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Colchicine pitfalls in management
1. Colchicine
Some pitfalls in management with Colchicine
An introduction : Mechanisms : Indications & Contraindications
Safwat EL-ARABY
Rheumatology
EGYPT
2. COLCHICINE TOXICITY
Death has occurred after ingestion of as little as 8 mg
Ampoules = 4 mg
But it is inevitable after the ingestion of more than 40 mg
Treatment :
Aspiration of the stomach
Intensive support measures
Hemodialysis
5. For Acute Gout
For Initiating Uricosuric agents
For FMF
Colchicine
Is it for preventing attacks ?
What attacks ( Gout OR FMF )?
6. Therapy of acute gouty attacks should be initiated within 24 hours
Colchicine
7. It binds to Tubulin in cell
( affecting cell division )
It inhibits function of
Leucocytes
It inhibits Chemotactic factors
It inhibits inflammation & IL-1 production
It inhibits release of histamine from mast cells
Colchicine โ Mechanism of actions
11. It is not safe for
patients with impaired
kidney functions
12.
13. For Acute Gout
For Initiating Uricosuric agents
For FMF
For What ?
Treatment
Prophylaxis
Avoidance of complications
Colchicine
14. Monogenic : Autoinflammatory Syndromes
Prototype : FMF
Colchicine
Recommended dose is 1 to 2 mg / day
Patients rarely respond to higher doses &
The doses are identical for adults & children
RAPHAELA GOLDBACH-MANSKY โ ADRIANA ALMEIDA DE JESUS โ
MICHAEL F. McDERMOTT โ DANIEL L. KASTNER : Monogenic
autoinflammatory diseases ;trearment of FMF . 1372-1378 6thedition of Textbook of Rhumatology ; 2015
17. Colchicine
If patients sensitive to colchicine
For patients with renal transplant
Acute abdominal pain vs Acute Appendicitis
RAPHAELAGOLDBACH-MANSKY โ ADRIANA ALMEIDA DE JESUS โ MICHAEL F. McDERMOTT โ DANIEL L.
KASTNER : Monogenic autoinflammatory diseases ;trearment of FMF . 1372-1378 6thedition of Textbook of Rhumatology ; 2015
FMF
18. Colchicine
Pregnancy
For growing children
Male : Fertility
RAPHAELA GOLDBACH-MANSKY โ ADRIANA ALMEIDA DE JESUS โ MICHAEL F. McDERMOTT โ DANIEL L.
KASTNER : Monogenic autoinflammatory diseases ;trearment of FMF . 1372-1378 6thedition of Textbook of Rhumatology ; 2015
FMF
21. Colchicine
The mainstay of treatment for
FMF is daily oral
prophylactic colchicine
Is Oral colchicine should be discontinued
in the face of an
FMF attack ?
FMF
RAPHAELA GOLDBACH-MANSKY โ ADRIANAALMEIDADE JESUS โ MICHAEL F. McDERMOTT โ
DANIEL L. KASTNER : Monogenic autoinflammatory diseases ;trearment of FMF . 1372-1378 6thedition of Textbook of Rhumatology ; 2015
22. Colchicine
Intravenous colchicine
Acute Gout ,
FMF,
Pericarditis,
1ry biliary cirrhosis,
Amyloidosis,and
Behรงetโฒs syndrome.
Indian Journal of Dermatology, Venereology and Leprology -- MEDKNOW PUBLICATIONS ON BEHALF OF THE INDIAN ASSOCIATION OF DERMATOLOGISTS, VENEREOLOGISTS AND
LEPROLOGISTS (IADVL) -- ISSN: 0378-6323 EISSN: 0973-3922 --VOL. 76, NUM. 2, 2010, PP. 201-205
For Whom
23. Colchicine
Intravenous colchicine
0.9% saline (but not in 5% dextrose as it may precipitate)
0.5 mg/mL (2 mL).
Single IV dosages should not exceed 2-3 mg,
Cumulative total dosages for an attack should not be more than
4-5 mg.
It is contraindicated in : patients with renal failure,
extrahepatic biliary obstruction, or
patients with combined renal and
hepatic insufficiency.
Indian Journal of Dermatology, Venereology and Leprology -- MEDKNOW PUBLICATIONS ON BEHALF OF THE INDIAN ASSOCIATION OF DERMATOLOGISTS, VENEREOLOGISTS AND
LEPROLOGISTS (IADVL) -- ISSN: 0378-6323 EISSN: 0973-3922 --VOL. 76, NUM. 2, 2010, PP. 201-205
25. THE โCLASSICโ PERIODIC FEVER SYNDROMES
Tumor necrosis factor receptorโassociated periodic syndrome ( TRAPS )
Colchicine is ineffective in preventing the febrile attacks of TRAPS, and it does not prevent the development of systemic
amyloidosis, either.
Corticosteroids can be used to treat the attacks of TRAPS
FMF Ineffective Accelerate
RAPHAELA GOLDBACH-MANSKY โ ADRIANAALMEIDADE
JESUS โ MICHAEL F. McDERMOTT โ
DANIEL L. KASTNER : Monogenic autoinflammatory diseases
;trearment of FMF . 1372-1378 6thedition of Textbook of Rhumatology ; 2015
Monogenic Autoinflammatory Syndromes
26. Colchicine
1- By starting at a low dose and gradually advancing
the dose as tolerated, ( Adaptation )
2- By dividing the daily dose,
3- By using simethicone for flatulence, and ( Disflatyl )
4- By treating the lactose intolerance.
How to minimize GI toxicities ?
eliminate only milk, yogurt, cottage cheese, and ice cream.
Milk with meals โ Lactase caplets
For Whom ? : Acute OR Prophylaxis
29. Colchicine
Off-label indication of colchicine in Dermatology :
In Dermatology
Vasculitis
Leucocytoclastic vasculitidis ( LCV )
Urticarial vasculitis
Scleroderma
Amyloidosis
Miscllanous
30. Colchicine
Off-label indication of colchicine in Dermatology :
Miscellaneous
Colchicine was found to be effective in Erythema nodosum leprosum,
Pyoderma gangrenosum,
severe cystic acne,
calcinosis cutis,
keloids,
Sarcoid,
Condyloma acuminate ,
fibromatosis ,
relapsing polychondritis,
primary anetoderma,
subcorneal pustular dermatosis ,
Erythema nodosum,
scleredema, and
actinic keratosis.]
Indian Journal of Dermatology, Venereology and Leprology -- MEDKNOW PUBLICATIONS ON
BEHALF OF THE INDIAN ASSOCIATION OF DERMATOLOGISTS, VENEREOLOGISTS AND LEPROLOGISTS
(IADVL) -- ISSN: 0378-6323 EISSN: 0973-3922 --VOL. 76, NUM. 2, 2010, PP. 201-205
31. Colchicine
In patients taking colchicine regular
blood counts and
measurement of serum chemistry levels
should be performed.LFTs
KFTs
AA protein
Monogenic autoinflammatory diseases are a group of illnesses that typically manifest in childhood and are caused by single-gene defects in innate immune regulatory pathways. These illnesses can mimic infections clinically, but the inflammatory lesions are aseptic. โ The prototypic autoinflammatory diseases are characterized by episodes of fever flares associated with localized inflammation, with periods of remission. Another group of autoinflammatory syndromes is caused by single-gene mutations in loci regulating interleukin-l (IL-1) processing, secretion, and signaling. โ A number of rare autoinflammatory diseases of Mendelian inheritance show variable responses to IL-1 inhibition and an inflammatory phenotype that is not well understood. โ Recently, novel autoinflammatory conditions unresponsive to IL-1blocking therapy have been identified; these include the proteasomeassociated autoinflammatory syndromes as well as early-onset inflammatory bowel disease caused by mutations in the IL-10 signaling pathway. โ Systemic AA amyloidosis can occur in any of these illnesses. โ Early diagnosis of these syndromes is important because effective therapies are available.
