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1 High Alert Adverse Reactions/Side Effects

GI: diarrhea, nausea, vomiting, abdominal pain. Derm: alopecia. Hemat: AGRANU- PDF Page #1
colchicine (kol-chi-seen) LOCYTOSIS, APLASTIC ANEMIA, leukopenia, thrombocytopenia. Neuro: peripheral
Colcrys neuritis.
Classification Interactions
Therapeutic: antigout agents Drug-Drug: Concurrent use of strong CYP3A4 inhibitors, including ataza-
Pregnancy Category D navir, clarithromycin, darunavir/ritonavir, indinavir, itraconazole, keto-
conazole, lopinavir/ritonavir, nefazodone, nelfinavir, ritonavir, saquina-
Indications vir, telithromycin, or tipranavir/ritonavir, mayqlevels and risk of toxicity;p
Prophylaxis and treatment of acute attacks of gouty arthritis. Familial Mediterranean colchicine dose in patients with normal renal or hepatic function; concurrent use in
fever. Unlabeled Use: Treatment of hepatic cirrhosis. patients with renal or hepatic impairment is contraindicated. Concurrent use of P-
glycoprotein inhibitors, including cyclosporine or ranolazine mayqlevels and
Action risk of toxicity;pcolchicine dose in patients with normal renal or hepatic function;
Interferes with the functions of WBCs in initiating and perpetuating the inflammatory concurrent use in patients with renal or hepatic impairment is contraindicated. Mod-
response to monosodium urate crystals. Therapeutic Effects: Decreased pain erate CYP3A4 inhibitors, including aprepitant, diltiazem, erythromycin, flu-
and inflammation in acute attacks of gout. Reduced number of attacks of gout and fa- conazole, fosamprenavir, or verapamil mayqlevels and risk of toxicity;pcol-
milial Mediterranean fever. chicine dose. Additive bone marrow depression may occur with bone marrow
Pharmacokinetics depressants or radiation therapy.qrisk of rhabdomyolysis with HMG-CoA re-
Absorption: Absorbed from the GI tract, then re-enters GI tract from biliary secre- ductase inhibitors, gemfibrozil, fenofibrate, or digoxin. Additive adverse GI ef-
tions, when more absorption may occur; bioavailability ⫽ 45%. fects with NSAIDs. May cause reversible malabsorption of vitamin B12.
Distribution: Concentrates in WBCs. Drug-Food: Grapefruit juice mayqlevels and risk of toxicity;pcolchicine dose.
Metabolism and Excretion: Partially metabolized by the liver by CYP3A4; also a
substrate for P-glycoprotein. Secreted in bile back into GI tract; eliminated in the fe- Route/Dosage
ces. 40– 65% excreted in the urine as unchanged drug. Treatment of Acute Gout Attacks
Half-life: 27– 31 hr. PO (Adults): 1.2 mg initially, then 0.6 mg 1 hr later (maximum dose of 1.8 mg in 1
TIME/ACTION PROFILE (anti-inflammatory activity) hr); Concomitant use of strong CYP3A4 inhibitors in patients with normal renal
ROUTE ONSET PEAK DURATION and hepatic function (atazanavir, clarithromycin, darunavir/ritonavir, indina-
PO 12 hr 24–72 hr unknown vir, itraconazole, ketoconazole, lopinavir/ritonavir, nefazodone, nelfinavir, ri-
tonavir, saquinavir, telithromycin, tipranavir/ritonavir)— 0.6 mg ⫻ 1 dose,
Contraindications/Precautions then 0.3 mg 1 hr later (do not repeat treatment course for ⱖ3 days); Concomitant
Contraindicated in: Hypersensitivity; Use of P-glycoprotein inhibitors or strong use of moderate CYP3A4 inhibitors (aprepitant, diltiazem, erythromycin, flu-
CYP3A4 inhibitors in patients with renal or hepatic impairment. conazole, fosamprenavir, grapefruit juice, verapamil)— 1.2 mg ⫻ 1 dose (do
Use Cautiously in: Geri: Elderly or debilitated patients (toxicity may be cumula- not repeat for ⱖ3 days); Concomitant use of P-glycoprotein inhibitors (cyclo-
tive); Renal impairment (dosepsuggested if CCr ⬍80 mL/min); OB, Lactation, sporine, ranolazine) in patients with normal renal and hepatic function— 0.6
Pedi: Safety not established for gout. mg x 1 dose (do not repeat for ⱖ3 days).
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
Name /bks_53161_deglins_md_disk/colchicine 02/11/2014 09:50AM
2 NURSING IMPLICATIONS
Renal Impairment
PO (Adults): CCr ⬍30 mL/min— 1.2 mg initially, then 0.6 mg 1 hr later; do not re-
peat treatment course for ⱖ2 wk; Dialysis— 0.6 mg ⫻ 1 dose; do not repeat treat-
ment course for ⱖ2 wk.
Prevention of Acute Gout Attacks
PO (Adults): 0.6 mg once or twice daily; Concomitant use of strong CYP3A4 in-
hibitors (atazanavir, clarithromycin, darunavir/ritonavir, indinavir, itracona-
zole, ketoconazole, lopinavir/ritonavir, nefazodone, nelfinavir, ritonavir, sa-
quinavir, telithromycin, tipranavir/ritonavir) or P-glycoprotein inhibitors
(cyclosporine, ranolazine) in patients with normal renal and hepatic func-
tion— if original dose was 0.6 mg twice daily,pto 0.3 mg once daily; if original dose
was 0.6 mg once daily,pto 0.3 mg every other day; Concomitant use of moderate
CYP3A4 inhibitors (aprepitant, diltiazem, erythromycin, fluconazole, fosam-
prenavir, grapefruit juice, verapamil)— if original dose was 0.6 mg twice daily,p
to 0.3 mg twice daily or 0.6 mg once daily; if original dose was 0.6 mg once daily,pto
0.3 mg once daily.
Renal Impairment
PO (Adults): CCr ⬍30 mL/min— 0.3 mg/day; Dialysis— 0.3 mg twice weekly.
Familial Mediterranean Fever
PO (Adults and Children ⬎12 yr): 1.2– 2.4 mg daily (in 1– 2 divided doses); may
qorpdose in 0.3 mg/day increments based on safety and efficacy; Concomitant
use of strong CYP3A4 inhibitors (atazanavir, clarithromycin, darunavir/ritona-
vir, indinavir, itraconazole, ketoconazole, lopinavir/ritonavir, nefazodone, nel-
finavir, ritonavir, saquinavir, telithromycin, tipranavir/ritonavir) or P-glyco-
protein inhibitors (cyclosporine, ranolazine) in patients with normal renal and
hepatic function— Do not exceed 0.6 mg/day (may be given as 0.3 mg twice daily);
Concomitant use of moderate CYP3A4 inhibitors (aprepitant, diltiazem, eryth-
romycin, fluconazole, fosamprenavir, grapefruit juice, verapamil)— Do not ex-
ceed 1.2 mg/day (may be given as 0.6 mg twice daily).
PO (Children 6– 12 yr): 0.9– 1.8 mg daily (in 1– 2 divided doses).
PO (Children 4– 6 yr): 0.3– 1.8 mg daily (in 1– 2 divided doses).
Renal Impairment
PO (Adults): CCr 30– 50 mL/min— dosepmay be necessary; CCr ⬍30 mL/min
or dialysis— 0.3 mg/day.
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Assessment PDF Page #2
● Monitor intake and output ratios. Fluids should be encouraged to promote a uri-
nary output of at least 2000 mL/day.
● Gout: Assess involved joints for pain, mobility, and edema throughout therapy.
During initiation of therapy, monitor for drug response every 1– 2 hr.
● Familial Mediterranean fever: Assess for signs and symptoms of familial Medi-
terranean fever (abdominal pain, chest pain, fever, chills, recurrent joint pain, red
and swollen skin lesions) periodically during therapy.
● Lab Test Considerations: In patients receiving prolonged therapy,
monitor baseline and periodic CBC; report significantpin values. May
causepplatelet count, leukopenia, aplastic anemia, and agranulocyto-
sis.
● May causeqin AST and alkaline phosphatase.
● May cause false-positive results for urine hemoglobin.
● May interfere with results of urinary 17-hydroxycorticosteroid concentrations.
● Toxicity and Overdose: High Alert: Assess patient for toxicity (muscle pain
or weakness, tingling or numbness in fingers or toes; pale or gray color to lips,
tongue, or palms of your hands; severe diarrhea or vomiting; unusual bleeding,
bruising, sore throat, fatigue, malaise, or weakness or tiredness). If these symp-
toms occur, discontinue colchicine and treat symptomatically. Opioids may be
needed to treat diarrhea.
Potential Nursing Diagnoses
Acute pain (Indications)
Impaired walking (Indications)
Implementation
● Do not confuse colchicine with Cortrosyn.
● Intermittent therapy with 3 days between courses may be used to decrease risk of
toxicity.
● PO: Administer without regard to meals.
Patient/Family Teaching
● Review medication administration schedule. Take missed doses as soon as re-
membered unless almost time for next dose. Do not double doses.
● Instruct patients taking prophylactic doses not to increase to therapeutic doses
during an acute attack to prevent toxicity. An NSAID or corticosteroid, preferably
via intrasynovial injection, should be used to treat acute attacks.
䉷 2015 F.A. Davis Company CONTINUED
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3
PDF Page #3
CONTINUED
colchicine
● Advise patient to avoid grapefruit and grapefruit juice during therapy; may in-
crease risk of toxicity.
● Advise patient to follow recommendations of health care professional regarding
weight loss, diet, and alcohol consumption.
● Instruct patient to report muscle pain or weakness, tingling or numb-
ness in fingers or toes; pale or gray color to lips, tongue, or palms of
your hands; severe diarrhea or vomiting; unusual bleeding, bruising,
sore throat, fatigue, malaise, or weakness or tiredness promptly. Medi-
cation should be withheld if symptoms of toxicity occur.
● Instruct patient to notify health care professional of all Rx or OTC medications, vi-
tamins, or herbal products being taken and to notify health care professional be-
fore taking any other Rx, OTC, or herbal products.
● Surgery may precipitate an acute attack of gout. Advise patient to confer with
health care professional regarding dose 3 days before surgical or dental proce-
dures.
Evaluation/Desired Outcomes
● Decrease in pain and swelling in affected joints within 12 hr.
● Relief of symptoms within 24– 48 hr.
● Prevention of acute gout attacks.
● Reduced number of attacks of familial Mediterranean fever.
Why was this drug prescribed for your patient?

⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.