Podcast 585:  You Sure You Want Colchicine for Gout?

<p><strong>Contributor: Don Stader, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style="font-weight: 400;">Gout is an arthritis caused by the deposition of urate crystals into the joint space</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Colchicine works by disrupting microtubules and prevents white blood cells from getting into the joint space which stops the inflammatory response </span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Colchicine has a high rate of adverse events, in particular explosive diarrhea</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">The drug also has a very narrow therapeutic index and overdose is nearly universally fatal, with no antidote or effective treatment option available</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Alternative agents such as steroids, which reduce the inflammatory response to urate crystals, along with NSAIDs may be better options for treatment</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-size: 10pt;"><span style= "font-weight: 400;">Angelidis C, Kotsialou Z, Kossyvakis C, et al.</span> <a href= "https://pubmed.ncbi.nlm.nih.gov/29359661/"><span style= "font-weight: 400;">Colchicine Pharmacokinetics and Mechanism of Action</span></a><span style="font-weight: 400;">.</span> <em><span style="font-weight: 400;">Curr Pharm Des</span></em><span style="font-weight: 400;">. 2018;24(6):659-663. doi:10.2174/1381612824666180123110042</span></span></p> <p><span style="font-size: 10pt;"><span style= "font-weight: 400;">Finkelstein Y, Aks SE, Hutson JR, et al.</span> <a href="https://pubmed.ncbi.nlm.nih.gov/20586571/"><span style= "font-weight: 400;">Colchicine poisoning: the dark side of an ancient drug.</span> <em><span style="font-weight: 400;">Clin Toxicol (Phila)</span></em><span style= "font-weight: 400;">.</span></a> <span style= "font-weight: 400;">2010;48(5):407-414. doi:10.3109