABSTRACT
Colchicine has a low therapeutic index. Its toxic effects generally occur at doses ≥ 0.5 mg/kg. We present the case of a 39-year-old female with toxicity following ingestion of 0.28 mg/kg. The patient presented to the emergency department (ED) with severe nausea, vomiting, and abdominal pain following an intentional multidrug ingestion that included colchicine, indomethacin, and zopiclone. Despite toxicologic management and supportive care, admission to the intensive care unit was required for clinical deterioration and symptom management. Shock and multiorgan failure resulted, with death occurring 52 hours postingestion. Although the toxic effects of colchicine are well documented, mortality caused by low doses is relatively uncommon. Management of toxicity consists of early diagnosis, decontamination, and supportive measures. Toxicity may be enhanced by drug interactions inhibiting metabolic enzymes or poor excretion due to renal failure. In this case, the ingestion of a nonsteroidal antiinflammatory drug and the associated volume depletion from the gastrointestinal effects of colchicine may have contributed to renal dysfunction, exacerbating the toxicity of colchicine. This ingestion of a relatively small dose of colchicine led to severe toxicity. Treatment options for colchicine toxicity are limited.
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Crielaard BJ, van der Wal S, Lammers T, Le HT, Hennink WE, Schiffelers RM, Storm G, Fens MH. A polymeric colchicinoid prodrug with reduced toxicity and improved efficacy for vascular disruption in cancer therapy. Int J Nanomedicine 2011; 6:2697-703. [PMID: 22114500 PMCID: PMC3218583 DOI: 10.2147/ijn.s24450] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Colchicinoids are very potent tubulin-binding compounds, which interfere with microtubule formation, giving them strong cytotoxic properties, such as cell mitosis inhibition and induction of microcytoskeleton depolymerization. While this makes them promising vascular disrupting agents (VDAs) in cancer therapy, their dose-limiting toxicity has prevented any clinical application for this purpose. Therefore, colchicinoids are considered attractive lead molecules for the development of novel vascular disrupting nanomedicine. In a previous study, a polymeric colchicinoid prodrug that showed favorable hydrolysis characteristics at physiological conditions was developed. In the current study, this polymeric colchicinoid prodrug was evaluated in vitro and in vivo for its toxicity and vascular disrupting potential. Cell viability studies with human umbilical vein endothelial cells, as an in vitro measure for colchicine activity, reflected the degradation kinetics of the prodrug accordingly. Upon intravenous treatment, in vivo, of B16F10 melanoma-bearing mice with colchicine or with the polymeric colchicinoid prodrug, apparent vascular disruption and consequent tumor necrosis was observed for the prodrug but not for free colchicine at an equivalent dose. Moreover, a five-times-higher dose of the prodrug was well tolerated, indicating reduced toxicity. These findings demonstrate that the polymeric colchicinoid prodrug has a substantially improved efficacy/toxicity ratio compared with that of colchicine, making it a promising VDA for cancer therapy.
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Affiliation(s)
- Bart J Crielaard
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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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: 346] [Impact Index Per Article: 24.7] [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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Abstract
PURPOSE OF REVIEW To describe obstacles to optimum management of gout by primary care physicians and to propose educational interventions to improve care. RECENT FINDINGS In the past, gout education has been hampered by infrequency of continuing medical education courses, loss of excitement for a disease in which therapies have not changed (until recently), insufficient evidence-based medicine, and the lack of motivation by physicians to re-learn this disease once in active practice. We identify 10 common myths that impede appropriate treatment of gout, identify gaps in evidence-based medicine that perpetuate those myths, and propose opportunities to improve education on these myths. It is through better gout-centered education that quality of care in gout can be enhanced. Residency may be one of the key points of intervention. As more evidence-based medicine publications address the optimum management of gout, national re-education can occur. More outreach by community rheumatologists to primary care physicians through educational programs and improved referral letters can help re-educate practitioners. Lastly, an often overlooked engine to change physician practices is consumer education, but current patient education programs are lacking. SUMMARY Novel education interventions for physician trainees, primary care physicians, and patients are proposed to improve the care of patients with gout.
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