Episode 944: Colchicine Overdose

Contributor: Aaron Lessen, MD

Educational Pearls:

• Colchicine is most commonly used for the prevention and treatment of gout

• There is research investigating the anti-inflammatory and cardioprotective effects of colchicine 

• This drug has a narrow therapeutic index: a small margin between effective dose and toxic dose

• Colchicine overdoses can be unintentional or intentional and are associated with poor outcomes

• Phase 1: 10 - 24 hours after ingestion

• Patient looks well but may have mild symptoms mimicking gastroenteritis

• Phase 2: 24 hours - 7 days after ingestion

• Multiple organ dysfunction syndrome (MODS)

• Phase 3: recovery is usually within a few weeks of ingestion

• Treatment for colchicine overdose

• Treat early and aggressively

• Gastrointestinal decontamination with activated charcoal and orogastric lavage 

• Dialysis and ECMO for MODS treatment

References

1. 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 Jun;48(5):407-14. doi: 10.3109/15563650.2010.495348. PMID: 20586571.

2. Gasparyan AY, Ayvazyan L, Yessirkepov M, Kitas GD. Colchicine as an anti-inflammatory and cardioprotective agent. Expert Opin Drug Metab Toxicol. 2015;11(11):1781-94. doi: 10.1517/17425255.2015.1076391. Epub 2015 Aug 4. PMID: 26239119.

Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3

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