Gout- Colchicine DI

Question 1

Colchicine MoA

Answer 1

Inhibits beta-tubulin polymerization into microtubules

Also prevents activation, degredation, and migration of neutrophils

Question 2

Colchicine flare dosing

Answer 2

1.2mg x1, then 0.6mg 1 hour later

Question 3

Colchicine prophy dosing

Answer 3

0.6mg PO QD-BID

Question 4

Colchicine dose adjustments for renal and hepatic impairment

Answer 4

Renal impairment: dose adjust when CrCl <30ml/min

Guidelines don’t state specific recommendations for hepatic dosing, but lower the dose if used

Question 5

Colchicine ADEs

Answer 5

GI symptoms (diarrhea)

Hematologic abnormalities (cytopenias like thrombocytopenia)

Rhabdomyolysis

Question 6

Who is at risk for rhabdomyolysis from colchicine?

Answer 6

Elderly patients and renal dysfunction patients

Question 7

Colchicine CI

Answer 7

Concurrent use of colchicine with P-gp or strong CYP3A4 inhibitors is CI’ed in renal and hepatic impairment

Question 8

Colchicine DDIs: strong CYP3A4 inhibitors

Answer 8

Clarithromycin, darunavir/ritonavir, itraconazole, ketoconazole

Question 9

Colchicine DDIs: moderate CYP3A4 inhibitors

Answer 9

Diltiazem, erythromycin, fluconazole, verapamil

Question 10

Colchicine DDIs: P-gp inhibitors

Answer 10

Cyclosporine, amiodarone, ranolazine

Question 11

The one big no-no with colchicine therapy

Answer 11

If you use it for prophy, don’t use it for flare treatment!